不同时期的连枷胸临床救治分析  

Analysis of clinical management of flail chest at different time

作　　者：梁贵友[1] 刘孙伟[1] 牛义民[1] 刘达兴[1] 徐刚[1] 蔡庆勇[1] 

机构地区：[1]遵义医学院附属医院胸心外科,563003

出　　处：《中华创伤杂志》2008年第1期46-49,共4页Chinese Journal of Trauma

摘　　要：目的比较不同时期连枷胸临床治疗方式和疗效，探讨连枷胸治疗经验。方法回顾性分析我院所收治的91例连枷胸患者的临床资料，按年代不同分为组Ⅰ（1995年1月-2000年12月）和组Ⅱ（2001年1月-2007年3月），按治疗方式不同分为保守治疗组和有创治疗组。结果组Ⅱ总例数63例，（9．00±3．16）例／年，明显高于组Ⅰ的28例和（4．67±1．21）例／年（P〈0．01）；治疗方法上组Ⅱ采取有创治疗措施增多；不同时期伤情严重度比较差异无统计学意义，但组Ⅰ的死亡率（25．0％）明显高于组Ⅱ（6．3％）（P〈0．05）；有创治疗组伤情较保守治疗组重，而死亡率（6．7％）却低于保守治疗组（17．4％）（P〈0．01），且有创治疗组中残留胸廓畸形例数、肺不张发生率明显低于保守治疗组（P〈0．05）。结论近6年来连枷胸患者死亡率明显降低，主要救治措施是早期稳定胸壁与治疗肺挫伤并重，保持呼吸道通畅，有效止痛，适时给予机械通气，预防和治疗呼吸功能不全和肺部感染。Objective To compare the treatments for flail chest and their clinical outcomes at different time so as to summarize the experiences in treatment of flail chest. Methods A retrospective study was conducted on 91 patients with flail chest hospitalized in our hospital from January 1995 to March 2007. All the patients were divided into Group Ⅰ （1995-2000） and Group Ⅱ （2001-2007） based on the period of hospitalization and into Conservative treatment group and Invasive treatment group based on the treatment modes. Results There were 63 patients [ （9.00 ± 3.16） patients every year] in Group Ⅱ , which was higher than 28 patients [ （4.67 ± 1.21 ） patients every year] in GroupⅠ （ P 〈 0.01 ）. Sixteen patients （25.4.%） in Group Ⅱ underwent invasive treatment and tracheotomy, more than that in Group Ⅰ , but no statistical difference was found. The mortality rate in Group Ⅰ was 25.0%, which was significantly higher than that in Group Ⅱ （6.3%） （P 〈0.05）. The mortality rate （6.7%）, ratio of the chest wall deformation and the incidence of pulmonary atelectasis in Invasive treatment group were significantly lower than those of Conservative treatment group （ 17.4-% ） （ P 〈 0.01 ）, though flail chest of Invasive treatment group was severer than that of Conservative treatment group. Condusions The mortality rate of flail chest has been significantly decreased over the recent six years. The key treatment measures are to restore stability of the chest wall at an early stage, effectively treat pulmonary contusion, ensure non-obstruction of the airway, effectively administer pain relief and mechanical ventilation, prevent and treat respiratory insufficiency and pulmonary infection.

关 键 词：连枷胸 挫伤 肺 呼吸 人工 胸壁固定 

分 类 号：R655[医药卫生—外科学]