胸腔镜辅助机械通气治疗严重胸外伤继发ARDS的临床研究

Clinical study of emergent thoracoscopy with mechanical ventilation for severe thoracic trauma secondary ARDS

目的探讨微创电视胸腔镜(VATS)联合早期机械通气治疗严重胸外伤继发急性呼吸窘迫综合征(ARDS)的临床效果。方法 32例严重胸外伤继发ARDS患者采用VATS联合早期机械通气治疗,为观察组;与30例采用常规开胸手术联合早期机械通气治疗,为对照组进行比较。结果 (1)观察组的存活率显著高于对照组,手术平均时间显著短于对照组,围手术期并发症发生率显著低于对照组(P<0.05)。(2)观察组呼吸机平均应用时间显著短于对照组,呼吸机相关性并发症发生率显著低于对照组(P<0.05)。结论针对严重胸外伤继发ARDS患者,掌握VATS合理的适应症和禁忌症,联合早期机械通气治疗,可以明显提高救治成功率,降低并发症。

Objective To study the clinical effect of emergent minimally invasive video assisted thoracic surgery （VATS） with early mechanical ventilation for severe thoracic trauma secondary acute respiratory distress syndrome （ARDS）. Methods 32 severe thoracic trauma secondary ARDS patients were given VATS with early mechanical ventilation as the experiment group, and another 30 patients accepted common operation with early mechanical ventilation as the control group. Results The survival rate in the experiment group was significantly higher than that in the control group. The operation mean time and complication rate during operation was significantly lower in the experiment group than in the control group （P 〈 0. 05）. The mean time using mechanical ventilation was signifi- cantly shorter, and the complication rate related to mechanical ventilation was significantly lower in the experiment group than in the control group （P 〈 0. 05）. Conclusion It is important for severe thoracic trauma secondary ARDS to understand indications and contraindications of VATS, which can improve the curative rate and reduce the complications.