胸部护板在胸部创伤早期治疗中的效果

目的评价胸部护板在以多发肋骨骨折、胸骨骨折为主的胸部创伤早期治疗中的临床效果。方法对46例肋骨骨折和（或）胸骨骨折创伤患者,随机分为传统治疗组（对照组,16例）、胸部护板治疗组（观察组,30例）,对两组患者的疼痛及血气分析指标、肺部并发症、住院时间进行评价。结果观察组与对照组疼痛指数评分（VAS）[（4．45±2．23）、（8．15±2．02）分,t=2．921,P〈0．01],血气分析Pa02[（88．16±9．12）mmHg与（77．22±6．24）mmHg,t=2．413,P〈0．05]、PaCO2[（40．91±3．40）mlnHg与（46．06±5．40）mmHg,t=2．335,P〈0．05]、肺部并发症[17％（5／30）、44％（7／16）,X2=23．478,P〈0．05]、住院时间[（7．26±4．17）d与（14．26±3．53）d,t=2．430,P〈0．05]比较差异均有统计学意义。结论胸部护板在胸部创伤早期治疗中能减少患者痛苦,明显改善病情,且简单易行,临床效果显著。     

胸部护板在胸部外伤患者排痰中的效果观察

目的:探讨胸部护板在胸部损伤患者主动排痰中的效果观察。方法:将我科2010年1月~2012年6月收治的60例胸外伤患者随机等分为对照组和观察组。观察组采用胸部护板固定,对照组无固定或普通胸带加用毛巾折叠后压迫加固定。分别观察两组患者入院后不同时间点疼痛指数、肺部并发症的发生率、住院时间。结果:使用胸部护板的观察组在不同时间点的疼痛指数明显比对照组轻,观察组患者的肺部并发症发生率低于对照组,住院时间短于对照组,两组比较差异均具有统计学意义(P0.05)。结论:使用胸部护板固定肋骨骨折、胸骨骨折部位,能有效地减轻疼痛,促进患者主动咳嗽、排痰,减少肺部感染的发生率,促进患者早日康复。     

胸部护板用于单纯性肋骨骨折患者的疗效观察与护理

目的：观察胸部护板外固定治疗对肋骨骨折患者的疗效。方法选择40例肋骨骨折患者，并随机分为护板组与对照组，每组各20例。护板组患者采用胸部护板行外固定治疗，对照组患者采用胸带或胸带加厚棉垫加压包扎等传统外固定方法。观察比较两组患者疼痛指数（VAS）、住院时间长短。结果与对照组相比，护板组患者疼痛强度降低，住院时间缩短，差异均有统计学意义（P＜0.05）。结论胸部护板对肋骨断裂的区域有固定效果，可明显降低疼痛强度，并能提高患者有效咳嗽咳痰、深呼吸、下床活动等行为，有利于患者的恢复，是一种简单有效的治疗肋骨骨折的方法。     

胸部护板治疗肋骨骨折的临床疗效观察

选取86例肋骨骨折患者,分为治疗组49例和对照组37例。治疗组采用医用记忆胸部护板外固定,对照组采用宽胶布胸带外固定。胸部护板治疗组治愈率,疼痛缓解率明显高于对照组,并发症及住院时间明显低于对照组,差异有统计学意义(P0.05)。医用记忆胸部护板外固定治疗肋骨骨折疗效肯定,明显优于宽胶布胸带外固定治疗方法。     

记忆金属胸部护板与传统固定方法治疗多发肋骨骨折的比较

背景:以往肋骨骨折的患者给予止痛剂,或者用胸部外固定带,虽然减轻了疼痛,但是使呼吸状态变差.记忆金属胸部护板作为一种新产品被应用于临床为多发肋骨骨折患者减轻了痛苦,与传统方法相比具有很多优点.目的:比较应用记忆金属胸部护板与传统固定方法治疗多发肋骨骨折效果的差异.方法:纳入104例经胸部X射线证实的多发肋骨骨折患者,按照随机数字表法分为2组.对照组40例采用传统的固定方法,即胸带或胸带加厚棉垫;胸部护板组64例采用记忆金属胸部护板治疗.在治疗后1,24,48,72 h记录两组患者在休息时及咳嗽时的目测类比评分、肺部并发症发生率以及住院时间差异.其中胸部护板组32例患者及对照组21例接受肺功能测试,分别记录治疗后1,24,48,72 h的肺活量.结果与结论:胸部护板组患者在休息时疼痛强度降低,在强迫性呼吸时(如咳嗽)降低更明显.使用记忆金属护板的32例患者的肺活量在观察期间持续不断增加,肺部并发症发生率显著低于对照组,平均住院时间显著少于对照组(P＜0.05).提示记忆金属胸部护板对肋骨断裂的区域有固定效果,明显降低疼痛强度,增加肺活量,减少肺部并发症的发生,缩短平均住院时间,是一种简单有效的治疗多发肋骨骨折的方法.     

记忆合金环抱器治疗重症胸部外伤多发性肋骨骨折患者的疗效分析

目的探讨记忆合金环抱器治疗重症胸部外伤多发性肋骨骨折的疗效。方法选取52例重症胸部外伤多发性肋骨骨折患者,将采用记忆合金环抱器手术治疗的26例患者设为手术组,将采用胸带固定治疗的26例患者设为非手术组。比较2组气管插管时间、气管切开患者例数、气管切开时间、胸腔引流量、胸管拔管时间、胸痛时间、肺部并发症、住院时间。结果手术组术后气管插管时间、气管切开患者例数及气管切开时间、胸腔引流量、胸管拔管时间、手术后胸痛持续时间、肺部并发症、住院时间均显著优于非手术组(P 0. 05)。结论记忆合金环抱器治疗重症胸部外伤多发性肋骨骨折疗效显著,可以缓解疼痛,减少并发症,缩短康复时间。     

记忆金属胸部护板治疗多根肋骨骨折的护理观察

目的 探讨记忆金属胸部护板用于治疗多根肋骨骨折的临床效果和护理体会.方法 对我院2006年7月至2009年6月52例多根肋骨骨折患者按自愿原则随机分为实验组27例,对照组25例,实验组采用记忆金属胸部护板外固定,而对照组采用传统的胸带或胸带加厚棉垫加压包扎外固定,分别观察两组患者人院后不同时间段的平静呼吸和强制呼吸疼痛指数、住院期间离床活动时间、总住院天数和肺部感染发生率,并进行统计学分析.结果 入院经不同处理方法1 h、24 h、48 h和72 h后平静时和强制性呼吸的疼痛指数评分实验组明显低于对照组;实验组离床活动时间明显多于对照组;实验组总住院天数比对照组缩短;实验组肺部感染发生率比对照组低;两组差异均有统计学意义(P<0.05).结论 使用记忆金属胸部护板固定肋骨骨折部位,能有效地减少疼痛,增加患者舒适度,减少住院天数,减少肺部感染的发生率,促进患者早日康复.     

多发肋骨骨折患者采用胸部护板固定治疗的临床效果

目的:观察分析对多发肋骨骨折患者采用胸部护板固定治疗的临床效果。方法:将在我院接受治疗的多发肋骨骨折106例患者,通过随机数字抽取表法分为两组,对照组53例采用传统胸带固定治疗,观察组53例采用胸部护板外固定治疗,比较两组患者的疼痛缓解情况及并发症发生率。结果:治疗前两组患者疼痛程度评分比较,差异无显著性(P>0.05);治疗时、治疗后24h、治疗后72 h两组患者的疼痛程度评分均降低,且观察组与对照组相比明显偏低,差异具有统计学意义(P<0.05)。观察组并发症发生率为1.89%,对照组并发症发生率为18.87%,观察组并发症发生率明显更低,差异具有统计学意义(P<0.05)。结论:对多发肋骨骨折患者采用胸部护板固定治疗能显著缓解患者的疼痛程度,且并发症发生率较低,值得临床上推广应用。     

沐舒坦在胸部创伤所致肺损伤中的应用

【目的】探讨静脉滴注大剂量（1g／d）沐舒坦对胸部创伤所致肺损伤的治疗作用。【方法】选择胸部创伤所致肺损伤患者55例。随机分为沐舒坦治疗组28例和时照组27例,时照组予常规治疗,治疗组则在常规治疗方法基础上加用沐舒坦1g／d静滴。记录并比较两组患者血气变化及肺部感染、肺不张发生率。【结果】治疗5d后两组患者动脉血气较治疗前均有明显改善（P〈0．05）,治疗组比对照组改善更明显（P〈0．05）。治疗组肺部感染、肺不张发生率较对照组显著减少,差异有统计学意义（P〈0．05）。【结论】大剂量沐舒坦对胸部创伤所致肺损伤具有明显的治疗作用,可减少急性肺损伤患者肺部并发症。     

胸部物理治疗在小儿肺炎和肺不张中的临床应用

[目的]探讨胸部物理治疗（CPT）在小儿肺炎、肺不张中的应用效果。[方法]选择60例肺炎、91例肺不张（51例阻塞性肺不张，40例压迫性肺不张）患儿，将肺炎组和肺不张组分别设物理治疗组（CPT组）和对照组，对照组进行常规治疗，CPT组在常规治疗基础上加用CPT治疗，观察两组胸部X线片改善、肺部听诊改善等指标。[结果]肺炎患儿的CPT组胸片痊愈、肺部听诊改善和住院天数较对照组短（P〈0．01）；阻塞性肺不张的CPT组胸片痊愈、肺部听诊改善较对照组短（P〈0．01），而压迫性肺不张CPT组胸片改善与对照组无差异（P〉0．05），肺部听诊改善时间低于对照组（P〈0．05）。[结论]CPT用于小儿肺炎、肺不张治疗中，可促使胸部X线片和听诊结果改善，从而减少呼吸道并发症，缩短住院时间。     

快速恢复外科理念在多发性肋骨骨折内固定手术中的应用研究

目的 探讨快速恢复外科(FTS)理念在多发性肋骨骨折内固定手术中的应用研究.方法 对我院2008年3月至2010年3月救治的48例胸外伤合并多发性肋骨骨折患者随机分为FTS组(24例)和传统方法组(24例),分别用FTS和传统围手术期方法处理.比较2组患者术后胸壁疼痛程度及持续时间、早期活动耐量、静脉输液维持时间、相对住院时间、胸壁瘢痕、并发症及其发生率等指标.结果 FTS组术后胸壁疼痛持续时间较传统方法组明显缩短[(112.46±23.24)min与(180.23±51.56)min,t=4.23,P＜0.05];早期活动耐量延长[(68.35±9.30)min与(33.48±5.18)min,t=2.87,P＜0.05];静脉输液维持时间缩短[(10.83±1.87)d与(13.30±2.12)d,t=2.38,P＜0.05];相对住院时间缩短[(12.35±2.03)d与(16.48±3.18)d,t=3.04,P＜0.05];并发症发生率少(8.3%与37.5%,x2=5.005,P＜0.05);术后胸壁疼痛程度减轻[(3.43±0.45)cm与(6.62±0.62)cm,P＜0.05];胸壁瘢痕愈合好.2组患者均顺利康复出院.结论 对于胸外伤合并多发性肋骨骨折的患者,采用FTS的围手术期治疗理念疗效满意,明显提高患者远期生活质量.

Abstract：

Objective To evaluate the application of fast track surgery (FTS) in the rib internal fixation of multiple rib fractures. Methods Forty-eight chest trauma with multiple rib fractures patients from March 2008 to March 2010 were divided into FTS group and traditional care group randomly. Meanwhile two groups accepted FTS and conventional management of perioperative period respectively. The degree and duration of the chest pain, early exercise tolerance, intravenous infusion time, the length of postoperative hospital stay,chest scar and postoperative complications were observed and compared between the two groups. Results The duration of chest pain was significantly shorter in FTS group than in the traditional care group([ 112. 46 ±23. 24 ] mins vs [ 180. 23 ± 51.56 ] mins, t = 4. 23 ,P ＜ 0. 05); the early exercise tolerance was longer([ 68. 35 ±9. 30 ] mins vs [ 33.48± 5. 18 ] mins,t = 2. 87, P ＜ 0. 05) ;the intravenous infusion time was shorter ([ 10. 83 ±1.87 ] d vs [ 13. 30 ± 2. 12 ] d, t = 2. 38, P ＜ 0. 05); the length of postoperative hospital stay was shorter([ 12. 35 ± 2.03 ] d vs [ 16. 48 ± 3. 18 ] d, t = 3.04, P ＜ 0. 05); the less postoperative complications(8.3% vs 37. 5 %, x2 = 5. 005,P ＜ 0. 05); chest pain was relieved([ 3.43 ± 0. 45 ] cm vs. [ 6. 62 ± 0. 62 ] cm, P ＜ 0. 05);the scar healed well. All patients were successfully discharged. Conclusion The perioperative idea of fast track surgery was feasible and effective in the chest trauma with multiple rib fractures patients. FTS can improve the patients long term living quality.     

16层螺旋CT在胸部外伤中的应用(附62例)

目的探讨16层螺旋CT在胸部外伤检查中的应用价值。方法对62例胸部外伤者进行16层螺旋CT检查并作三维和多平面重建,与胸片相比较。结果16层螺旋CT对胸壁骨折(肋骨、锁骨、胸骨、肩胛骨、胸椎等)检出率明显高于平片;确诊和排除了肋骨骨折;对胸部并发症(血气胸、肺挫伤、纵隔损伤、皮下气肿等)检出率较平片明显提高,并对损伤作定位、定性;同时发现了其他损伤(肝脾挫伤、腰椎和附件骨折等)。结论16层螺旋CT对胸部外伤的检查是一种重要的辅助手段。     

Surgical rib fixation for flail chest deformity improves liberation from mechanical ventilation

Purpose

The goal of this study was to determine the impact of surgical rib fixation (SRF) in a treatment protocol for severe blunt chest trauma.

Materials and methods

Patients with flail chest admitted between September 2009 and June 2010 to our level I trauma center who failed traditional management and underwent SRF were matched with an historical group. Outcome variables evaluated include age, injury severity score, intensive care unit length of stay (LOS), hospital LOS, ventilator days, total number of rib fractures, and total number of segmental rib fractures.

Results

The 2 groups were similar in age, injury severity score, intensive care unit LOS, hospital LOS, total number of rib fractures, and total segmental rib fractures. The operative group demonstrated a significant reduction in total ventilator days as compared with the nonsurgical group (4.5 [0-30] vs 16.0 [4-40]; P = .040). Patients with SRF were permanently liberated from the ventilator within a median of 1.5 days (0-8 days).

Conclusions

Surgical rib fixation resulted in a significant decrease in ventilator days and may represent a novel approach to decreasing morbidity in flail chest patients when used as a rescue therapy in patients with declining pulmonary status. Larger studies are required to further identify these benefits.     

肋骨内固定术治疗创伤性连枷胸

目的 比较肋骨内固定术和外固定胸廓治疗创伤性连枷胸的临床疗效.方法 回顾性分析2006年1月至2009年6月收治的86例以创伤性连枷胸为主的多发伤病例的临床资料,分为内固定组和外固定组.内固定组45例,采用镍钛记忆合金环抱式接骨器内固定肋骨骨折;外固定组41例,采用外固定胸廓非手术保守治疗.比较2组的临床疗效.结果 内固定组患者胸壁畸形均消失,而外固定组中有19例患者遗留胸壁畸形.内固定组患者平均住院时间、平均住ICU时间和平均机械通气时间均短于外固定组[(15.1±1.8)d与(22.9±2.8)d,t=-15.724;(5.7±1.5)d与(14.4±2.9)d,t=-17.711;(3.9±1.5)d与(11.6 ±2.3)d,t=-17.256;P均＜0.01],内固定组患者呼吸系统并发症[包括肺部炎症或(和)肺不张或(和)呼吸功能衰竭]的发生率低于外固定组(35.6%与70.7%,x2=10.641,P＜0.01).出院3个月后,内固定组患者肺功能指标包括肺总量、用力肺活量、1秒钟用力呼气容积、呼气峰流量、75%肺活量最大呼气流量均高于外固定组[(89.5±3.1)%与(79.1±5.1)%,t=11.705;(80.2±2.8)%与(69.8±3.8)%,t=14.241;(74.8±4.4)%与(71.9±3.6)%,t=3.201;(82.8±4.4)%与(79.8±4.9)%,t=2.885;(68.2±2.2)%与(61.9±2.9)%,t=11.286;P均＜0.01].结论 肋骨内固定手术治疗创伤性连枷胸,可以迅速纠正畸形,稳定胸廓,消除反常呼吸,治疗过程顺利,缩短重症监护及住院时间,减少并发症,还可以减轻连枷胸对患者远期肺功能的影响.采用镍钛记忆合金环抱式接骨器内固定肋骨,手术简单、方便,疗效确切.

Abstract：

Objective To compare the effects of rib internal fixation and thoracic external fixation in treatment of traumatic flail chest. Methods Eighty six cases of traumatic flail chest with multiple injuries,admitted to hospital from January 2006 to June 2009 ,were recruited into the study and divided into rib internal fixation and thoracic external fixation groups randomly. The clinical data were analyzed retrospectively. Rib internal fixations with Ti-Ni shape memory alloy embracing connector were performed in internal-fixation group(n = 45) and thoracic external fixations were performed in external-fixation group(n = 41). The outcomes were compared between the two groups. Results No patient in internal-fixation group developed chest wall deformity,while 19 patients in external-fixation group had chest wall deformity left. The mean times of hospital stay([ 15. 1 ± 1.8]d vs [22. 9 ±2. 8]d,t = - 15. 724,P ＜0. 01) ,ICU stay([5.7 ± 1.5]d vs [ 14. 4 ±2. 9]d,t =- 17.711, P ＜ 0. 01), and mechanical ventilation([ 3.9 ± 1.5 ] d vs [ 1 1.6 ± 2. 3 ] d, t = - 17. 256, P ＜ 0. 01),in internal-fixation group were significantly shorter than those in external-fixation group. The occurrence rate of respiratory complications (including pulmonary inflammation and (or) atelectasis and (or) respiratory failure)in internal-fixation group was significantly lower than those in external-fixation group(35.6% vs. 70. 7% ,x2 =10.641,P ＜ 0.01). Followed-up data of three months after discharge showed that the pulmonary function parameters, such as total lung capacity([ 89. 5 ± 3. 1 ] % vs. [ 79. 1 ± 5. 1 ] %, t = 11. 705, P ＜ 0. 01), forced vital capacity([ 80. 2 ± 2. 8 ] % vs. [ 69. 8 ± 3. 8 ] % ,t = 14. 241 ,P ＜0. 01) ,forced expiratory volume in the 1st second ([74.8 ±4.4]% vs. [71.9 ±3.6]% ,t =3.201,P ＜0.01),peak expiratory flow ([82.8 ±4.4]%vs. [79. 8 ±4. 9]% ,t =2. 885,P ＜0. 01) and forced expiratory flows at 75% of the vital capacity( [68.2 ±2. 2] % vs. [61.9 ± 2. 9 ]%, t = 11. 286; P ＜ 0. 01) were significantly higher in internal-fixation group than those in external-fixation group. Conclusion Rib internal fixation for traumatic flail chest can quickly correct chest wall deformity, stabilize thoracis and eliminate paradoxical chest wall movement. Patients accepted this treatment have a shorter therapy process during the intensive care unit and hospital stay, less pulmonary complications. They also show less long-term restrictive pulmonary functions impairment, when compared to the patients in the thoracic external fixation group. Rib internal fixation with Ti-Ni shape memory alloy embracing connector is a simple and effective therapy.     

Delayed pneumothorax complicating minor rib fracture after chest trauma

Objective

Pneumothorax (PTX) after trauma is a preventable cause of death. Drainage procedures such as chest tube insertion have been traditionally advocated to prevent fatal tension PTX. We evaluated the safety of close observation in patients with delayed PTX complicating rib fracture after minor chest trauma.

Materials and Methods

Adult patients (>18 years) with a diagnosis of chest trauma and 3 or fewer fractured ribs were reviewed. Case patients were divided according to age, location and number of fractured ribs, mechanism of trauma, and initial pulmonary complication after thoracic trauma for comparative analysis.

Results

There were 207 male (70.2%) and 88 female (29.8%) patients whose ages ranged from 18 to 93 years (median, 55 years). The mechanisms of trauma were a motor vehicle accident in 207 patients, falls in 66, pedestrian injury in 10, and assaults in 14. Ninety-five patients sustained 1 rib fracture, 95 had 2 rib fractures, and 105 suffered 3 rib fractures. Right-sided injury occurred in 164 cases, left-sided injury did in 127, and bilateral injury did in 4. The most frequent location of rib fractures was from the fourth rib to the ninth rib. The initial pulmonary complications after trauma were PTX in 16 patients, hemothorax in 43, pneumohemothorax in 14, lung contusion in 75, and isolated subcutaneous emphysema (SubcEmph) in 33. Thirty percent of the patients (n = 5/16) who presented with traumatic PTX were observed safely without drainage. Delayed PTX was recorded in 16 patients, occurring mostly during the first 2 days of their admission. Associated extrathoracic injury was recorded in 189 patients. The mean hospital stay of the patients was 7.66 days. Longer hospital stay was related to increasing number of fractured ribs, need for thoracic drainage, and the presence of associated extrathoracic injury. The mortality rate for the entire group was 2%. The presence of SubcEmph was the only risk factor associated with the development of delayed PTX.

Conclusions

Patients sustaining blunt chest trauma and minor rib fractures should be admitted for close observation when presenting with SubcEmph because of possible delayed presentation of PTX.     

胸外伤肋骨骨折内固定术治疗的适应证及疗效评价

目的探讨胸外伤肋骨骨折施行内固定手术的适应证并评估其疗效。方法总结我科2009—2011年因胸外伤肋骨骨折行内固定术治疗27例病人的适应证并分析其疗效。结果内固定术适应证：①严重肋骨骨折并发内脏损伤;②胸部严重变形,胸壁软化,出现连枷胸;③骨折端错位明显;④肋骨骨折保守治疗无法缓解疼痛,并且伴有血气胸;⑤病人无严重其他疾病,耐受手术。本组病人全部康复出院,无死亡及严重术后并发症发生。随访所有病人生活均能自理,部分病人恢复正常工作。结论严重胸外伤肋骨骨折选择适当的适应证行内固定术治疗是可行的。     

单孔胸腔镜手术治疗早期肺癌临床研究

目的对比单孔胸腔镜与传统三孔胸腔镜手术治疗早期肺癌的临床效果及安全性。方法回顾性分析2017年7月至2019年3月南京医科大学第一附属医院胸外科收治的早期肺癌患者114例的临床资料,其中46例行单孔胸腔镜手术(单孔组),68例行传统三孔胸腔镜手术(三孔组),比较两组在手术时间、术中出血、术中止血时间、淋巴结清扫数目、术后留置胸管时间、胸腔总引流量、术后住院时间、肺部并发症、术后疼痛程度及感觉异常等指标上的异同。结果单孔组的手术时间、止血时间、术后带管时间、胸腔总引流量、术后住院时间、术后1个月视觉模拟评分(VAS)及感觉异常率均显著优于三孔组(P <0. 05,P <0. 01),而两组术中出血、淋巴结清扫数目、术后肺部并发症、术后心律失常及术后第1天、拔管后、出院时VAS评分比较,差异无统计学意义(P均> 0. 05)。结论单孔胸腔镜手术治疗早期肺癌具有良好的临床效果及安全性,较三孔胸腔镜具有更大的优势。     

肋骨环抱器内固定治疗多发性肋骨骨折的疗效分析

目的探讨肋骨环抱器在多发性肋骨骨折中的应用效果。方法多发性肋骨骨折84例患者随机分为治疗组(40例)和对照组(44例),治疗组实施肋骨环抱器内固定治疗,对照组实施非手术治疗,比较两组患者的疼痛时间、住院时间、住院费用,肺部感染、肺不张、胸廓畸形发生率,胸廓完整性。结果在疼痛时间、住院时间、并发症,胸廓完整性等方面比较,治疗组均显著优于对照组(P<0.05)。结论肋骨环抱器治疗多发性肋骨骨折效果显著,可有效缓解疼痛、缩短住院时间,降低并发症发生率,有效恢复胸廓完整性。