股骨干骨折扩髓与不扩髓固定对肺气体交换功能的影响

目的 :探讨股骨干骨折髓内钉固定过程中扩髓与不扩髓对肺气体交换功能的影响。方法 :38例股骨干骨折分别采用扩髓和不扩髓交锁钉内固定 ,术中不同时间段进行动脉血气分析 ,计算肺泡死腔分数 (Vd/Vt)、氧合指数(PaO2 /FiO2 )。结果 :扩髓组 ,髓腔扩大后Vd/Vt增加 (p <0 .0 5 ) ;PaO2 /FiO2 降低 (p <0 .0 1) ;不扩髓组 ,插入髓钉后30minVd/Vt增加 ( p <0 .0 5 ) ,PaO2 /FiO2 降低 ( p <0 .0 1) ,髓内钉插入后 6 0min时二者在 2组间均恢复正常 ;扩髓后 2组间Vd/Vt、PaO2 /FiO2 差异具有显著性 ,其它时间段 2组间无差异 ;动脉血气分析 ,各时间段和组间差异无显著性。结论 :扩大髓腔的髓内钉固定 ,并不影响肺气体交换功能 ,股骨干骨折患者血流动力学稳定时 ,能耐受扩髓髓内钉固定手术。

The Influence of Reamed and Unreamed Femoral Intramedullary Nailing on Function of Pulmonary Gas Exchange

Objective:To investigate the influence of reamed and unreamed femoral intramedullary nailing on the function of pulmonary gas exchange.Methods:Thirty-eight cases femoral fractures were prospectively enrolled and fixed with reamed or unreamed intramedullarly nailing respectively.During the operating procedure,the arterial blood gas were measured at four consecutive time point;then the alveolar dead space fraction(Vd/Vt) and oxygenation ratio(PaO 2/FiO 2) were calculated.Results:In the Reamed group,after the canal were reamed,there was an increase of Vd/Vt(p<0.05),and decreases of PaO 2/FiO 2(p<0.01).In the Unreamed group,the increase of Vd/Vt(p<0.05) and decrease of PaO 2/FiO 2(p<0.01) was only found 30 minutes after nailing.They all restored to normal level 60 minutes after the insertion of nail.There was significant difference when the canal were opened(reamed in the Reamed group) between two group.The arterial blood gas had no significant difference between two group at every time point.Conclusions:Reamed femoral intramedullary nailing has no adverse effects on pulmonary gas exchange. If the hemodynamics of patients is stable,they can tolerate the procedure of reamed femoral intramedullary nailing.