创伤性连枷胸不同时机手术固定疗效的对比

Contrast research of clinical efficacy in severe thoracic injury in dif-ferent time operation

目的探讨重症胸外伤合并胸壁软化不同手术时机的临床疗效。方法对比研究了49例重症胸外伤救治的临床资料，包括治疗前后动脉血气、氧合指数、基础生命体征变化、疼痛程度、手术时间、平均住院日、机械通气辅助时间、急性呼吸窘迫综合征病死率以及胸片情况。结果早期手术26例患者全部存活，无一例死亡，胸片改善时间最快治疗后第3天，最长第9天效果满意；晚期手术23例患者1例死亡。两组患者血气分析显示：SAT、PO2、PCO2、PaO2／FiO2在手术后均有显著改善，与术前比较均有显著差异。疼痛程度手术后明显减轻、主动咳嗽增加。结论创伤性连枷胸患者早期行手术内固定治疗，辅以呼吸机辅助呼吸，可大大改善患者的缺氧状况，减少气管切开，缩短呼吸机辅助时间，明显缩短恢复期，并未加重肺损伤和增加病死率。

Objective To investigate the relationship between the timing of surgery for severe thoracic trauma combined with softening chest wall and the clinical outcome. Methods We comparatively studied the clinical data of 49 patients （divided into two groups） with severe thoracic trauma before and after surgery, including arterial blood gases, oxygenation index, vital signs, pain degree, time of operation , average length of stay, assisted mechanical ventilation time, fatality rate of ARDS and the status of chest X-ray. Results Twenty-six cases all survived after early operation with satisfied effect of chest X-ray improvement（ 3-9 days） ; While 1 patient died in 23 cases who received later operation. There was significant difference in SAT, PO2, PCO2, PaO2/FiO2 after surgery （P 〈 0.05 ）. And the pain degree was alleviated obviously, initiated cough increased apparently. Conclusions Patients with traumatic flail chest should receive early operation of internal fixation and assisted mechanical ventilation. It may improve the patient＇s hypoxia condition, reduce the incision of trachea and lung injury, shorten the assisted me- chanical ventilation time and recovery time and cut down the mortality rate.