机械通气联合选择性肋骨切开复位内固定术治疗多发性肋骨骨折合并ARDS的临床观察

Clinical observation of mechanical ventilation combined with selective rib open reduction and internal fixation for multiple rib fractures with ARDS

目的探究机械通气联合选择性肋骨切开复位内固定术治疗多发性肋骨骨折合并ARDS的临床效果。方法选取2010年8月至2014年8月我院收治的120例多发性肋骨骨折合并急性呼吸窘迫综合征(ARDS)患者,随机分为手术组和非手术组,各60例。对手术组患者运用机械通气联合选择性肋骨切开复位内固定术实施治疗,非手术组则单纯运用机械通气给予治疗。治疗后,就两组镇痛镇静剂使用时间、气管切开率、p H值等氧合指标改善情况,以及Pa CO2机械通气时间、呼吸机相关性肺炎发生率、入住ICU时间、SPO2及Pa O2予以比较分析。结果手术组在镇痛镇静剂使用时间、气管切开率、p H值等氧合指标改善情况、Pa CO2、机械通气时间、呼吸机相关性肺炎发生率、入住ICU时间、SPO2及Pa O2等指标与非手术组比较,均优于非手术组,且差异明显(P<0.05)。结论针对多发性肋骨骨折合并ARDS患者,对其采用机械通气联合选择性肋骨切开复位内固定术治疗,临床疗效相比于单纯采用机械通气治疗,疗效更为确切,在临床中具有很好的应用价值。

Objective To explore the clinical effect of mechanical ventilation combined with selective rib open reduction and internal fixation in the treatment of multiple rib fractures with ARDS. Methods One hundrad and twenty cases with multiple rib fractures combined acute respiratory distress syndrome（ARDS） patients received in our hospital from Aug.2010 to Aug. 2014 were randomly divided into operation group and non operation group, with 60 cases in each group. The operation group was treated by mechanical ventilation combined with selective rib open reduction and internal fixation. The non operation group was treated with mechanical ventilation. After the treatment, the analgesic and sedative utility time, tracheal incision rate, p H value and other indicators to improve oxygenation, and Pa CO2, occurrence rate of mechanical ventilation time, the occurrence rate of ventilator associated pneumonia, time in the ICU, SPO_2 and PaO_2 and such indicators were compared and analyzed. Results The analgesic and sedative use time, tracheal incision rate, p H value, and other oxygen index the PaCO_2, duration of mechanical ventilation and rate occurrence of ventilator associated pneumonia and the time in ICU, SPO_2 and PaO_2 was significantly difference compared to the non operation group（ P 〈0.05）. Conclusion Mechanical ventilation combined with selective ribs open reduction the internal fixation method is effective for multiple rib fracfure patients with ARDS, and is valuable for popularization.