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目的总结分析对严重多发伤连枷胸患者实施急诊肋骨内固定术的优势和局限性。方法收集我科2013年1月~2014年12月严重多发伤合并连枷胸患者的临床资料,根据是否有急诊剖胸探查手术指征,将患者分为手术组与非手术组,手术组患者在实施剖胸探查术同时行肋骨内固定术。比较两组患者损伤严重度(ISS)评分、入院24小时输血量、呼吸机治疗时间、ICU住院时间、肺部感染发生率及死亡率等。结果共47例患者纳入本研究,有急诊开胸探查手术指征的患者11例,与非手术组比较,手术组患者ISS评分、24小时输血量明显高于非手术组,而呼吸机治疗时间及ICU监护时间小于非手术组,差异具有统计学意义(P<0.05),两组患者肺部感染发生率以及死亡率比较差异无统计学意义(P>0.05)。结论对合并连枷胸的严重多发伤患者,实施急诊肋骨内固定术,可以减少患者呼吸机治疗时间及ICU住院时间,在治疗过程中可酌情实施。
Objective To summarize and analyze the advantages and limitations of emergency rib internal fixation in patients with severe multiple traumatic flail chest. Methods The clinical data of patients with severe multiple injuries and flail chest from January 2013 to December 2014 in our department were collected. According to whether there was an emergency thoracotomy, the patients were divided into operation group and non-operation group. Patients in operation group Thoracotomy exploration while performing rib internal fixation. The severity of injury (ISS) score, blood transfusion volume 24 hours after admission, ventilator treatment time, ICU hospital stay, incidence of lung infection and mortality were compared between the two groups. Results A total of 47 patients were enrolled in this study. There were 11 patients with emergency thoracotomy for surgical indications. Compared with the non-surgical group, the ISS score and 24-hour blood transfusion volume in the operation group were significantly higher than those in the non-operation group. The ventilator treatment time (P <0.05). There was no significant difference in the incidence of pulmonary infection and mortality between the two groups (P> 0.05). Conclusions For patients with severe multiple traumatic injuries complicated with flail chest, the implementation of emergency rib internal fixation can reduce the duration of ventilator treatment and ICU stay in hospital and be implemented as appropriate during the treatment.