Cannon Robert M, Smith Jason W, Franklin Glen A, Harbrecht Brian G, Miller Frank B, Richardson J D
Department of Surgery, University of Louisville, Louisville, Kentucky, USA.
Am Surg. 2012 Apr;78(4):398-402.
Flail chest represents a severe injury with mortality historically reported at up to 30 per cent. Although management has changed dramatically over the past several decades, there is a paucity of large recent series. With Institutional Review Board approval, a retrospective review of all patients with flail chest admitted from January 2001 through May 2010 was undertaken. Patient demographics, outcomes, and cause of death were specifically analyzed with univariate and multivariate analysis. There were 164 patients at a median age of 51.4 years. Head injury and pulmonary contusion were present in 67 (40.8%) and 125 (77%), respectively. Pneumonia developed in 72 (43.9%). There were 41 deaths (25%), for which flail chest contributed to 15 (9.1%). Of the patients with flail chest-related death, the majority (n = 10 [66.7%]) died within 48 hours of presentation. There were only five deaths (3.0%) related to flail chest after 48 hours. Multivariate analysis of ventilator dependency revealed requirement for laparotomy (P = 0.019) or tracheostomy (P < 0.0001) and pneumonia (P = 0.0002) as significant. Pneumonia was the most significant independent predictor of overall (P < 0.0001) and intensive care unit length of stay (P < 0.0001). The mortality associated with flail chest has greatly improved; however, the rate of pneumonia remains high. Further efforts at pneumonia prevention are thus warranted.
连枷胸是一种严重损伤，历史报道的死亡率高达30%。尽管在过去几十年中治疗方法发生了巨大变化，但近期缺乏大量相关病例系列报道。经机构审查委员会批准，对2001年1月至2010年5月期间收治的所有连枷胸患者进行了回顾性研究。采用单因素和多因素分析方法，对患者的人口统计学特征、预后及死亡原因进行了具体分析。共有164例患者，中位年龄为51.4岁。分别有67例（40.8%）和125例（77%）存在头部损伤和肺挫伤。72例（43.9%）发生了肺炎。死亡41例（25%），其中连枷胸导致15例（9.1%）死亡。在因连枷胸相关死亡的患者中，大多数（n = 10 [66.7%]）在就诊后48小时内死亡。48小时后仅有5例（3.0%）与连枷胸相关的死亡。多因素分析显示，呼吸机依赖与剖腹手术（P = 0.019）或气管切开术（P < 0.0001）以及肺炎（P = 0.0002）显著相关。肺炎是总体住院时间（P < 0.0001）和重症监护病房住院时间（P < 0.0001）的最显著独立预测因素。与连枷胸相关的死亡率已大幅改善；然而，肺炎发生率仍然很高。因此，有必要进一步努力预防肺炎。
