早期机械通气治疗连枷胸并发急性肺挫伤的疗效评价  

Evaluation of the effect of early mechanical ventilation in the treatment of flail chest complicated with acute pulmonary contusion

作　　者：严四军[1] 邓波荣[1] 刘燕[1] 曹祥[1] 黄洁健[1] 乔德成[1] 

机构地区：[1]解放军第161中心医院心胸外科,武汉430010

出　　处：《临床急诊杂志》2011年第1期22-25,共4页Journal of Clinical Emergency

摘　　要：目的:观察不同时期机械通气对连枷胸并发急性肺挫伤的治疗效果。方法:回顾性分析2001年3月—2010年2月我院收治的51例连枷胸并发肺挫伤患者的临床资料。根据受伤后至实施机械通气的间隔时间分为早期机械通气组(32例)和后期机械通气组(19例),观察治疗前后的血气参数变化,比较两组间的机械通气治疗时间、ICU时间和并发症发生率、病死率等。结果:早期机械通气者入院时呼吸衰竭程度比后期机械通气者严重,而机械通气后24h前者呼吸衰竭程度比后者轻(P<0.01)。前者机械通气治疗时间、ICU时间及急性呼吸窘迫综合征(ARDS)的发生率明显低于后者(P<0.01),且肺部感染、多脏器功能障碍综合征(MODS)的发病率及病死率亦低于后者(P<0.05)。结论:尽早对连枷胸并发急性肺挫伤患者实施机械通气不仅能取得良好的内固定治疗效果,并能有效改善肺挫伤低氧血症,减少ARDS、MODS等并发症,缩短机械通气治疗时间及ICU时间,提高治愈率。Objective：To investigate the therapeutic efficacy of mechanical ventilation in the treatment of flail chest complicated with acute pulmonary contusion.Method：The data of 51 cases suffered of flail chest complicated with acute pulmonary contusion in our hospital from March 2001 to February 2010 were retrospectively analyzed.According to the starting time of mechanical ventilation,the patients were divided into two groups：the early mechanical ventilation group（n=32）and the later mechanical ventilation group（n=19）.The parameters of blood gas,time of mechanical ventilation,time in intensive care unit（ICU）,incidence of complications,and the mortality were compared between the two groups.Result：The degree of respiratory failure of the early mechanical ventilation group was serious than that of the later mechanical ventilation group on admission.However,the degree of respiratory failure of the former was more lightly than that of the latter 24 hours after ventilation（P〈0.01）.The time of mechanical ventilation and in ICU of the former were obviously shorter than that of the latter,and the incidence of acute respiratory distress syndrome（ARDS） of the former was obviously lower too（P〈0.01a）.The incidence of pulmonary infection and multiple organ dysfunction syndrome（MODS） and mortality of the former were lower than those of the latter as well（P〈0.05）.Conclusion： Early mechanical ventilation on patients suffered from flail chest complicated with acute pulmonary contusion can not only get satisfactory internal fixation but also effectively improve hypoxemia,reduce complications such as ARDS,MODS,shorten the time of mechanical ventilation and the time in ICU,and improve the cure rate.

关 键 词：连枷胸 肺挫伤 机械通气 

分 类 号：R563[医药卫生—呼吸系统]