胸廓外固定与爪型纯钛肋骨接骨板内固定治疗连枷胸并呼吸衰竭患者临床效果的对比研究  

Clinical Effect in Treating Flail Chest Patients Complicated with Respiratory Failure:a Comparative Study between External Thoracic Fixation and Internal Fixation of Claw-type Pure Titanium Rib Bone Plate

作　　者：周志刚[1] 黄斐 杨金良[1] 黄刚[1] 张萌[1] 曹利娟[1] HUANG Fei;YANG Jinliang;HUANG Gang;ZHANG Meng;CAO Lijuan(Department of Thoracic Surgery,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院胸外科

出　　处：《实用心脑肺血管病杂志》2019年第7期83-87,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：河北省医学科学研究重点课题(20160613)

摘　　要：目的比较胸廓外固定和爪型纯钛肋骨接骨板内固定治疗连枷胸并呼吸衰竭患者的临床效果。方法选取2016年2月-2018年8月河北医科大学第三医院收治的严重胸部钝性伤、多处肋骨骨折所致连枷胸并呼吸衰竭患者150例,根据手术方式分为对照组(n=69)和观察组(n=81)。在常规对症治疗基础上,对照组患者行胸廓外固定,观察组患者行爪型纯钛肋骨接骨板内固定。比较两组患者ICU停留时间、机械通气时间、住院时间,术后2个月肺功能指标〔包括用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、呼气流量峰值(PEF)、肺总容量(TLC)〕,术前(T0)、术后3 h(T1)、术后24 h(T2)、术后48 h(T3)血流动力学指标〔包括中心静脉压(CVP)、心脏指数(CI)及血管外肺水指数(EVLWI)〕,手术前后血清胱抑素C(Cys C)水平,术前及术后3 d血气分析指标〔包括经皮二氧化碳分压(TcPCO2)、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)〕,并观察治疗期间两组患者并发症发生情况。结果(1)观察组患者ICU停留时间、机械通气时间、住院时间短于对照组(P<0.05)。(2)术后2个月观察组患者FVC、FEV1、PEF、TLC大于对照组,差异有统计学意义(P<0.05)。(3)时间与方法在CVP、CI、EVLWI上存在交互作用(P<0.05);时间、方法在CVP、CI、EVLWI上主效应显著(P<0.05)。观察组患者T1~T3 CVP高于对照组,T1~T2 CI高于对照组,T1~T3 EVLWI低于对照组(P<0.05)。(4)术前两组患者血清CysC水平比较,差异无统计学意义(P>0.05);术后观察组患者血清CysC水平低于对照组(P<0.05)。(5)两组患者术前TcPCO2、PaCO2、PaO2比较,差异无统计学意义(P>0.05);术后3 d观察组患者TcPCO2、PaCO2低于对照组,PaO2高于对照组(P<0.05)。(6)治疗期间两组患者未发生切口感染、骨折愈合不良等并发症。结论与胸廓外固定相比,爪型纯钛肋骨接骨板内固定可更有效地缩短连枷胸并呼吸衰竭患者ICU停留时间、机械Objective To compare the clinical effect in treating flail chest patients complicated with respiratory failure between external thoracic fixation and internal fixation of claw-type pure titanium rib bone plate.Methods From February 2016 to August 2018,a total of 150 flail chest patients complicated with respiratory failure that caused by severe blunt chest injury and multiple rib fracture were selected in the Third Hospital of Hebei Medical University,and they were divided into control group(n=69)and observation group(n=81)according to the operation methods.Based on conventional symptomatic treatment,patients in control group were treated with external thoracic fixation,while patients in observation group were treated with internal fixation of claw-type pure titanium rib bone plate.ICU stays,duration of mechanical ventilation,hospital stays,index of pulmonary function(including FVC,FEV1,PEF and TLC)2 months after surgery,hemodynamic parameters(including CVP,CI and EVLWI)before surgery(T0),3 hours after surgery(T1),24 hours after surgery(T2)and 48 hours after surgery(T3),serum levels cystatin C before and after surgery,blood-gas analysis results(including TcPCO2,PaCO2 and PaO2)before surgery and 3 days after surgery were compared between the two groups,and incidence of complications was observed during treatment.Results(1)ICU stays,duration of mechanical ventilation and hospital stays in observation group were statistically significantly shorter than those in control group(P<0.05).(2)FVC,FEV1,PEF and TLC in observation group were statistically significantly longer than those in control group 2 months after surgery(P<0.05).(3)There was statistically significant between time and method in CVP,CI and EVLWI(P<0.05);main effects of time and method were statistically significant in CVP,CI and EVLWI(P<0.05).CVP in observation group was statistically significantly higher than that in control group from T1 to T3,while CI in observation group was statistically significantly lower than that in control group from T1 to T2,whi

关 键 词：连枷胸 呼吸衰竭 外固定器 内固定器 爪型纯钛肋骨接骨板 肺功能 血流动力学 缺氧 疗效比较研究 

分 类 号：R655[医药卫生—外科学] R563.8[医药卫生—临床医学]