摘要
目的研究机械通气对老年多发肋骨骨折合并肺挫伤患者肺功能及预后的影响,为临床治疗提供新思路。方法选取2014年7月~2017年6月老年多发肋骨骨折合并肺挫伤确诊患者,给予相同的常规治疗,其中常规吸氧治疗的对照组32例和机械通气治疗的观察组41例。对比对照组患者与观察组患者肺功能、血气分析指标和预后指标。结果两组患者治疗后的肺功能指标第一秒用力呼气量(FEV1)、FEV1/用力肺活量FVC的比值(FEV1%)和呼气流量峰值(PEF)均显著高于治疗前(P<0.05),治疗后观察组FEV1、FEV1%和PEF均高于对照组,且具有统计学意义(P<0.05);相较于治疗前,两组治疗后的血气指标酸碱度(pH值)、动脉氧分压(PaO2)和氧合指数(PaO2/FiO2)均显著增高(P<0.05),两组治疗后的二氧化碳分压(PaCO2)显著降低(P<0.05),治疗后观察组PaO2/FiO2高于对照组,PaCO2低于对照组,均具有统计学意义(P<0.05);相较于对照组,观察组患者入住ICU病房时间、急性生理与慢性健康评分(APACHEⅡ评分)、并发症肺不张、胸腔积液、急性呼吸窘迫综合征(ARDS)、多器官功能障碍综合征(MODS)的发生率和病死率均较低,且有统计学意义(P<0.05),然而观察组肺炎的发病率增高(P<0.05)。结论尽管机械通气可能导致肺部感染几率提高,但总体来说机械通气可以改善老年多发肋骨骨折合并肺挫伤患者的肺功能,降低患者病死率,因此具有较高的临床推广意义。
Objective To investigate the effect of mechanical ventilation on pulmonary function and prognosis in elderly patients with multiple rib fractures combined with pulmonary contusion,so as to provide new ideas for clinical treatment.Methods Patients diagnosed with senile multiple rib fractures combined with pulmonary contusion from July 2014 to June 2017 were enrolled.The patients were given the same conventional therapy,among whom 32 patients in the control group were given conventional oxygen therapy,and 41 patients in the observation group were given mechanical ventilation.The pulmonary function,indexes of blood gas analysis,and prognostic markers between the observation group and the control group were compared.Results The forced expiratory volume in first second(FEV1),FEV1/FVC(FEV1%)and peak expiratory flow(PEF)after treatment in the two groups were significantly higher than those before treatment(P<0.05),and FEV1,FEV1%and PEF after treatment in the observation group were higher than those in the control group,all with statistical significance(P<0.05);compared with before treatment,the pH value,arterial oxygen partial pressure(PaO2)and oxygenation index(PaO2/FiO2)after treatment in the two groups were significantly increased(P<0.05),the partial pressure of carbon dioxide(PaCO2)after treatment in the two groups was significantly decreased(P<0.05),PaO2/FiO2 after treatment in the observation group was higher than that in the control group,and PaCO2 after treatment in the observation group was lower than that in the control group,all with statistical significance(P<0.05);compared with the control group,the ICU stay time,the acute physiology and chronic health evaluationⅡscore(APACHEⅡscore)and the incidences and mortalities of complications including atelectasis,pleural effusions,acute respiratory distress syndrome(ARDS)and multiple organ dysfunction syndrome(MODS)in the observation group were relatively lower,with statistical significance(P<0.05),however,the incidence of pneumonia in the observation group was
作者
宋超
尹江宁
刘志祯
魏法星
SONG Chao;YIN Jiangning;LIU Zhizhen;WEI Faxing(Emergency Department,Affiliated Hospital of Jiangsu University,Zhenjiang212000,China)
出处
《中国现代医生》
2019年第35期15-18,共4页
China Modern Doctor
关键词
机械通气
老年
多发肋骨骨折
肺挫伤
预后
Mechanical ventilation
Senile
Multiple fractured ribs
Pulmonary contusion
Prognosis
