2019 年第 11 期 第 14 卷

加速肺康复措施在肺挫伤合并多发肋骨骨折围术期救治中的应用

Application of accelerated pulmonary rehabilitation measures in perioperative treatment of lung contusion complicated with multiple rib fractures

作者：向敏峰漆奋强韦福旺蒋清柏

英文作者：

单位：545005广西壮族自治区柳州市工人医院心胸外科

英文单位：

关键词：肺挫伤；加速肺康复外科；肋骨骨折；围术期

英文关键词：

• 摘要：

• 【摘要】目的    探讨加速肺康复措施在肺挫伤合并多发肋骨骨折围术期救治中的应用价值。方法    选取2014年1月至2018年12月广西壮族自治区柳州市工人医院收治的肺挫伤合并多发肋骨骨折接受手术治疗的患者92例，应用随机数字表法分为观察组和对照组，各46例。观察组围术期采取规范系统的加速肺康复措施，重点抓术后早期下床活动、吹气球、爬楼梯训练等物理康复措施，对照组按常规模式处理。对比2组术后血气分析、肺功能指标及肺部并发症发生情况、住院天数、住院费用。结果    观察组术后第1天动脉血氧分压及动脉血氧饱和度高于对照组［(80±28) mmHg（1 mmHg=0.133 kPa）比(73±9)mmHg、(96±5)%比(94±4)%］，差异有统计学意义（t=2.472，P=0.046；t=2.468，P=0.043）；pH值及动脉血二氧化碳分压差异无统计学意义（P>0.05）。术后1周观察组呼气峰值流速高于对照组［（4.3±2.0）L/s比（3.9±1.5）L/s］，差异有统计学意义(P<0.05)，2组第1秒用力呼气容积比较差异无统计学意义(P>0.05)。观察组术后肺部感染、肺不张、48 h后机械通气率低于对照组，差异均有统计学意义(均P<0.05)。结论    肺挫伤合并多发肋骨骨折围术期采取规范系统的加速肺康复措施，可改善肺功能，减少肺部并发症，有助于患者的快速康复。

• 【Abstract】Objective    To discuss the value of accelerated pulmonary rehabilitation measures in perioperative treatment of lung contusion complicated with multiple rib fractures. Methods    A total of 92 patients with lung contusion and multiple rib fractures were enrolled from January 2014 to December 2018 in Liuzhou Workers Hospital, Guangxi Zhuang Autonomous Region. They were randomly divided into observation group and control group, with 46 cases in each group. The observation group was treated with standardized and systematic measures to accelerate pulmonary rehabilitation during perioperative period, focusing on physical rehabilitation measures such as early ambulation, blowing balloon and climbing stairs. The control group had routine perioperative treatment. Blood gas, pulmonary function indexes, pulmonary complications, hospital stay time and medical expenses were analyzed. Results    Arterial partial pressure of oxygen and arterial oxygen saturation in observation group were significantly higher than those in control group on the first day after operation［(80±28)mmHg vs (73±9)mmHg, (96±5)% vs (94±4)%］(t=2.472, P=0.046; t=2.468, P=0.043); there were no significant differences in pH value and arterial partial pressure of carbon dioxide between groups(all P>0.05). One week after operation, the peak expiratory flow in observation group was significantly higher than that in control group［（4.3±2.0）L/s vs （3.9±1.5）L/s］(P<0.05); there was no significant difference of forced expiratory volume in 1 second between groups(P>0.05). Incidences of pulmonary infection, atelectasis and mechanical ventilation 48 hours after operation in observation group were significantly lower than those in control group(all P<0.05). Conclusion    Accelerated pulmonary rehabilitation measures can improve pulmonary function, reduce complications and promote recovery in patients with lung contusion and multiple rib fractures.