Pettiford Brian L, Luketich James D, Landreneau Rodney J
Heart, Lung and Esophlageal Surgery Institute, University of Pittsburgh Medical Center, Shadyside Medical Center, Pittsburgh, PA 15232, USA.
Thorac Surg Clin. 2007 Feb;17(1):25-33. doi: 10.1016/j.thorsurg.2007.02.005.
Flail chest is an uncommon consequence of blunt trauma. It usually occurs in the setting of a high-speed motor vehicle crash and can carry a high morbidity and mortality. The outcome of flail chest injury is a function of associated injuries. Isolated flail chest may be successfully managed with aggressive pulmonary toilet including facemask oxygen, CPAP, and chest physiotherapy. Adequate analgesia is of paramount importance in patient recovery and may contribute to the return of normal respiratory mechanics. Early intubation and mechanical ventilation is paramount in patients with refractory respiratory failure or other serious traumatic injuries. Prolonged mechanical ventilation is associated with the development of pneumonia and a poor outcome. Tracheotomy and frequent flexible bronchoscopy should be considered to provide effective pulmonary toilet. Surgical stabilization is associated with a faster ventilator wean, shorter ICU time, less hospital cost, and recovery of pulmonary function in a select group of patients with flail chest. Open fixation is appropriate in patients who are unable to be weaned from the ventilator secondary to the mechanics of flail chest. Persistent pain, severe chest wall instability, and a progressive decline in pulmonary function testing in a patient with flail chest are also indications for surgical stabilization. Open fixation is also indicated for flail chest when thoracotomy is performed for other concomitant injuries. There is no role for surgical stabilization for patients with severe pulmonary contusion. The underlying lung injury and respiratory failure preclude early ventilator weaning. Supportive therapy and pneumatic stabilization is the recommended approach for this patient subset.
连枷胸是钝性创伤的一种不常见后果。它通常发生在高速机动车碰撞的情况下，并且可能伴有高发病率和死亡率。连枷胸损伤的结果取决于相关损伤。孤立性连枷胸可通过积极的肺部清洁治疗成功处理，包括面罩给氧、持续气道正压通气（CPAP）和胸部物理治疗。充分镇痛对患者康复至关重要，可能有助于恢复正常呼吸力学。对于难治性呼吸衰竭或其他严重创伤性损伤的患者，早期插管和机械通气至关重要。长时间机械通气与肺炎的发生及不良预后相关。应考虑行气管切开术和频繁的可弯曲支气管镜检查以提供有效的肺部清洁治疗。手术固定与部分连枷胸患者更快撤机、缩短重症监护病房（ICU）时间、降低住院费用及肺功能恢复相关。对于因连枷胸力学因素导致无法撤机的患者，开放固定是合适的。连枷胸患者持续疼痛、严重胸壁不稳定以及肺功能测试逐渐下降也是手术固定的指征。当因其他合并伤行开胸手术时，连枷胸也需行开放固定。对于严重肺挫伤患者，手术固定无作用。潜在的肺损伤和呼吸衰竭妨碍早期撤机。支持治疗和气动固定是针对这类患者亚组的推荐方法。
