微创Judet固定架手术对创伤性连伽胸患者呼吸功能的影响  

Effect of minimally invasive Judet fixation on respiratory function of patients with traumatic flail chest

作　　者：王庆淮[1] 谭宁[1] 吴震群 张洁珍[1] 

机构地区：[1]广西医科大学第八附属医院广西贵港市人民医院胸心外科,537100

出　　处：《中华胸部外科电子杂志》2015年第3期192-196,共5页CHINESE JOURNAL OF THORACIC SURGERY：Electronic Edition

基　　金：广西贵港市科学研究与技术开发计划项目资助(贵科攻201511001)

摘　　要：目的分析早期微创Jude固定架手术治疗创伤性连伽胸对患者呼吸功能的影响。方法回顾性分析2008年1月至2014年12月治疗的60例连枷胸伴肺挫伤患者，按人院时间先后随机分为两组。手术治疗组（n=30）：入院72h内应用Judet固定架手术治疗（微创嵌入式Judet固定架手术治疗）；保守治疗组（n=30）：采用单纯胸带加压包扎或叠形胶布外固定或呼吸机辅助呼吸。比较两组患者呼吸功能的恢复情况和术后并发症发生率。结果手术治疗组术后24h第1秒最大呼气量（FEV1）、最大通气量（MMV）、用力肺活量（FVC）明显优于保守治疗组，差异均有统计学意义（t=1．923，P=0．026；t=4．981，P=0．037；t=1．892，P=0．024）；而住院期间肺部感染率也显著低于保守治疗组，差异有统计学意义（χ2=4．286，P=0．049）。结论连枷胸伴肺挫伤早期手术综合治疗是必要可行的，能促进患者功能恢复，及时有效地恢复胸廓的畸形，快速恢复呼吸功能，降低并发症发生率，是一种比较理想的治疗手段。Objective To investigate the effect of early minimally invasive Judet fixation on the respiratory function of patients with traumatic flail chest. Methods The clinical data of 60 patients with flail chest complicated by pulmonary contusion treated between January 2008 and December 2014 were retrospectively analyzed. Patients were randomly divided into two groups according to the admission time. Patients in surgical treatment group（n：30） were managed with Judet fixation （minimally invasive fixation of embedded Judet） within 72 h after admission, and patients in conservative treatment group （n =30） received chest compression bandaging, butterfly-shaped adhesive external fixation or ventilatorassisted ventilation. The recovery of respiratory function and incidences of postoperative complications were compared between two groups. Results The forced expiratory volume in one second （FEV1）, maximum minute ventilation（MMV） and forced vital capacity（FVC） 24 h after operation in surgical treatment group were significantly better than those in conservative treatment group （t=1. 923, P =0.026; t=4.981, P=0.037; t=1.892, P=0.024）. Besides, the prevalence of pulmonary infection in surgical treatment group was significantly lower than that in conservative treatment group（χ2=4. 286, P=0.049）. Conclusions Early surgical comprehensive treatment for flail chest complicated by pulmonary contusion is necessary and feasible, which can promote the recovery from chest deformity and recovery of respiratory function, and reduce the incidences of complications.

关 键 词：Judet固定架 创伤性连伽胸 呼吸功能 

分 类 号：R655[医药卫生—外科学]