连枷胸伴严重肺挫伤的机械通气内固定疗法

目的:探讨连枷胸伴严重肺挫伤机械通气内固定疗法的临床治疗经验。方法:对1990～2001年收治的13例患者以治疗肺挫伤为重点行机械通气内固定治疗,采用SIMV+PEEP模式,撤机后用低张弹力胸带固定胸壁。结果:机械通气后PaO_2、氧指数、PaCO_2、pH值明显改善,与通气前相比,有极显著差异(P<0.01)。治愈10例,死亡3例,发生肺部感染2例,应激性溃疡1例,褥疮1例。7例随访1～8年,患者肺功能良好,生活能自理。结论:连枷胸伴肺挫伤机械通气内固定疗法效果可靠,但有一定的应用指征。重点治疗肺挫伤,缩短机械通气时间是减少肺部感染等并发症、提高治愈率的关键;同时要重视胸壁固定。

Intra- tranchea Stabilization of Flail Chest Accompanied Severe Pulmonary Contusion with Ventilator Therapy

Objective: To evaluate the experience of clinical management on flail chest accompanied severe pulmonary contusion. Methods: 13 cases were treated with intra ~ tranchea stabilization of mechanical ventilation using of SIMV + PEEP from 1990 to 2001 in our unit. We stabilized chest wall with low elastic chest belt after removing ventilator. Results: PaO2,Oxygen -index,PaCO2 and pH were significantly better after ventilation than pre - ventilation (P<0.01). There were 3 deaths. 10 cases were cured, and accompanied by pulmonary infections in 2, irritable ulcer in 1, decubitus in 1. 7 cases recoverd normai pulmonary function, taking care by himself with l to 8 years follow - up. Conclusion: The encouraging result of intra -tranchea stabilization of flail chest accompanied severe pulmonary contusion with ventilator therapy deserves recommend, but the indications for mechanical ventilation must be grasped. The key of decreasing complication such as pulmonary infection and improving the cure rate of this disease is shortening duration of mechanical ventilation by active treatment of pulmonary contusion, meanwhile make much of chest fixation.