机械通气治疗连枷胸合并呼吸衰竭16例

Clinical study on sixteen cases of flail chest complicated with respiratory failure with ventilation

目的:探讨连枷胸致呼吸衰竭的病理生理、机械通气治疗的指征、模式参数调节及撤离.方法:总结16例采用机械通气治疗的连枷胸合并呼吸衰竭病例的临床治疗过程及转归.结果:其中13例经机械通气4～14d后一次性成功脱机,转普通病房继续治疗5～1 3d后出院;3例死亡病例分别死于重度颅脑损伤及失血性休克.结论:连枷胸如有机械通气指征,应尽早使用.机械通气模式可选用SIMV(同步间歇指令通气)+PSV(压力支持),宜选择偏高潮气量(10～12ml/kg),PEEP(呼气末正压)有利于病情恢复.浅快呼吸指数(f/VT)是目前撤机最有预测价值的指标.

ve To discuss the pathogenesis of flail chest complicated with respiratory failure and the indication of mechanical ventilation,the regulation of mode and parameter, weaning from mechanical ventilation. Methods Sixteen cases of flail chest complicated with respiratory failure with ventilation were reviewed. Results thirteen patients were weaned from ventilation after 4 to 14 days and removed to common wards in 5 to 13 days. 3 patients died of severe craniocerebral injury and hemorrhagic shock. Conclusions Mechanical ventilation should be used as early as possible if there are indications. The mode mechanical ventilation should be as of synchronized intermittent mandatory ventilation (SIMV) combined with pressure support ventilation(PSV). Tidal volume (TV)should be as large as (10-12ml/kg). Positive end expiratory pressure(PEEP) is helpful for the recovery from illness. The shallow rapid spiro-index(f/VT ratio)is the most valuable predictor of success in weaning patient from mechanical ventilation at present.