疼痛评分和动脉血氧分压作为筛选指标在肋骨内固定手术中的应用

目的探讨疼痛评分和动脉血氧分压（PaO2）作为肋骨内固定手术指征筛选指标的可行性。方法回顾性分析2010年9月至2013年2月上海市浦东医院收治48例肋骨骨折患者的临床资料。采用视觉模拟评分法，选取其中3d后疼痛评分≥6分、PaO2〈60mmHg患者共24例作为试验组[男16例，女8例；年龄（49．294-15．73）岁]；另选取3d后疼痛评分≤5分、PaO，≥60mmHg患者共24例作为对照组[男19例，女5例；年龄（48．634-13．49）岁]。两组患者均采用爪形钢板行肋骨内固定术。术后3d、1周观察疼痛评分和PaO2。结果试验组术后3d疼痛评分小于术前[（4．09±0．93）分VS．（8-21±1．18）分，尸〈0．05]，术后1周疼痛评分小于术前[（3,204-0．98）分VS．（8．214±1．18）分，P〈0．05]；对照组术后3d疼痛评分与术前比较差异无统计学意义（P〉0．05），术后l周疼痛评分小于术前（P〉0．05）。试验组术后3dPa02大于术前[（61．004±3．47）mmHgVS．（53．004-3．97）mmHg，P〈0．05]；对照组术后3dPaO：大于术前[（66．714-5．15）mmHgVS．（66．004-5．00）mmHg，P〉0．05]。术后3d试验组发生肺炎4例，对照组2例（X2=0．762，P〉0．05）。术后3d疼痛评分下降值试验组高于对照组[（4．134-1．45）分VS．（0．004±0．42）分，P〈0．05]，术后1周疼痛评分下降值试验组高于对照组[（5．044-1．23）分VS．（0．08±0．28）分，P〈0．05]，术后3dPaO2升高值试验组高于对照组[（7．424-3．59）mmHgVS．（0．214±0．98）mmHg，P〈0．05]。结论将肋骨骨折后3d疼痛评分≥6分、PaO2〈60mmHg作为肋骨内固定手术的筛选指标具有合理性和可行性。

Use of Pain Scale and Arterial Oxygen Partial Pressure as Screening Internal Fixation Indications for Patients withMultiple Rib Fractures

Objective To explore the feasibility to use pain scale and arterial oxygen partial pressure （PaO2）as screening internal fixation indications for patients with multiple rib fractures. Methods Clinical data of 48 patients with multiple rib fractures who were admitted to Shanghai Pudong Hospital from September 2010 to February 2013 were retros- pectively analyzed. Visual analogue scale （VAS） was used for pain assessment. Twenty-four patients whose VAS was greater than or equal to 6 and PaO2 was less than 60 mm Hg 3 days after injury were chosen as the experimental group, including 16 males and 8 females with their age of 49.29± 15.73 years. Another 24 patients whose VAS was less than or equal to 5 and PaO2 was greater than 60 mm Hg 3 days after injury were chosen as the control group, including 19 males and 5 females with their age of 48.63 4±13.49 years. Patients in both groups received rib internal fixation with steel plates. Three days and 1 week after surgery respectively, VAS and PaO2 were compared between the 2 groups. Results In the experimental group, VAS 3 days after surgery was significantly lower than preoperative VAS （4.09±0.93 vs. 8.21 ± 1.18,P 〈 0.05 ）, and VAS 1 week after surgery was significantly lower than preoperative VAS （3.20±0.98 vs. 8.21± 1.18, P 〈 0.05 ）. In the control group, there was no statistical difference between VAS 3 days after surgery and preoperative VAS （P 〉 0.05 ）, and there was no statistical difference between VAS 1 week after surgery and preoperative VAS （P 〉 0.05 ）. Three days after surgery, PaO2 ofthe experimental group was significantly higher than preoperative PaO2 （ 61.00 ~ 3.47 mm Hg vs. 53.00 ± 3.97 mm Hg, P 〈 0.05 ）. There was no statistical difference between PaO2 3 days after surgery and preoperative PaO2 in the control group （66.71 ＋ 5.15 mm Hg vs. 66.00_＋ 5.00 mm Hg, P 〉 0.05 ）. Three days after surgery, pneumonia occurred in 4 patients in the experimental group and 2 patients in the control group （2＇2=0.762 , P 〉 0.05 ）. Three days after surgery, pain scale reduc- tion of the experimental group was significantly higher than that of the control group （4.13 ± 1.45 vs. 0.00 ± 0.42, P 〈 0.05 ）. One week after surgery,pain scale reduction of the experimental group was significantly higher than that of the control group （ 5.04± 1.23 vs. 0.08± 0.28, P 〈 0.05 ）. Three days after surgery, PaO2 increase of the experimental group was significantly higher than that of the control group （7.42 ± 3.59 mm Hg vs. 0.21 _ 0.98 mmHg,P 〈 0.05 ）. Conclusion It＇s reasonable and feasible to use pain scale greater than or equal to 6 and PaO2 less than 60 mm Hg as internal fixation indications for patients with multiple rib fractures.