早期手术与晚期手术治疗重症胸外伤合并胸壁软化的效果比较  

Comparison of the effects of early operation and late operation in the treatment of severe thoracic trauma complicated with chest wall softening

作　　者：雷鸣 付思佳 田磊 黄倩 LEI Ming;FU Sijia;TIAN Lei;HUANG Qian(Xi'an No.3 Hospital,Xi'an 710018;the South Area of the PLA Air Force 986 Hospital,Xi'an 710054,China)

机构地区：[1]西安市第三医院,陕西西安710018 [2]空军第九八六医院南区,陕西西安710054

出　　处：《临床医学研究与实践》2020年第26期76-78,共3页Clinical Research and Practice

摘　　要：目的比较早期手术与晚期手术治疗重症胸外伤合并胸壁软化的效果。方法对2015年7月至2019年12月西安市第三医院和空军第九八六医院胸外科100例接受手术治疗的重症胸外伤合并胸壁软化患者进行回顾性研究,根据手术治疗时机将患者分为早期手术组(60例)和晚期手术组(40例)。早期手术组在伤后72 h内进行手术,晚期手术组在伤后72 h后进行手术。比较两组免疫功能指标、肺功能指标、动脉血气分析指标、血清炎症因子水平、术后并发症发生情况及术后恢复时间。结果手术后,两组的FEV1、FEV1/FVC、PaO2、PaCO2、SpO2均较手术前改善(P<0.05),但组间比较,差异无统计学意义(P>0.05)。手术后,两组的CD3+、CD4/CD8均较手术前升高,C反应蛋白、白细胞介素-6水平均较手术前降低,且早期手术组优于晚期手术组(P<0.05)。早期手术组的术后并发症总发生率低于晚期手术组,呼吸机辅助呼吸时间、下床活动时间、住院时间均短于晚期手术组(P<0.05)。结论对重症胸外伤合并胸壁软化患者实施早期手术,对患者肺功能、动脉血气状况的改善效果与晚期手术相当,而相比于晚期手术,早期手术可改善患者的免疫功能,减轻术后炎症反应,降低术后并发症风险,缩短术后恢复时间。Objective To compare the effects of early operation and late operation in the treatment of severe thoracic trauma complicated with chest wall softening.Methods From July 2015 to December 2019,100 patients with severe thoracic trauma complicated with chest wall softening who received surgical treatment in the thoracic surgery department of Xi’an No.3 hospital and the PLA air force 986 hospital were retrospectively studied.According to the timing of surgical treatment,the patients were divided into early operation group(60 cases)and late operation group(40 cases).The early operation group was operated within 72 hours after injury,and the late operation group was operated after 72 hours.The immune function indexes,pulmonary function indexes,arterial blood gas analysis indexes,serum inflammatory factors levels,postoperative complications and postoperative recovery time were compared between the two groups.Results After operation,FEV1,FEV1/FVC,PaO2,PaCO2 and Sp O2 of the two groups improved compared with those before operation(P<0.05),but there were no significant differences between the two groups(P>0.05).After operation,the levels of CD3+,CD4/CD8 in the two groups were higher than those before operation,and the levels of C reactive protein and interleukin-6 were lower than those before operation,and those of the early operation group were better than the late operation group(P<0.05).The total incidence of postoperative complications in the early operation group was lower than that in the late operation group,and the ventilator assisted breathing time,ambulation time and hospitalization time were shorter than those in the late operation group(P<0.05).Conclusion Early operation can improve the pulmonary function and arterial blood gas status of patients with severe chest injury and chest wall softening,which is equivalent to those of late operation.Compared with late operation,early operation can improve the immune function of patients,reduce the postoperative inflammatory response,decrease the risk of postoperative

关 键 词：重症胸外伤 胸壁软化 早期手术 晚期手术 

分 类 号：R655[医药卫生—外科学]