不同手术时机治疗多发肋骨骨折对患者免疫反应及并发症的影响  

Effect of treatment of multiple rib fractures at different operation timing on patients’immune response and complications

作　　者：杨彦辉[1] 曾小飞[2] 王毅[1] 罗雷[1] 李季[1] 李晓亮[1] 刘高华 刘蔡杨 谢晓阳[1] Yang Yanhui;Zeng Xiaofei;Wang Yi;Luo Lei;Li Ji;LI Xiaoliang;Liu Gaohua;Liu Caiyang;Xie Xiaoyang(Department of Cardiothoracic Surgery,the First People’s Hospital of Neijiang,Neijiang,Sichuan 641000,China;Department of Cardiothoracic Surgery,the First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China)

机构地区：[1]内江市第一人民医院胸心外科,四川内江641000 [2]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》2021年第2期103-107,共5页Journal of Traumatic Surgery

摘　　要：目的研究不同手术时机治疗多发性肋骨骨折(MRF)对免疫反应及并发症的影响。方法回顾性分析2015年1月—2018年12月四川省内江市第一人民医院及成都医学院第一附属医院胸心外科收治的MRF患者86例,依据不同手术时机分为早期组(n=43)与常规组(n=43)。早期组于伤后72h内行胸腔镜内固定治疗,常规组于伤后72h后行胸腔镜内固定治疗。观察并比较两组手术时间、术中出血量、拔管时间、下床时间、疼痛时间及术后住院时间,术前及术后7d血清细胞免疫因子:CD3+、CD4+、CD8+、CD4+/CD8+,血清炎性因子:超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6),血清氧化应激因子:丙二醛(MDA)、晚期氧化蛋白产物(AOPP),疼痛程度及术后并发症。结果早期组拔管时间(9.35±0.96)d、下床时间(1.12±0.13)d、疼痛时间(8.92±0.94)d、术后住院时间(10.48±1.19)d均短于常规组[(12.75±1.30)d、(1.26±0.14)d、(9.97±1.02)d、(12.79±1.30)d],差异均有统计学意义(P<0.05)。术后7d,早期组CD3+(79.93±5.91)%、CD4+(53.87±3.49)%、CD4+/CD8+(1.78±0.19)均高于常规组[(67.64±5.75)%、(49.29±3.43)%、(1.67±0.17)],早期组CD8+(8.98±1.96)%、hs-CRP(14.85±1.64)mg/L、TNF-α(35.65±3.75)μg/L、IL-6(66.91±6.86)μg/L、MDA(10.66±1.63)mmol/L、AOPP(27.56±3.62)μmol/L、VAS评分(2.75±0.39)分均低于常规组[(13.02±2.05)%、(25.52±1.70)mg/L、(57.86±3.84)μg/L、(79.64±7.29)μg/L、(15.54±1.65)mmol/L、(36.96±3.72)μmol/L、(3.94±0.43)分],差异均有统计学意义(P<0.05)。早期组术后并发症发生率(4.65%)低于常规组(34.88%),差异有统计学意义(P<0.05)。结论早期手术治疗MRF可有效缓解机体应激,解除免疫抑制,减轻炎性反应,减少术后并发症。Objective To study the effects of treatment of multiple rib fractures(MRF)at different operation timing on immune response and postoperative complications.Methods A retrospective analysis was conducted in 86 patients with MRF,who were treated in Department of Cardiothoracic Surgery,the First People’s Hospital of Neijiang City and the First Affiliated Hospital Of Chengdu Medical College from Jan.2015 to Dec.2018.These patients were divided into early group(n=43)and conventional group(n=43)according to different operation timing.Patients in the early group received laparoscopic internal fixation treatment within 72 hours after injury,while patients in the conventional group received laparoscopic internal fixation treatment 72 hours after injury.Operation time,intraoperative blood loss,time of tube removing,out-of-bed time,pain time and postoperative hospital stay in the two groups were observed.Before and 7days after operation,the levels of serum cellular immunity factors such as CD3+,CD4+,CD8+,CD4+/CD8+in the two groups were observed.The levels of serum inflammatory factors such as hypersensitive c-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)in the two groups were observed.The levels of serum oxidative stress factors such as malondialdehyde(MDA),advanced oxidative protein product(AOPP),pain degree and postoperative complications in the two groups were observed and compared.Results The time of tube removing(9.35±0.96)days,out-of-bed time(1.12±0.13)days,pain time(8.92±0.94)days and postoperative hospital stay(10.48±1.19)days in the early group were less than those in the conventional group[(12.75±1.30)days,(1.26±0.14)days,(9.97±1.02)days and(12.79±1.30)days,P<0.05].At 7 days after operation,CD3+(57.93±5.91)%,CD4+(33.87±3.49)%,CD4+/CD8+(1.78±0.19)in the early group were higher than those in the conventional group[(55.64±5.75)%,(32.29±3.43)%,1.67±0.17].CD8+(18.98±1.96)%,hs-CRP(14.85±1.64)mg/L,TNF-α(35.65±3.75)μg/L,IL-6(66.91±6.86)μg/L,MDA(14.66±1.63)mmol/L,AOPP(

关 键 词：多发性肋骨骨折 胸腔镜 应激因子 免疫因子 炎性因子 并发症 

分 类 号：R655[医药卫生—外科学]