肋骨环抱器对创伤性连枷胸患者肺功能、血流动力学的影响  

Effects of ribs embracing fixator on lung function and hemodynamics in traumatic flail chest patients

作　　者：何小平[1] 李书平[1] 曾小飞[1] 何东升[1] 王洪 陆宇海 马瑞东[1] HE Xiao-ping;Li Shu-ping;ZENG Xiao-fei;HE Dong-sheng;WANG Hong;LU Yu-hai;MA Rui-dong(Department of Cardiothoracic Surgery,the First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China)

机构地区：[1]成都医学院第一附属医院胸心外科

出　　处：《创伤外科杂志》2019年第12期889-892,896,共5页Journal of Traumatic Surgery

基　　金：四川省教育厅科研课题重点项目(18ZA0165)

摘　　要：目的研究肋骨环抱器(REF)对创伤性连枷胸(TFC)患者肺功能、血流动力学的影响。方法2015年1月—2018年12月成都医学院第一附属医院胸心外科收治TFC患者64例,男性40例,女性24例;年龄28~75岁,平均47.7岁。依据随机数字表法分为REF组与护板组,各32例。观察两组患者引流管留置时间、机械通气时间、入住ICU时间及平均住院时间等恢复指标,治疗1个月后用力肺活量(FVC)、肺总容量(TLC)、第1秒用力呼气量(FEV1)、最大用力呼气中段流速(MMEF)、呼气高峰流量(PEFR)等肺功能指标,治疗前及治疗2d后中心静脉压(CVP)、血管外肺水指数(ELWI)及心指数(CI)等血流动力学指标,治疗前及治疗7d后血清去甲肾上腺素(NE)、五羟色胺(5-HT)、P物质(SP)等疼痛因子,及并发症发生情况。结果REF组引流管留置时间、机械通气时间、入住ICU时间及平均住院时间[(3.45±0.37)d、(3.64±0.38)d、(3.86±0.40)d、(13.32±1.54)d]均少于护板组[(6.82±0.71)d、(5.78±0.61)d、(7.12±0.74)d、(19.46±2.18)d](P<0.05)。治疗1个月后,REF组FVC、TLC、FEV1、MMEF、PEFR[(3.46±0.35)L、(5.08±0.51)L、(3.00±0.32)L、(2.32±0.25)%、(4.74±0.49)L/s]均大于护板组[(3.27±0.33)L、(4.82±0.48)L、(2.83±0.29)L、(2.19±0.23)%、(4.43±0.46)L/s](P<0.05)。治疗2d后,REF组CI[(4.50±0.46)L/min/m 2]大于护板组[(4.22±0.44)L/min/m 2],CVP、ELWI[(9.53±0.97)P/mmHg、(12.44±1.29)mL/kg]小于护板组[(10.16±1.08)P/mmHg、(13.14±1.38)mL/kg](P<0.05)。治疗7d后,REF组NE、5-HT、SP[(226.48±23.90)ng/mL、(554.28±58.24)ng/mL、(137.28±14.61)ng/mL]小于护板组[(239.84±24.07)ng/mL、(586.75±59.51)ng/mL、(145.17±15.03)ng/mL](P<0.05)。REF组并发症发病率(9.39%)低于护板组(31.25%,P<0.05)。结论REF治疗TFC可快速稳定胸壁,改善患者肺功能及血流动力学,减少疼痛因子生成,且并发症少,恢复快,较外固定具有显著优势。Objective To study the effect of ribs embracing fixator(REF)on lung function and hemodynamics in patients with taumatic flail chest(TFC).Methods Totally 64 patients with TFC admitted to the Department of Thoracic Surgery in the First Affiliated Hospital of Chengdu Medical College from Jan.2015 to Dec.2018 were included in this study.There were 40 males and 24 females aged 28-75,with an average age of 47.7 years.They were divided into REF group and guard plate group using random number table method,with 32 patients in each group.External fixation was given to patients in the guard plate group,and REF was given to patients in the REF group.The levels of recovery factors such as drainage tube indwelling time,mechanical ventilation time,stay in ICU and average hospitalization time in the two groups were observed.The levels of lung function factors such as forced vital capacity(FVC),total lung volume(TLC),forced respiratory volume in the first second(FEV1),maximum mid-expiratory flow(MMEF),peak expiratory flow rate(PEFR)30 d after treatment,as well as the levels of hemodynamics factors such as central venous pressure(CVP),extravascular lung water index(ELWI)and cardiac index(CI)before and 2d after treatment,and the levels of pain factors such as Norepinephrine(NE),Serotonin(5-HT),P substance(SP)before and 7d after treatment and complications in the two groups were observed.Results Drainage tube indwelling time,mechanical ventilation time,stay in ICU and average hospitalization time in the REF group[(3.45±0.37)d,(3.64±0.38)d,(3.86±0.40)d,(13.32±1.54)d]were lower than those in the guard plate group[(6.82±0.71)d,(5.78±0.61)d,(7.12±0.74)d,(19.46±2.18)d](P<0.05).At 30 d after treatment,FVC,TLC,FEV1,MMEF,PEFR in the REF group[(3.46±0.35)L,(5.08±0.51)L,(3.00±0.32)L,(2.32±0.25)%,(4.74±0.49)L/s]were higher than those in the guard plate group[(3.27±0.33)L,(4.82±0.48)L,(2.83±0.29)L,(2.19±0.23)%,(4.43±0.46)L/s](P<0.05).At 2 d after treatment,CI in the REF group[(4.50±0.46)L/min/m 2]was higher than that in guard

关 键 词：创伤性连枷胸 肋骨环抱器 肺功能 血流动力学 

分 类 号：R683.1[医药卫生—骨科学]