机械通气在连枷胸伴原发性脑干伤中的救治作用

The role of mechanical ventilation in the management of flail chest with primary brain stem injury.

目的 强调机械通气在连枷胸伴原发性脑干伤救治中的重要性。方法 本组共 12例。入院后即行机械通气辅助呼吸内固定 ,每分钟按 3～ 6μg/kg持续推注多巴胺 ,直至停机械通气 ,静推纳洛酮 4mg/次 ,每 8h1次。有 8例入院当天行亚低温治疗 ,温度控制在 (3 3 .0± 1.8)℃。给予良好营养支持 ,3例肌注生长激素。伤后1～ 5 d每天监测外周静脉血中神经原特异性烯醇化酶动态变化。病情稳定后 ,及时高压氧治疗。结果 本组 9例存活 ,3例死亡。机械通气持续时间为 (8.8± 0 .9) d,开始高压氧治疗时间 (14± 5 ) d,治疗持续时间 (2 9± 1.8) d,亚低温治疗时间 (6.8± 1.1) d。纳洛酮使用时间 (16± 3 ) d。存活的 9例神经原持异性烯醇化酶 (NSE)平均为 (19±10 )μg/L ,从第 5天开始逐渐下降 ,死亡的 3例病人 NSE平均 (3 7± 14 )μg/L,无明显下降趋势。存活和死亡患者NSE水平比较差异有显著性 (P<0 .0 5 )。结论 机构通气不但明显改善连枷胸病人的低氧血症 ,而且为脑干伤后神经功能恢复提供良好血氧环境。

Objective To emphasize the great role of mechanical ventilation in the emergency management of flail chest and primary brain stem injury.Method There were 12 cases in our group.Lateral flail chest and the primary brain stem injury existed simultaneously.While being hospitalized,9 patients′ GCS was 3,the rest were of 5.Mechanical ventilation support was taken at once as soon as the patients were admitted,dopamine was transfused (3～6 μg·kg -1 ·min -1 ) until mechanical ventilation was ceased.Naloxone was injected intravenously(4 mg q8h),mild hypothermic management was performed in 8 patients(33 0±1 8)℃.Fine nutritional support was given,while growth hormone was injected in 3 patients.Serum neurone specific enolase(NSE) was determined from the lst day to 5th day after the trauma.As soon as the patient′s situation trended better,hyperbaric oxygen therapy was taken at once.Results Three patients died,and 9 patients survived in this group.Mechanical ventilation lasted for (8.8±0.9)days,hyperbaric oxygen therapy began in (14 0±5.2)days after the trauma and lasted for (29 0±1.8)days,mild hypothermic treatment lasted for (6.8±1.1)days.Naloxone was transfused for (16.1±3.2)days.The survived patients showed a (19±10)μg/L level of serum PPH,PPH went down gradually from the 5th days after the injury.The average NSE level of the three dead cases was (37±14)μg/L(P<0.05),no downtrend was showed.Conclusion Mechanical ventilation relieves hypoxaemia due to flail chest,and it helps nervous function recover from primary brain stem injury rapidly.Mechanical ventilation is equal to hyperbaric oxygen therapy performed immediately when the brain stem was injured.