Strategien in Diagnostik und Therapie des Thoraxtraumas

Zusammenfassung

In bis zu 20 % aller Unfallverletzungen findet sich eine Beteiligung des Brustkorbes, die entweder als isoliertes Thoraxtrauma (25-35 %) oder als Mitverletzung des Thorax (65-75 %) bei Polytraumata beobachtet werden. Zu 90-95 % handelt es sich um stumpfe Thoraxtraumen, in 5-10 % um penetrierende Verletzungen. Führend sind Frakturen des knöchernen Thorax, Lungenkontusion und Hämato-/Pneumothorax. Seltener werden Verletzungen der Mediastinalorgane und des Zwerchfells beobachtet. Die apparative Primärdiagnostik erfolgt durch Computertomographie und Ultraschall, sie wird bei speziellen Organverletzungen durch Bronchoskopie und Ösophagoskopie, Echokardiographie und Koronarangiographie ergänzt. Zu 90 % ist eine konservative Therapie durch Gabe von Analgetika, Sauerstoff, Einlage einer Thoraxdrainage und Sekretolyse ausreichend. Eine primär operative Therapie ist in 10 % indiziert. Die Letalität ist höher nach stumpfem als nach penetrierendem Thoraxtrauma.

Abstract

Chest injury is encountered in 20 % of all traumatized patients. 25-35 % have an isolated trauma to the chest. 65-75 % are seen as accompanying injuries in polytraumatized patients. Blunt trauma occurs in 90-95 % and penetrating injury in 5-10 %. Fractures to the thoracic bone structure are the most common type of injury, followed by contusions to the lung, hemothorax and pneumothorax. Injuries to the mediastinum and diaphragm are less frequent. Primary diagnosis is best established by computer tomography and sonography. If airway, oesophageal or cardiac injury are suspected special diagnostics such as bronchoscopy, esophageal endoscopy, echocardiography and coronary angiography should be employed. 90 % of all thoracic injuries can be treated conservatively with analgesics, oxygen, chest tube drainage and secretolysis. Primary surgical therapy is indicated in 10 %. Mortality is higher following blunt trauma than after penetrating injuries.

Schlüsselwörter

Thoraxtrauma - Polytrauma - stumpfes Trauma - Lungenkontusion - chirurgische Therapie

Key words

chest injury - polytrauma - blunt trauma - lung contusion - surgery

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