创伤性横膈疝气的延迟表现病例报告及文献回顾.PDFVIP

156 J Emerg Crit Care Med. Vol. 20, No. 3, 2009 12 33 X 13 9 1 X 4 7%-66% 1-7%(1-4) 4.5-6%(5) (5) 30%-50%(6-8) (9) 33 15 97 8 11 1 97 9 23 2 3 710 (06)2812811 57199 (06)2833806 E-mail: sunnyapple82@.tw 901 9 36.4℃ 143/75 74/ 18/ 1 L1 15400 (15,400/μL) 78% 17% 14.8 (14.8gm/dL) 230000 (230000/μL) 14.5 (14.5mg/dL) 1.14 (1.14mg/dL) 135.9 (135.9mEq/L) 3.63 4 157 (3.63mEq/L) B) X ( X ( A ) H2 () 1541 Sennertus (10,11) 1579 Ambroise Paré (10,12) (5,13-16) Paré (strangulation) (obstruction or perforation of the gastrointestinal tract) 80-86% (1,5,17) (5,17) 0.8-1.6%(9,10,18,19) (6,17) (56-90%) (4,6,21,22) (20) 2 10 “” (1,4,23-28) (A) X (B) X 158 J Emerg Crit Care Med. Vol. 20, No. 3, 2009 (6,29) (posterolateral) (6,30) (10,34) (shearing force)(10,31-33) (10,32,35) (10,36) 7-20 (10,37) 100 (10,38) (1,26) (39) 100 () (39) (9) (20) (5) 95% (20) (5) (5,40,41) (15) (20) 159 (10) Grimes (obstructive phase)(9,10) (latent phase) (5) (39) X X 17-40%(15) (9) 75%(9) X X X (20) (6) X ( X X (1) ) (15) 46%(6,24) X X 50% (20) (the crus of the diaphragm) (the collar sign)(6) (15) (20) Grimes 1974 (5) 25-80%(20) (5) (5,10) (5,10) (20) (15) (6) (6) Killen(6) (helical CT) 78% 50% Huang YM(5) 71-84% 77-100% 83% (gastrogra?ne transit study) X 160 J Emerg Crit Care Med. Vol. 20, No. 3, 2009 X X 1. Murray JG, Caoili E, Gruden JF, Evans SJ, Halvorsen RA Jr, Mackersie RC. Acute rupture of diaphragm due to blunt trauma: diagnostic s e n s i t i v i t y a n d s p e c i f i c i t y o f C T. A J R 1996;166:1035-9. 2. M e y e r s B F, M c C a b e C J . T r a u m a t i c diaphragmatic hernia: occult marker of serious injury. Ann Surg 1993;218:783-90. 3. Estrera A, Platt M, Mills L. Traumatic injuries of diaphragm. Chest 1979;75:306-13. 4. Voeller GR, Reisser JR, Fabian TC, Kudsk K, Mangiante EC. Blunt diaphragm injuries: a ?ve-year experience. Am Surg 1990;56:28-31. 5. H u a n g Y M , K a o C C , L i u K Y. A c u t e traumatic diaphragmatic rupture with tension gastrothorax: report of a case. Formos J Su