无创正压通气治疗连枷胸合并肺挫伤

Ventilatory treatment of flail chest together with pulmonary contusion

目的 探讨无创正压通气模式 (NIPPV)对连枷胸合并肺挫伤的早期治疗作用。方法 应用Bear 10 0 0呼吸机通气治疗连枷胸合并肺挫伤 2 9例 :分为无创正压呼吸机通气治疗组 (无创组 )和气管插管呼吸机通气治疗组 (有创组 )。结果 全组病人无死亡。无创正压通气治疗连枷胸合并肺挫伤 ,效果满意 ,能明显改善氧分压、氧合指数 ;同时 ,脱机时间、ICU时间明显短于有创组。结论 连枷胸和肺挫伤是两个相互影响、相互作用的因素 ,共同加重呼吸、循环功能障碍 ,治疗上应采取机械通气、胸壁固定以及激素等综合治疗 ,以降低此类患者死亡率。

Objective To evaluate the early therapeutic effect on flail chest together with pulmonary contusion by non-injury positive pressure ventilation(NIPPV).Methods Twenty-nine patients with flail chest with pulmonary contusion treated with NIPPV by using the ventilator Bear1000 were analysed retrospectively.Two groups were established:the one treated with NIPPV was called the non-injuried group and the other one treated with ventilator by way of tracheal intubation was called the injuried group.Results There were no death in all the patients.Compared with the injuried group,it is effective to treat the entity with NIPPV not only improving the Pa0 2 、Pa0 2 /Sa0 2 but also shortening the duration of ventilatory support and the average stay in ICU.Conclusion The respiratory and cardiac functions are affected by the flail chest and pulmonary contusion.It is recommended to use mechanical ventilation especially NIPPV,chest wall fixation and adrenocortical hormone to treat the flail chest together with pulmonary contusion.