Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Interfaculty Bioinformatics Unit and SIB Swiss Institute of Bioinformatics, University of Bern, Bern, Switzerland.
Interact Cardiovasc Thorac Surg. 2022 May 2;34(5):768-774. doi: 10.1093/icvts/ivac023.
Blunt chest trauma after mechanical resuscitation manoeuvres appears to have a significant impact on the often complicated course. Due to a lack of data in the literature, the purpose of this study was to investigate the feasibility and immediate outcome of chest wall stabilization for flail chest in this vulnerable patient population.
We retrospectively reviewed the medical records of patients after cardiopulmonary resuscitation between January 2014 and December 2018 who were diagnosed with flail chest. We attempted to compare patients after surgery with those after conservative treatment.
Of a total of 56 patients with blunt chest trauma after mechanical resuscitation and after coronary angiography, 25 were diagnosed with flail chest. After the exclusion of 2 patients because of an initial decision to palliate, 13 patients after surgical stabilization could be compared with 10 patients after conservative therapy. Although there was no significant difference in the total duration of ventilatory support, there was a significant advantage when the time after stabilization to extubation was compared with the duration of ventilation in the conservative group. The presence of pulmonary contusion, poor Glasgow Coma Scale score or the development of pneumonia negatively affected the outcome, but additional sternal fracture did not.
Surgical stabilization for chest wall instability is well tolerated even by this vulnerable patient population. Our results should be used for further randomized controlled approaches. It is necessary to evaluate the situation with all parameters in an interdisciplinary manner and to decide on a possible surgical therapy at an early stage if possible.
机械复苏后钝性胸部创伤似乎对经常出现的复杂病程有重大影响。由于文献中缺乏数据，本研究旨在调查在这种脆弱的患者人群中，对连枷胸进行胸壁稳定的可行性和即刻结果。
我们回顾性分析了 2014 年 1 月至 2018 年 12 月心肺复苏后诊断为连枷胸的患者的病历。我们试图比较手术治疗和保守治疗的患者。
在总共 56 例因机械复苏后行冠状动脉造影后发生钝性胸部创伤的患者中，25 例被诊断为连枷胸。排除因初始姑息治疗决定而排除的 2 例患者后，可将 13 例手术稳定后的患者与 10 例保守治疗的患者进行比较。虽然通气支持的总持续时间无显著差异，但与保守组的通气持续时间相比，稳定后至拔管的时间有显著优势。肺挫伤、格拉斯哥昏迷评分差或肺炎的发生会对结果产生负面影响，但额外的胸骨骨折没有影响。
即使是这种脆弱的患者群体，手术稳定胸壁不稳定也能很好地耐受。我们的结果应用于进一步的随机对照研究。有必要在多学科的基础上评估所有参数的情况，并在可能的情况下尽早决定是否进行可能的手术治疗。
