胸部护板联合机械通气治疗连枷胸合并肺挫伤的效果分析(1)
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2010年7月1日
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【摘要】目的 探讨胸部护板联合机械通气治疗连枷胸合并肺挫伤的疗效。方法 回顾性分析2002年2月至2010年2月本院收治的37例严重连枷胸合并肺挫伤患者,37例患者分为胸部护板组(20例)和对照组(17例)。对两组患者治疗24h后的酸碱度(pH值)、氧分压(PaO2)、二氧化碳分压(PaCO2)、氧饱和度(SaO2%)、机械通气时间以及疼痛指数(数字疼痛分级法 NVS)进行比较分析。结果 两组比较PH值、PaO2、PaCO2、SaO2%及机械通气时间有差异(p<0.05);两组疼痛指数比较差异有显著性(p<0.01)。结论 胸部护板联合机械通气在治疗连枷胸合并肺损伤患者中能明显改善病情,减轻患者疼痛。
【关键词】钛合金胸部护板 连枷胸 肺损伤 机械通气 肋骨骨折
中图分类号:R561文献标识码:A 文章编号:1005-0515(2010)07-048-03
To analyze the effect of the chest protection plate with mechanical
ventilation in flail chest combined with pulmonary contusion.
【Abstract】Objective Investigate the effect of the chest protection plate with mechanical ventilation in flail chest combined with pulmonary contusion.Method A retrospective analysis was carried out on 37 patients with severe flail chest combined with pulmonary contusion. They were admitted to the hospital from February 2002 to February 2010. 37 patients were divided into the chest guard plate groups and control groups.To analysis the PH value、PaO2、PaCO2、SaO2%、the mechanical ventilation time and the pain index after treatment. Result 24h after treatment between the two groups PH value, PaO2、PaCO2、SaO2%, the mechanical ventilation time ,there were differences(p<0.05) and the pain index were significant differences(p<0.01) Conclusion It was found that the chest guard plate with mechanical ventilation was able to significantly improve the conditions of the paticnts with flail chest combined with pulmonary contusion comlblicated as well as lessen their pain.
【Key words】Chest Protection Plate Frail chest Pulmonary contusion Mechanical ventilation External fixation of chest wall
连枷胸合并肺挫伤,是指胸部受到强大钝性外力撞击或挤压后多根多处肋骨骨折后局部胸廓软化,形成浮动胸壁,同时合并有肺部损伤的创伤性病变。连枷胸形成后软化区与胸廓其他部分运动不同步,表现为反常呼吸并可造成纵隔摆动,加之肺挫伤后肺水肿,可严重影响肺通气和换气功能。其病理生理过程较复杂,重者可导致急性肺损伤(acute lung injury, ALI)和急性呼吸窘迫综合征(acute respiratory distress syndrome , ARDS),死亡率高达12%～50%[1]。本研究通过对37例需机械通气的连枷胸合并肺挫伤患者的两种不同治疗方法的研究,观察胸部护板固定对此类患者的疗效。
1 资料与方法
1.1 一般资料
本组患者中男23例,女14例,年龄23～51岁,平均40.1岁,伤后到医院就诊时间20 min至2 h。因机动车撞击致伤24例,高处坠落伤11例,塌方砸伤2例。单侧多处肋骨骨折27例,双侧多处肋骨骨折10例,合并血气胸者7例,合并腹部外伤者5例,其中肝损伤3例,脾损伤2例,膀胱损伤2例,合并四肢骨折者11例,胸腔闭式引流14例,如合并脑外伤意识障碍者不作为研究对象 ......
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