连枷胸91例临床救治分析

目的 比较连枷胸的治疗方式和疗效的不同，探讨连枷胸救治经验。方法回顾性分析我院于1995年1月至2008年6月所收治的91例连枷胸患者的临床资料。结果按时期不同分为两组：2组中采取有创治疗措施增多；两不同时期组伤情严重度比较无差别，但1组死亡率（25％）明显高于2组（6.3％）（P〈0.05）；按治疗方式不同分为两组：有创治疗组伤情量化较保守治疗组重（P〈0.05），而两组死亡率比较，差异无统计学意义（P〉0.05），且有创治疗组中残留胸廓畸形例数、肺不张发生率明显低于保守治疗组（P〈0.05）。结论 连枷胸积极的有创治疗效果优于保守治疗；提高连枷胸患者生存率的主要措施是早期稳定胸壁与治疗肺挫伤并重，保持呼吸道通畅，有效止痛，适时给予机械通气，预防和治疗呼吸功能不全和肺部感染。

Analysis of clinical management of 91 patients with traumatic flail chest

Objective To compare the treatments and clinical outcomes and summarize the experience in the treatment of traumatic flail chest. Methods A retrospective study was carried out on 91 patients with traumatic flail chest hospitalized in our hospital from January 1995 to June 2008. Results Although there was no significant difference in the severity of injury between group Ⅰ and group Ⅱ, the death rate of patients in group I in which patients underwent less invasive treatment was higher （7 deaths, 25% ） than that in group Ⅱ （4 deaths, 6.3% ） （P〈0.05）. The condition of the patients in invasivc treatment group was more severe than that in conservative treatment group, however, there was no significant mortality difference between invasive treatment group and conservative treatment group （P〉0.05 ）. The ratio of the chest wall deformation and the incidence of pulmonary atelectasis in invasive treatment group were less than those in conservative group. Conclusion The therapeutic effect of invasive treatment was better than that of conservative treatment. The key treatment measures are to restore stability of the chest wall at an early stage, effectively treat pulmonary contusion, and ensure non-obstruction of the airway plus effective pain relief, prevent and treat the insufficiency of respiration and pulmonary infection. Mechanical ventilation should be administered to patients when necessary.