连枷胸的机械通气治疗

目的探讨机械通气治疗连枷胸的指征、呼吸机的管理,以及连枷胸、肺挫伤与呼吸功能障碍的关系。方法回顾分析1996年1月-2004年10月我院收治的66例连枷胸患者,将其分为机械通气组和非机械通气组,并对两组的损伤特点和治疗情况进行比较。结果非机械通气治疗38例;机械通气治疗28例,采用同步间歇指令通气(SIMV)+呼吸末正压通气(PEEP)模式,机械通气后PaO2、PaCO2及pH值明显改善,与通气前比较,差异有统计学意义(P<0.01)。全组死亡9例,总体死亡率为14%,其中机械通气组死亡4例(14%),非机械通气组死亡5例(13%),两组死亡率比较,差异无统计学意义(P>0.05)。结论(1)机械通气治疗连枷胸效果可靠,但要有一定的应用指征;(2)机械通气的指征为:低氧血症和(或0高碳酸血症,合并颅脑外伤、严重休克,双侧连枷胸,有气道阻塞或反复肺不张;(3)缩短机械通气时间,防治肺部感染是减少住院时间的关键。

Mechanical ventilation in the treatment of flail chest

Objective To discuss the indication of mechanical ventilation for fail chest, the management of ventilators, and the relationship between flail chest, pulmonary contusion and the respiratory failure. Methods A retrospective analysis was carried out on 66 cases of flail chest treated in our hospital from January 1996 to October 2004 that were divided into ventilatory treatment group (38 cases) and nonventilatory treatment group (28 cases) for comparison between the clinical features and treatment results. Results Posterior to combined mechanical ventilation including intermittent mandatory ventilation (SIMV) and positive end-expiratory pressure (PEEP), PaO_ 2 , PaCO_ 2 and pH were more significantly improved compared with pre-ventilation (P<0.01). Nine cases died with overall mortality of 14%. There were four deaths (14%) in ventilatory treatment group and five (13%) in nonventilatory treatment group, with insignificant difference between both groups (P>0.05). Conclusions (1) Ventilator therapy deserves recommend to treat flail chest, but the indications must be well controlled. (2) The indications for mechanical ventilation include presence of hypoxia and/or hypercapnia (PaO_ 2 <60 mmHg, PaCO_ 2 >55 mmHg), associated severe trauma with unconsciousness and/or shock state, bilateral flail chest and presence of airway obstruction or repeated atelectasis. (3) Shortening the duration of mechanical ventilation and preventing pulmonary infections are key measures to reduce the hospitalization.