Kasai T, Tajimi K, Kobayashi K
Trauma and Critical Care Center, Teikyo University School of Medicine, Tokyo, Japan.
Nihon Geka Gakkai Zasshi. 1990 Oct;91(10):1617-22.
A better understanding in pathophysiology of flail chest has brought an evolution to the principles of it's management. The methods of stabilization changed from surgical to pneumatic measures and now, a concept of conservative treatment is recognized. Adhering to our protocol for flail chest, which essentially limits mechanical ventilation, we have prospectively treated 36 patients since 1981. The patient were divided into two groups according to their need for mechanical ventilation. There were 16 patients (44.4%) in a group treated in conservative manner and with no mechanical ventilation (Group A). There were 20 patients (55.6%) in a group treated by mechanical ventilation (Group B). Group A had 6.2% incidence of pneumonia, 3.6 days average stay in ICU and mortality rate of 0%. Group B had 75% pneumonia, 22.5 days average in ICU and 15% mortality. Group B patients required respiratory support for 14 days average, which was not reduced by surgical stabilization. Restrictive pulmonary disturbance in group A was milder than that of group B, and this again was not affected by surgical stabilization. We conclude that 40% of flail chest are controllable without mechanical ventilation and that the result of this conservative therapy is superior to any other treatments.
对连枷胸病理生理学的更好理解带来了其治疗原则的演变。稳定方法从手术措施转变为气动措施，现在，保守治疗的概念得到了认可。自1981年以来，我们遵循连枷胸治疗方案（该方案本质上限制机械通气），前瞻性地治疗了36例患者。根据患者对机械通气的需求将其分为两组。一组16例患者（44.4%）采用保守方式治疗且未进行机械通气（A组）。另一组20例患者（55.6%）接受机械通气治疗（B组）。A组肺炎发生率为6.2%，在重症监护病房（ICU）的平均住院时间为3.6天，死亡率为0%。B组肺炎发生率为75%，在ICU的平均住院时间为22.5天，死亡率为15%。B组患者平均需要呼吸支持14天，手术固定并未减少这一需求。A组的限制性肺功能障碍比B组轻，而且这同样不受手术固定的影响。我们得出结论，40%的连枷胸患者无需机械通气即可得到控制，并且这种保守治疗的效果优于任何其他治疗方法。
