创伤性连枷胸临床救治体会

【目的】总结创伤性连枷胸临床治疗经验，提高救治成功率。【方法】回顾性分析2001年1月-2007年12月我院收治的87例创伤性连枷胸，尤其是58例重伤患者在机械通气治疗过程，采用同步间歇指令（svncronized intermittemt mandatory ventilation，SIMV）辅助通气模式＋压力支持（preseure support ventilation，PSV）和，或呼气末正压（positive end expiratorv pressure，PEEP），必要时行浮动胸壁床旁或手术室手术固定等治疗措施。【结果】死亡3例，其余84例全部治愈，肺功能基本恢复正常。机械通气后24h血气化验结果中的氧分压、二氧化碳分压和氧合指数等与通气前比较明显改善（P〈0．05）。【结论】创伤性连枷胸并发的肺挫伤和引发反常呼吸是引起呼吸功能障碍及低氧血症的主要原因，尤其是合并多发伤的患者，肺功能损害进一步加重。积极早期给予机械通气、固定浮动胸壁等综合治疗措施是治疗成功的关键。

Clinical cure experience of traumatic flail chest

[Objective] To summarize the experience of clinical management of traumatic flail chest for raising the successful rate of treatment. [Methods] The experience of clinical treatment of eighty-seven cases of traumatic flail chest from January 2000 to December 2007 in hospital were analyzed retrospectively. Fifty-eight patients were treated with protective machine ventilation （SIMV ＋ PSV ＋ PEEP or SIMV ＋ PEEP）, Operative fixation was performed when necessary. [Results] There were 3 deaths and 84 cases were cured, the lung function recovered normally. The arterial blood gas leveal at 24 hours after mechanical ventilation had been improved obviously （ P 〈 0.05）. [Conclusions] Pulmonary contusion and paradoxical respiratory movement arisen by traumatic flail chest were the main reasons that cause pulmonary disfunction and hypoxemia. The key of management is to use the protective machine ventilation and to restore the stability of the chest wall in early days actively.