手术与机械通气治疗连枷胸效果比较

Comparison of surgical and mechanical ventilation for flail chest

目的比较手术与机械通气治疗连枷胸的效果。方法 2013年3月至2017年5月我院ICU收治连枷胸患者81例,其中手术治疗53例(手术组),机械通气治疗28例(机械通气组),比较2组患者机械通气时间、卧床时间、给氧时间、胸引管留置时间、抗生素使用时间、药物镇痛次数、药物镇痛患者比例、停机/术后独自咳痰比例、ICU治疗时间、住院时间、病死率、2个月内再入院率及远期肺功能。结果机械通气组机械通气时间、卧床时间、给氧时间、抗生素使用时间、ICU治疗时间及住院时间与手术组比较均较长,2组比较差异有统计学意义(P<0.05);但是机械通气组镇痛次数多、镇痛病例多、术后/停机早期独自咳痰的比例小及住院费用低,与手术组比较差异有统计学意义(P<0.05)。2组患者出院后3个月肺功能主要指标差异均无统计学意义(P>0.05)。结论手术与机械通气对连枷胸的治疗近期效果有差异,对远期肺功能影响无明显差异,但机械通气创伤小、费用低,临床上可根据具体情况选择治疗方案。

Objective To compare the efficacy of surgical treatment（ ST） and mechanical ventilation treatment（ MVT） for flail chest.Methods From March 2013 to May 2017,81 patients with flail chest who underwent ST（ 28 cases） and MVT（ 53 cases） were enrolled in ICU. The relevant indicators of efficacy were compared including mechanical ventilation（ MV） time,bed rest time,oxygen administration time,catheterization time,antibiotic use time,drug analgesia,drug analgesia patients,proportion of stop/postoperative sputum alone,ICU treatment time,hospital stay,mortality,readmission within two months and long-term pulmonary function after discharge. Results The MV time,bed time,oxygen time,antibiotic use time,ICU treatment time and hospitalization time of MVT were longer than those of ST group,the differences were significant（ P〈0. 05）. MVT had more analgesic times,more analgesic cases,smaller proportion of offline/postoperative sputum along and less hospitalization fees compared with ST group,the differences were significant（ P〈0. 05）. There was no significant difference in the main indexes of pulmonary function between two groups in 3 months after discharge. Conclusion ST and MVT respectively has advantages and disadvantages for flail chest. There is no significant difference in long-term pulmonary function of ST and MVT. While MVT has less trauma and lower cost. The appropriate treatment could be selected according to the clinical situation.