机械通气联合肋骨环抱器内固定治疗连枷胸伴呼吸衰竭临床观察

Clinical observation on the treatment of flail chest with respiratory failure by the internal fixation of mechanical ventilation combined with ribs embracing fixator

目的探讨机械通气联合肋骨环抱器内固定治疗连枷胸伴呼吸衰竭的疗效。方法回顾性分析我科2005年1月至2011年3月收治的连枷胸伴呼吸衰竭42例的临床资料,其中19例采用机械通气联合肋骨环抱器内固定治疗(手术组),23例仅采用机械通气治疗(非手术组)。比较两组气管切开率、入住ICU时间、机械通气时间、呼吸机相关性肺炎发生率、镇痛剂使用时间等指标。结果与非手术组相比,手术组气管切开率、呼吸机相关性肺炎发生率明显降低,入住ICU时间、机械通气时间及镇痛剂使用时间均明显缩短。结论机械通气联合肋骨环抱器内固定治疗连枷胸伴呼吸衰竭的方法,通过可靠的内固定迅速稳定胸壁,消除反常呼吸对呼吸功能的影响,疗效优于单纯机械通气治疗方法。

Objective To investigate the medical effection of treating flail chest with respiratory failure with the internal fixation of mechanical ventilation combined with ribs embracing fixator.Methods There was a retrospective analysis on the cases of the flail chest with respiratory failure from January 2005 to March 2011 in 42 patients clinical data,of which 19 cases were treated with internal fixation by mechanical ventilation combined with ribs embracing fixator（surgery group）,23 cases only using of machinery ventilation（non-surgical group）.Two groups were compared with the rate of tracheotomy,ICU stay time,mechanical ventilation,ventilator-associated pneumonia incidence,the time of analgesic use and other indicators.Results Compared with non-surgical group,the rate of tracheotomy and the incidence of the ventilator associated pneumonia of the surgical group was significantly reduced.And the time of ICU stay,mechanical ventilation and use of analgesic was significantly shortened.Conclusion The method of treating flail chest with respiratory failure by the internal fixation of mechanical ventilation combined with ribs embracing fixator is more effective than mechanical ventilation alone by reliable,rapid and stable fixation of the chest wall and removal of the infection of abnormal breathing on respiratory function.