摘要
目的探讨胸腔镜辅助肋骨骨折内固定手术时机对术后呼吸衰竭的影响。方法回顾性分析2008年10月—2017年6月我院收治的221例多发肋骨骨折患者的临床资料。根据患者伤后进行手术的时间分为A组82例、B组74例和C组65例,A组伤后<72 h进行手术,B组伤后72～120 h进行手术,C组伤后≥120 h进行手术。观察3组术后呼吸衰竭发生率的差异,并分析术后发生呼吸衰竭的相关影响因素。结果 A组术后呼吸衰竭的发生率高于B组和C组(P <0. 01),B组和C组比较差异无统计学意义(P> 0. 05)。年龄、手术时间、肋骨骨折根数、胸部简略创伤量表评分、损伤严重程度评分、手术时机、肺挫伤简易评分为多发肋骨骨折患者术后发生呼吸衰竭的独立影响因素(P <0. 05)。结论受伤72 h后手术可显著降低肋骨骨折内固定术后呼吸衰竭的发生率,手术时机是术后发生呼吸衰竭的独立影响因素。
Objective To investigate time of thoracoscope-assisted internal fixation surgery for patients with rib fracture and effect on postoperative respiratory failure. Methods Clinical data of 221 patients with multiple rib fractures admitted during October 2008 and June 2017 was retrospectively analyzed,and the patients were divided into group A( n = 82),group B( n = 74) and group C( n = 65) according to operative times. Group A underwent operation within 72 h after injury,and group B underwent operation in 72-120 h after injury,while group C underwent operation in or more than 120 h after injury. Among three groups,differences of incidence rate of respiratory failure were observed,and related factors affecting postoperative pathogenesy of respiratory failure were analyzed. Results Incidence rate of postoperative respiratory failure in group A was significantly higher than those in group B and C( P < 0. 01),but there was no significant difference in the rate between group B and C( P > 0. 05). Age,operative duration,number of rib fractures,thoracic abbreviated injury scale( AIS) score,injury severity scale( ISS) score,operation time and pulmonary contusion simple score were independent factors affecting postoperative respiratory failure in patients with multiple rib fractures( P < 0. 05). Conclusion Incidence rate of postoperative respiratory failure may be significantly reduced in 72 h after injury in patients with rib fracture after internal fixation,and operative time is an independent risk factor for postoperative respiratory failure.
引文
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