不同内固定时机治疗创伤性连枷胸患者的临床效果研究

Retrospective Study of Different internal Fixation Timing for Patients with Traumatic Flail Chest

目的:探讨不同内固定时机治疗创伤性连枷胸患者的临床效果。方法:回顾性收集我院2016年1月2017年12月行内固定术治疗创伤性连枷胸患者74例的基本资料,按照患者受伤至接受内固定术的时机进行分组,其中受伤后72 h以内行内固定手术的44例患者,为早期组;受伤后在72 h以外行内固定手术的30例患者,为晚期组,比较两组患者术后恢复状况、胸部AIS评分、创伤严重程度评分(ISS)、血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、呼吸频率(RR)、心率(HR),记录并发症状况。结果:早期组的通气时间、胸腔引流管拔管时间、胸外ICU时间、住院时间分别为[(25.12±4.35)h、(3.21±0.67)d、(3.75±0.79)d、(11.63±4.35)d],均低于晚期组[(36.82±5.39)h、(4.36±0.84)d、(4.89±0.93)d、(16.72±5.19)d],差异有统计学意义(P<0.05)。早期组和晚期组手术后3天胸部AIS评分分别为(3.15±0.32)、(3.67±0.34),ISS评分分别为(14.91±3.58)、(17.29±4.27),均低于术前,差异具有统计学意义(P<0.05)。与手术前比,两组患者手术后3天的PaO2升高,PaCO2、RR、HR降低;但手术后3天早期组和晚期组的PaO2、PaCO2、RR、HR比较差异无统计学意义(P>0.05)。早期组救治成功率95.45%(42/44)高于晚期组救治成功率80.00%(24/30),差异有统计学意义(P<0.05),两组间并发症发生率比较差异无统计学意义(P>0.05)。结论:与晚期比较,早期行内固定手术治疗创伤性连枷胸患者,有助于患者术后恢复,且在吸循环功能与术后不良反应上无明显差异。

Objective To explore the retrospective study of different internal fixation timing for patients with traumatic flail chest.Methods The basic data of 74 patients with traumatic flail chest underwent internal fixation from January 2016 to December 2017 were retrospectively collected and divided into two groups according to the timing of internal fixation,including 44 patients who underwent internal fixation within 72 hours after admission as Early group,and 30 patients who underwent internal fixation beyond 72 hours as Late group.The recovery status,chest AIS score,Injury Severity Score(ISS),oxygen tension(PaO2),partial pressure of carbon dioxide(PaCO2),respiratory rate(RR),heart rate(HR)were compared between the two groups and the complications was also recorded.Results The ventilation time,extubation time,ICU time and hospitalization time in the Early group(25.12±4.35,3.21±0.67,3.75±0.79,11.63±4.35)were lower than the Late group(36.82±5.39,4.36±0.84,4.89±0.93,16.72±5.19),and the difference was statistically significant(P<0.05).The thoracic AIS scores of the Early group and the Late group were(3.15±0.32),(3.67±0.34)and(14.91±3.58),(17.29±4.27)respectively on the 3rd day after treatment,and the difference was statistically significant(P<0.05).Compared with pre-operation,PaO2 increased,PaCO2,RR and HR decreased in the two groups,postoperative levels of PaO2,PaCO2,RR and HR in the two groups had no significant difference(P>0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Compared with the late stage,early internal fixation for traumatic flail chest is helpful to the recovery of patients.It had no significant difference in respiratory and circulatory function as well as in postoperative complications.