摘要
目的分析肋骨内固定联合机械通气和外固定胸廓治疗合并肺挫伤的创伤性连枷胸的临床疗效。方法选取2011年1月-2014年12月合并肺挫伤的创伤性连枷胸患者共60例，按随机数字表法分为治疗组（30例）和对照组（30例）。对照组予以胸廓外固定联合机械通气治疗，治疗组在对照组基础上，加用肋骨内固定。比较两组患者的一般治疗情况、治疗前和治疗24h动脉血气和生命体征、出院后3个月肺功能、并发症发生率和病死率。结果治疗组住ICU时间（6．8±1．0）d、住院时间（15．0±1．8）d和机械通气时间（4．8±1．0）d均显著低于对照组[（13．6±2．5）d、（21．4±2．6）d、（10．3±1．3）d]（P〈0．01）。同组内比较，治疗24h后的pH值、氧分压（PaO2）、氧合指数及收缩压（SBP）均显著高于治疗前（P〈0．05），二氧化碳分压（PaCO2）、心率（HR）和呼吸频率（RR）均显著低于治疗前（P〈0．05）；组间比较，治疗组治疗24h后的pH值、PaO2、氧合指数和SBP显著高于对照组（P〈0．05），PaCO2、HR和RR显著低于对照组（P〈0．05）。治疗组出院后3个月的肺活量（FVC）（81．7±2．6）％、一秒量（FEV1）（75．4±4．1）％、最高呼气流速（PEF）（83．2±4．6）％、呼吸后期瞬间流速（FEF75％）（69．1±2．3）％及肺总量（TLC）（88．7±3．4）％均显著高于对照组[（69．0±3．6）％、（71．3±3．9）％、（78．9±4．3）％、（62．3±3．3）％、（79．0±4．6）％]（P〈0．01）。治疗组发生肺部感染4例（13％），肺不张3例（10％），肋间神经痛1例（3％）；对照组发生肺部感染6例（20％），肺不张5例（17％），肋间神经痛4例（13％），胸廓畸形4例（13％）（P〈0．05）。两组病死率差异无统计学意义。结论在联合机械通气和外固定胸廓治疗的基础上，加用肋骨内固定治疗合并肺挫伤的
Objective To analyze the clinical efficacy of internal rib fixation combined with external chest fixation and mechanical ventilation for traumatic flail chest with pulmonary contusion. Methods Sixty cases of traumatic flail chest with pulmonary contusion treated from January 2011 to December 2014 were assigned to experimental group （30 cases） and control group （30 cases） according to the random number table. Patients in control group received thoracic external fixation combined with mechanical ventilation. In experimental group the patients received the same care but in addition they had rib fixation. The two groups were compared with regard to general condition, arterial blood gas as well as vital signs before treatment and 24 hours after treatment, lung function 3 months after discharge, complication rate and mortality. Results ICU stay [ （6.8 ±1.0）d], hospital stay [ （15.0 ±1.8）d] and duration of mechanical ventilation [ （4.8 ± 1.0） d ] in experimental group were significantly lower than these in control group [ （ 13.6 ± 2.5 ） d, （21.4 ± 2.6） d, （ 10.3 ± 1.3 ） d, respectively ] （ P 〈 0.01 ）. After treatment for 24 hours in either group, the pH value, PaO2, oxygenation index and systolic pressure （SBP） were significantly increased, and partial pressure of carbon dioxide （PaCO2 ）, heart rate （HR） and respiratory rate （RR） were significantly lowered as compared to these before treatment （P 〈0.05 ）. After treatment for 24 hours, experimental group demonstrated significantly enhanced levels in pH value, PaO2, oxygenation index and SBP but lowered levels in PaCO2, HR and RR as compared to control group （ P 〈 0.05 ）. Three months after discharge, forced vital capacity （ FVC）, forced expiratory volume in one second （FEV1）, peak expiratory flow （PEF）, 75% forced expiratory flow （FEF75%） and total lung capacity （TLC） in experimental group were （81.7 ±2.6）%, （75.4 ±4.1）%, （83.2 ±4.6）%, （69. 1 ± 2.3 ） %, and （
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2015年第10期895-898,共4页
Chinese Journal of Trauma
关键词
肋骨骨折
通气机
机械
连枷胸
Rib fractures
Ventilators, mechanical
Flail chest
