CAJ | 학술논문

目的：比较创伤性连枷胸不同手术时机内固定治疗的效果。方法选择创伤性连枷胸患者53例的临床资料，其中28例患者伤后72 h 内行手术内固定治疗（早期组），25例患者在伤后72 h 后行手术治疗（晚期组），观察两组患者术后恢复情况（术后通气时间、X 线胸片改善时间、住 ICU 时间、拔管时间、住院时间），比较两组患者治疗前后呼吸功能变化情况及并发症。结果早期组术后通气时间、胸片改善时间、住ICU 时间、拔管时间及住院时间分别为（27．4±4．8）h、（88．6±7．5）h、（3．8±0．7）d、（3．2±0．8）d、（13．2±5.0）d，均明显短于晚期组的（40．7±5．2）h、（195．3±8．0）h、（5．6±1．4）d、（5．2±1．3）d、（19．8±6．4）d，差异均有统计学意义（t ＝7．389、11．204、3．837、3．916、5．261，均 P ＜0．05）。治疗后两组 PaO2、PaCO2、PaO2／FiO2、RR、HR 均较治疗前改善，治疗前后差异均有统计学意义（早期组：t ＝12．497、6.205、4．136、7．381、14.327，均 P ＜0．05；晚期组：t ＝11．976、5．813、4．649、6．892、14．627，均 P ＜0．05），但组间治疗后比较，差异均无统计学意义（t ＝0．126、0．013、0．002、0．010、0．215，均 P ＞0．05）。两组均未出现病死情况，两组肺不张、ARDS 及胸廓畸形发生率差异无统计学意义（P ＞0．05）。结论创伤性连枷胸早期手术治疗能迅速改善呼吸循环功能，能缩短患者术后恢复期，并且不增加并发症，因此在条件许可的情况下，应早期行手术内固定治疗。
목적：비교창상성련가흉불동수술시궤내고정치료적효과。방법선택창상성련가흉환자53례적림상자료，기중28례환자상후72 h 내행수술내고정치료（조기조），25례환자재상후72 h 후행수술치료（만기조），관찰량조환자술후회복정황（술후통기시간、X 선흉편개선시간、주 ICU 시간、발관시간、주원시간），비교량조환자치료전후호흡공능변화정황급병발증。결과조기조술후통기시간、흉편개선시간、주ICU 시간、발관시간급주원시간분별위（27．4±4．8）h、（88．6±7．5）h、（3．8±0．7）d、（3．2±0．8）d、（13．2±5.0）d，균명현단우만기조적（40．7±5．2）h、（195．3±8．0）h、（5．6±1．4）d、（5．2±1．3）d、（19．8±6．4）d，차이균유통계학의의（t ＝7．389、11．204、3．837、3．916、5．261，균 P ＜0．05）。치료후량조 PaO2、PaCO2、PaO2／FiO2、RR、HR 균교치료전개선，치료전후차이균유통계학의의（조기조：t ＝12．497、6.205、4．136、7．381、14.327，균 P ＜0．05；만기조：t ＝11．976、5．813、4．649、6．892、14．627，균 P ＜0．05），단조간치료후비교，차이균무통계학의의（t ＝0．126、0．013、0．002、0．010、0．215，균 P ＞0．05）。량조균미출현병사정황，량조폐불장、ARDS 급흉곽기형발생솔차이무통계학의의（P ＞0．05）。결론창상성련가흉조기수술치료능신속개선호흡순배공능，능축단환자술후회복기，병차불증가병발증，인차재조건허가적정황하，응조기행수술내고정치료。
Objective To compare the effects of different opportunity internal fixation in treatment of trau-matic flail chest.Methods Clinical data of 53 cases of patients with traumatic flail chest were selected,in which 28 patients were given internal fixation treatment in 72h after injury (early surgery group),25 patients were given sur-gery after 72h(late surgery group),recovery situation(postoperative ventilation time,chest improve time,ICU stay time,extubation time,hospitalization time)of the two groups were observed,respiratory function changes and compli-cations were compared before and after treatment.Results Postoperative ventilation time,chest X -ray improvement time,ICU stay time,extubation time and hospitalization time of the early operation group were (27.4 ±4.8)h, (88.6 ±7.5)h,(3.8 ±0.7)d,(3.2 ±0.8)d,(13.2 ±5.0)d,which were significantly shorter in the late operation group of (40.7 ±5.2)h,(195.3 ±8.0)h,(5.6 ±1.4)d,(5.2 ±1.3)d,(19.8 ±6.4)d,with significant difference (t =7.389,11.204,3.837,3.916,5.261,all P <0.05 ).After treatment,PaO2 ,PaCO2 ,PaO2 /FiO2 ,RR and HR were all significantly improved (early surgery group t =12.497,6.205,4.136,7.381,14.327,all P <0.05;late sur-gery group t =11.976,5.813,4.649,6.892,14.627,all P <0.05),but the indexes between the two groups were not significantly different(t =0.126,0.013,0.002,0.010,0.215,all P >0.05 ).There was no dead case in the two groups,and the incidence of atelectasis,ARDS and thoracic deformity had no significantly different between two groups (P >0.05 ).Conclusion In treatment of traumatic flail chest,early surgical treatment can rapidly improve the respiratory and circulatory function,it can shorten the postoperative recovery time,and does not increase complica-tions.So,when conditions permit,patients should be given early surgical fixation.