连枷胸合并血气胸的急诊处理临床分析

摘要

目的：观察连枷胸合并血气胸根据手术时机行急诊肋骨内固定术的临床效果。方法回顾性分析2013年1月～2014年2月收治的49例连枷胸合并血气胸患者的临床资料，其中男性31例，女性18例；年龄19～79岁，平均年龄（49．2±7．8）岁。按手术时机分组：受伤后2d内接受早期手术者26例为观察组，2～7d接受晚期手术者23例为对照组，分析两组患者的机械通气时间、下床时间、拔管时间、疼痛程度以及并发症情况。结果观察组机械通气时间、下床时间、拔管时间分别为（95．2±13．1） h、（48．8±11．2） h、（32．8±10．7）h，显著少于对照组的相应指标（P＜0．05）；观察组术后疼痛视觉模拟评分（VAS）和重度疼痛比例显著低于对照组（ P＜0．05），观察组肺不张、肺部感染发生率和死亡率明显低于对照组，而两组患者胸廓畸形和肋间神经痛发生率无明显差别。结论早期急诊肋骨内固定术治疗连枷胸合并血气胸可以及时消除胸壁软化及反常呼吸运动，改善呼吸功能，减少并发症，明显有利于病情恢复。%Objective To observe the effect of the timing of surgery for emergency rib internal fixation in the treatment of flail chest complicated with hemopneumothorax . Methods Forty-nine patients with flail chest complicated with haemopneumothorax were selected and grouped according to the timing of surgery :26 patients who had received early surgery 2 d after the injury were set as the observation group;23 cases who received late surgery 2 to 7 d after injury were set as the control group .The mechanical ventilation time ,time for getting out of bed ,extu-bation time,pains and complications in the two groups were analyzed and compared .Results Time for mechanical ventilation,for getting out of bed and extubation of patients in the observation group were (95.2 ±13.1)h,(48.8 ± 11.2)h and (32.8 ±10.7)h,respectively,significantly shorter than those in the control group (P<0.05);the post-operative VAS pain score and proportion of patients suffering from severe pains in the observation group were signifi -cantly lower than those in the control group ( P<0.05);the main adverse reactions in the two groups of patients were manifested mainly as lung atelectasis ,pulmonary infection ,thoracic deformity ,intercostal neuralgia ,and the incidence of adverse reactions in the observation group was significantly lower than that in the control group ( P<0.05);the in-cidence of lung atelectasis ,pulmonary infection and mortality in the observation group was significantly lower than that in the control group ,and the incidence of thoracic deformity and intercostal neuralgia occurrence rate had no ob -vious difference between the two groups .Conclusion Early emergency surgery for rib internal fixation can elimi-nate chest wall malacia and abnormal breathing for patients with flail chest combined hemopneumothorax ,which can improve their respiratory function and reduce complications ,thus boosting the recovery of the patients .