机械通气联合内固定治疗创伤性连枷胸合并肺挫伤的临床研究  

Clinical study of mechanical ventilation in combination with internal fixation in treating traumatic flail chest accompanied by lung contusion

作　　者：曾小飞[1] 贾维坤[1] 马瑞东[1] 李书平[1] 何东升[1] ZENG Xiao-fei;JIA Wei-kun;MA Rui-dong;LI Shu-ping;HE Dong-sheng(Department of Cardiothoracic Surgery,First Affiliated)

机构地区：[1]成都医学院第一附属医院胸心外科,成都610500

出　　处：《创伤外科杂志》2018年第4期263-267,共5页Journal of Traumatic Surgery

摘　　要：目的研究机械通气联合内固定治疗创伤性连枷胸合并肺挫伤的临床疗效。方法选择2013年1月—2017年1月于成都医学院第一附属医院行手术治疗的创伤性连枷胸合并肺挫伤患者62例,随机分为试验组(n=31)与对照组(n=31),对照组行胸廓外固定+机械通气治疗,试验组行机械通气+内固定治疗。观察两组入住ICU时间、机械通气时间、住院时间,治疗后90d肺功能指标,治疗前及治疗后3d动脉血气指标,术前、术后7d血清炎性因子等指标以及并发症。结果试验组入住ICU时间、机械通气时间、住院时间均小于对照组,差异有统计学意义(P<0.05)。试验组治疗后90d肺活量(VC)、肺总量(TLC)及最大自主通气量(MVV)均高于对照组,残气量(RV)低于对照组,差异有统计学意义(P<0.05)。治疗后3d,两组动脉血氧分压(PaO_2)、氧合指数均较治疗前增大,PaCO_2较治疗前减小,试验组PaO_2、氧合指数均大于对照组,动脉血二氧化碳分压(PaCO_2)小于对照组,差异有统计学意义(P<0.05)。治疗前及治疗后3d,两组动脉血pH值差异无统计学意义(P>0.05)。治疗后7d,两组白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)均较治疗前减小,试验组IL-6、TNF-α、CRP均小于对照组,差异有统计学意义(P<0.05)。试验组并发症发生率(19.35%)低于对照组(51.61%),差异有统计学意义(P<0.05)。结论机械通气联合内固定治疗创伤性连枷胸合并肺挫伤可提高患者肺功能,改善动脉血气指标,减少机体炎性反应,且恢复快、并发症发生率低,值得临床推荐。Objective To study the clinical efficacy of mechanical ventilation in combination with internal fixation in treating traumatic flail chest accompanied by lung contusion(TFC-LC).Methods A total of 62 TFC-LC patients who were performed operative treatment from Jan.2013 to Jan.2017 in our hospital were selected.They were randomly divided into experimental group(n=31)and control group(n=31).Patients in control group underwent external fixation and mechanical ventilation,and those in experimental group were treated by mechanical ventilation and internal fixation.The ICU stay time,mechanical ventilation time,hospital stays,lung function indicators at 90days after the treatment,arterial blood gas indices before treatment and at 3days after treatment,serum inflammatory factors before treatment and at 7days after treatment,postoperative complications and other indicators of the two groups were observed.Results The ICU stay time,mechanical ventilation time and hospital stays in experimental group were shorter than those in control group(P<0.05).At 90days after treatment,VC,TLC and MVV in experimental group were higher than those in control group,and RV was lower than that in control group(P<0.05).At 3days after treatment,the level of PaO 2 and oxygenation index in both groups increased compared with those before treatment,and the level of PaCO 2 was lower than that before treatment.The level of PaO 2 and oxygenation index in experimental group were higher than those in control group,and the level of PaCO 2 was lower than that in control group(P<0.05).Before treatment and at 3days after treatment,the difference in pH value of arterial blood between the two groups was not statistically significant(P>0.05).At 7days after treatment,the levels of IL-6,TNF-αand CRP in both groups decreased compared with those before treatment,and the levels of IL-6,TNF-αand CRP in experimental group were lower than those in control group(P<0.05).The incidence of postoperative complications in experimental group(19.35%)was lower than that in co

关 键 词：部损伤 肺挫伤 连枷胸 外固定 机械通气 内固定 

分 类 号：R655[医药卫生—外科学]