不同时机手术内固定治疗创伤性连枷胸疗效比较

Effect comparison of different opportunity internal fixation in the treatment of traumatic flail chest

目的：比较创伤性连枷胸不同手术时机内固定治疗的效果。方法选择创伤性连枷胸患者53例的临床资料，其中28例患者伤后72 h 内行手术内固定治疗（早期组），25例患者在伤后72 h 后行手术治疗（晚期组），观察两组患者术后恢复情况（术后通气时间、X 线胸片改善时间、住 ICU 时间、拔管时间、住院时间），比较两组患者治疗前后呼吸功能变化情况及并发症。结果早期组术后通气时间、胸片改善时间、住ICU 时间、拔管时间及住院时间分别为（27．4±4．8）h、（88．6±7．5）h、（3．8±0．7）d、（3．2±0．8）d、（13．2±5.0）d，均明显短于晚期组的（40．7±5．2）h、（195．3±8．0）h、（5．6±1．4）d、（5．2±1．3）d、（19．8±6．4）d，差异均有统计学意义（t ＝7．389、11．204、3．837、3．916、5．261，均 P ＜0．05）。治疗后两组 PaO2、PaCO2、PaO2／FiO2、RR、HR 均较治疗前改善，治疗前后差异均有统计学意义（早期组：t ＝12．497、6.205、4．136、7．381、14.327，均 P ＜0．05；晚期组：t ＝11．976、5．813、4．649、6．892、14．627，均 P ＜0．05），但组间治疗后比较，差异均无统计学意义（t ＝0．126、0．013、0．002、0．010、0．215，均 P ＞0．05）。两组均未出现病死情况，两组肺不张、ARDS 及胸廓畸形发生率差异无统计学意义（P ＞0．05）。结论创伤性连枷胸早期手术治疗能迅速改善呼吸循环功能，能缩短患者术后恢复期，并且不增加并发症，因此在条件许可的情况下，应早期行手术内固定治疗。

Objective To compare the effects of different opportunity internal fixation in treatment of trau-matic flail chest.Methods Clinical data of 53 cases of patients with traumatic flail chest were selected,in which 28 patients were given internal fixation treatment in 72h after injury （early surgery group）,25 patients were given sur-gery after 72h（late surgery group）,recovery situation（postoperative ventilation time,chest improve time,ICU stay time,extubation time,hospitalization time）of the two groups were observed,respiratory function changes and compli-cations were compared before and after treatment.Results Postoperative ventilation time,chest X -ray improvement time,ICU stay time,extubation time and hospitalization time of the early operation group were （27.4 ±4.8）h, （88.6 ±7.5）h,（3.8 ±0.7）d,（3.2 ±0.8）d,（13.2 ±5.0）d,which were significantly shorter in the late operation group of （40.7 ±5.2）h,（195.3 ±8.0）h,（5.6 ±1.4）d,（5.2 ±1.3）d,（19.8 ±6.4）d,with significant difference （t =7.389,11.204,3.837,3.916,5.261,all P 〈0.05 ）.After treatment,PaO2 ,PaCO2 ,PaO2 /FiO2 ,RR and HR were all significantly improved （early surgery group t =12.497,6.205,4.136,7.381,14.327,all P 〈0.05;late sur-gery group t =11.976,5.813,4.649,6.892,14.627,all P 〈0.05）,but the indexes between the two groups were not significantly different（t =0.126,0.013,0.002,0.010,0.215,all P 〉0.05 ）.There was no dead case in the two groups,and the incidence of atelectasis,ARDS and thoracic deformity had no significantly different between two groups （P 〉0.05 ）.Conclusion In treatment of traumatic flail chest,early surgical treatment can rapidly improve the respiratory and circulatory function,it can shorten the postoperative recovery time,and does not increase complica-tions.So,when conditions permit,patients should be given early surgical fixation.