中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Trauma
2015年
10期
895-898
,共4页
张子腾%胡志亮%宗灵%马鸣%孟纯阳
張子騰%鬍誌亮%宗靈%馬鳴%孟純暘
장자등%호지량%종령%마명%맹순양
肋骨骨折%通气机,机械%连枷胸
肋骨骨摺%通氣機,機械%連枷胸
륵골골절%통기궤,궤계%련가흉
Rib fractures%Ventilators,mechanical%Flail chest
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24 h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、(21.42.6)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24 h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创伤性连枷胸的疗效更佳.
目的 分析肋骨內固定聯閤機械通氣和外固定胸廓治療閤併肺挫傷的創傷性連枷胸的臨床療效. 方法 選取2011年1月-2014年12月閤併肺挫傷的創傷性連枷胸患者共60例,按隨機數字錶法分為治療組(30例)和對照組(30例).對照組予以胸廓外固定聯閤機械通氣治療,治療組在對照組基礎上,加用肋骨內固定.比較兩組患者的一般治療情況、治療前和治療24 h動脈血氣和生命體徵、齣院後3箇月肺功能、併髮癥髮生率和病死率. 結果 治療組住ICU時間(6.8±1.0)d、住院時間(15.0±1.8)d和機械通氣時間(4.8±1.0)d均顯著低于對照組[(13.6±2.5)d、(21.42.6)d、(10.3±1.3)d](P＜0.01).同組內比較,治療24h後的pH值、氧分壓(PaO2)、氧閤指數及收縮壓(SBP)均顯著高于治療前(P＜0.05),二氧化碳分壓(PaCO2)、心率(HR)和呼吸頻率(RR)均顯著低于治療前(P＜0.05);組間比較,治療組治療24 h後的pH值、PaO2、氧閤指數和SBP顯著高于對照組(P＜0.05),PaCO2、HR和RR顯著低于對照組(P＜0.05).治療組齣院後3箇月的肺活量(FVC)(81.7±2.6)％、一秒量(FEV1)(75.4±4.1)％、最高呼氣流速(PEF)(83.2±4.6)％、呼吸後期瞬間流速(FEF75％) (69.1±2.3)％及肺總量(TLC)(88.7±3.4)％均顯著高于對照組[(69.0±3.6)％、(71.3±3.9)％、(78.9±4.3)％、(62.3±3.3)％、(79.0±4.6)％](P＜0.01).治療組髮生肺部感染4例(13％),肺不張3例(10％),肋間神經痛1例(3％);對照組髮生肺部感染6例(20％),肺不張5例(17％),肋間神經痛4例(13％),胸廓畸形4例(13％)(P＜0.05).兩組病死率差異無統計學意義. 結論 在聯閤機械通氣和外固定胸廓治療的基礎上,加用肋骨內固定治療閤併肺挫傷的創傷性連枷胸的療效更佳.
목적 분석륵골내고정연합궤계통기화외고정흉곽치료합병폐좌상적창상성련가흉적림상료효. 방법 선취2011년1월-2014년12월합병폐좌상적창상성련가흉환자공60례,안수궤수자표법분위치료조(30례)화대조조(30례).대조조여이흉곽외고정연합궤계통기치료,치료조재대조조기출상,가용륵골내고정.비교량조환자적일반치료정황、치료전화치료24 h동맥혈기화생명체정、출원후3개월폐공능、병발증발생솔화병사솔. 결과 치료조주ICU시간(6.8±1.0)d、주원시간(15.0±1.8)d화궤계통기시간(4.8±1.0)d균현저저우대조조[(13.6±2.5)d、(21.42.6)d、(10.3±1.3)d](P＜0.01).동조내비교,치료24h후적pH치、양분압(PaO2)、양합지수급수축압(SBP)균현저고우치료전(P＜0.05),이양화탄분압(PaCO2)、심솔(HR)화호흡빈솔(RR)균현저저우치료전(P＜0.05);조간비교,치료조치료24 h후적pH치、PaO2、양합지수화SBP현저고우대조조(P＜0.05),PaCO2、HR화RR현저저우대조조(P＜0.05).치료조출원후3개월적폐활량(FVC)(81.7±2.6)％、일초량(FEV1)(75.4±4.1)％、최고호기류속(PEF)(83.2±4.6)％、호흡후기순간류속(FEF75％) (69.1±2.3)％급폐총량(TLC)(88.7±3.4)％균현저고우대조조[(69.0±3.6)％、(71.3±3.9)％、(78.9±4.3)％、(62.3±3.3)％、(79.0±4.6)％](P＜0.01).치료조발생폐부감염4례(13％),폐불장3례(10％),륵간신경통1례(3％);대조조발생폐부감염6례(20％),폐불장5례(17％),륵간신경통4례(13％),흉곽기형4례(13％)(P＜0.05).량조병사솔차이무통계학의의. 결론 재연합궤계통기화외고정흉곽치료적기출상,가용륵골내고정치료합병폐좌상적창상성련가흉적료효경가.
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 (88.7 ±3.4)％ respectively, significantly higher than (69.0 ±3.6)％, (71.3 ± 3.9) ％, (78.9 ± 4.3) ％, (62.3 ± 3.3) ％, and (79.0 ± 4.6) ％ respectively in control group (P ＜0.01).In experimental group, there were four cases of pulmonary infection (13％), three pulmonary atelectasis(10％) and one intercostal neuralgia (3％).In control group, there were six cases of pulmonary infection (20％), five pulmonary atelectasis (17％), four intercostal neuralgia (13％) and four thoracocyllosis(13％)(P ＜0.05).There was no significant difference in mortality between the two groups.Conclusion Treatment effect of internal rib fixation for flail chest with pulmonary contusion is improved in combination with mechanical ventilation and external chest fixation.
