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多发肋骨骨折内固定手术时机选择对患者恢复的影响

Effect of timing selection of internal fixation on recovery of patients with multiple rib fractures

    摘要
  • 摘要:
      目的  观察多发肋骨骨折内固定术手术时机选择对患者恢复的影响效果。
      方法  回顾性分析174例多发肋骨骨折患者的临床资料，根据行内固定术手术时间的不同将患者分为观察组（受伤72 h内行内固定术）91例和对照组（受伤72 h及以上行内固定术）83例。比较2组患者手术一般情况、视觉模拟评分法（VAS）评分、血清疼痛因子水平、血气分析指标水平和并发症发生情况。
      结果  2组患者手术时间、术中出血量差异无统计学意义（P>0.05），但观察组术后呼吸机使用时间、住院时间短于对照组，差异有统计学意义（P < 0.05）。术后，2组VAS评分、动脉血二氧化碳分压水平低于术前，动脉血氧分压水平高于术前，且观察组变化幅度大于对照组，差异均有统计学意义（P < 0.05）。术后，2组血清致痛物质、5-羟色胺及去甲肾上腺素水平均低于术前，且观察组低于对照组，差异有统计学意义（P < 0.05）。观察组并发症总发生率为3.30%，低于对照组的13.25%，差异有统计学意义（P < 0.05）。
      结论  相较于72 h及以上行内固定术，多发肋骨骨折患者受伤72 h内行内固定术可有效缩短呼吸机使用时间与住院时间，缓解疼痛，改善血气分析指标，并降低血清致痛物质水平与并发症发生率。

     

    Abstract:
      Objective  To observe the effect of timing selection of internal fixation on recovery of patients with multiple rib fractures.
      Methods  The clinical data of 174 patients with multiple rib fractures who were treated in our hospital was retrospectively analyzed. Patients were divided into two groups according to different operation time of internal fixation. A total of 91 patients who underwent internal fixation within 72 hours of injury were selected as observation group, and 83 patients who underwent internal fixation after 72 hours of injury were selected as control group. The general operation conditions, Visual Analogue Scale (VAS) score, serum pain factor level, blood gas analysis index level and incidence of complications were compared.
      Results  There were no significant differences in operation time and intraoperative blood loss between the two groups (P>0.05), but the postoperative ventilator use time and hospital stay in the observation group were shorter than those in the control group (P < 0.05). After operation, the VAS score and carbon dioxide partial pressure of the two groups decreased significantly, but the decrease degree was greater in the observation group (P < 0.05). After the operation, the blood oxygen partial pressure of the two groups increased significantly, but the observation group increased more significantly (P < 0.05). After the operation, the serum pain-causing substances, serotonin and norepinephrine levels of the two groups were significantly lower than treatment before, but the observation group decreased more significantly (P < 0.05). The total incidence of complications in the observation group was 3.30%, which was significantly lower than 13.25% in the control group (P < 0.05).
      Conclusion  Internal fixation within 72 hours after injury in patients with multiple rib fractures can effectively shorten the use time of ventilator and hospitalization time, relieve pain, improve blood gas analysis indexes, reduce the level of pain causing substances in serum, and reduce the incidence of complications compared with internal fixation more than 72 hours after injury.

     

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