连枷胸伴原发性脑干伤救治中机械通气的作用  

Role of mechanical ventilation in management of flail chest with primary brain stem injury

作　　者：周建峰[1] 庄彩萍[2] 胡晓民[1] 王国辉[1] 张斌[1] 彭有鼎[1] 

机构地区：[1]解放军第414医院胸外科,江苏南京210015 [2]解放军第414医院骨科,江苏南京210015

出　　处：《南京军医学院学报》2003年第3期161-162,共2页Journal of Nanjing Military Medical College

摘　　要：目的:强调机械通气在连枷胸伴原发性脑干伤救治中的重要性。方法:本组共4例。均为全身多发伤,同时存在一侧连枷胸和原发性脑干伤。入院时GCS评分3分3例,5分1例。入院后即行机械通气辅助呼吸内固定,持续推注3～6μg/kg·(min)多巴胺,直至停机械通气,静推纳洛酮4 mg/次,1次/8 h。有2例入院当天行亚低温治疗,温度控制在(33±1.8)℃。给予良好营养支持,3例肌注生长激素。病情稳定后,及时高压氧治疗。结果:本组3例存活,存活者伤后3个月GCS13分2例,GCS 14分1例;1例因脑干功能衰竭死亡。结论:机械通气不但明显改善了连枷胸所致的低氧血症,而且为脑干伤后神经功能恢复提供良好的血氧环境。其意义相当于伤后立即行高压氧治疗。Objective: To emphasize the importance of mechanical ventilation in the emergency management of flail chest and primary brain-stem injury. Methods:Four patients had multiple injuries in this group with lateral flail chest and the primary brain-stem injuries simultaneously. Glasgow Coma Scale (GCS) was 3 in 3 patients and 5 in 1 patient on admission. Mechanical ventilation support was given as soon as the patients were admitted. Dopamine was transfused 3-6 μg/kg/min until the mechanical ventilation was stopped. Naloxone was injected intravenously (4 mg, every 8 hours). Two patients had hypothermia treatment on admission, the temperature remained at 33 ± 1.8 ℃. Fine nutritional support was given. Three patients had growth hormone intramuscularly. As soon as the patients became stable, hyperbaric oxygen therapy was performed at once. Results: Three patients survived and one died from the failure of brain-stem function in this group. Among the survivors, GCS of two patients was 13 and one was 14 at 3 months. Conclusion; Mechanical ventilation can not only improves hypoxaemia caused by flail chest, but also provides a good blood-oxygen environment for the recovery of nerve function after primary brain-stem injury. It equals to hyperbaric oxygen therapy performed at once after brain-stem injury.

关 键 词：机械通气 连枷胸 原发性脑干伤 纳洛酮 交通事故 

分 类 号：R655[医药卫生—外科学] R651.15[医药卫生—临床医学]