创伤性连枷胸62例救治分析

目的 探讨创伤性连枷胸的治疗方法和效果.方法 回顾性分析我院2002年10月2006年9月收治的62例创伤性连枷胸的临床资料.结果 治愈53例(85.5%),随访肺功能无明显减退;死亡9例(14.5%).肋骨悬吊牵引12例(双侧6例),肋骨内固定8例,呼吸机治疗12例.合并肺不张23例,气管切开15例,纤维支气管镜治疗18例.结论 创伤性连枷胸应采取综合治疗措施.除积极治疗肺挫伤外,对严重的浮动胸壁应行牵引固定或内固定.呼吸机的使用指征主要是胸壁固定不能纠正的严重低氧血症和ARDS先兆.早期气管切开能提高生成率.

Treatment of traumatic flail chest in 62 cases

Objective To evaluate the therapy of traumatic flail chest and its effects.Methods The clinical data of 62 cases with flail chest in our hospital from Oct.2002 to Sep.2006 were studied retrospectively. Results Fifty-three cases were cured(85.5%), there was not obvious pulmonary dysfunction during the followed-up, 9 cases died(14.5%). Suspended traction of ribs were performed in 12 cases, internal fixation of ribs in 8 cases, 12 cases were treated with respirator. Pulmonary atelectasis was found in 23 cases. 15 cases underwent tracheotomy, and fibroptic bronchoscopy for diagnosis and treatment were performed in 18 cases. Conclusion Integrative therapy should be taken for traumatic flail chest. Beside treatment of pulmonary contusion, traction or internal fixation of ribs for severe floating chest is necessary. The main indication of respirator is severe hypoxemia uncorrected by fixed chest and foreboding of ARDS. Early tracheotomy contributes a lot to a higher survival rate.