7031Regions Hospital, St. Paul, MN, USA.
J Intensive Care Med. 2023 Apr;38(4):327-339. doi: 10.1177/08850666221148644. Epub 2023 Jan 4.
Rib fractures are present in 15% of all traumas and 60% of patients with chest traumas. Rib fractures are not life-threatening in isolation, but they can be quite painful which leads to splinting and compromise of respiratory function. Splinting limits the ability of a patient to take a deep breath, which leads to atelectasis, atelectasis to poor secretion removal, and poor secretion removal leads to pneumonia. Pneumonia is the common pathway to respiratory failure in patients with rib fractures. It is noted that in the elderly, each rib fracture increases developing pneumonia by 27% and the risk of dying by 19%. From a public health perspective, rib fractures have long-term implications with only 59% of patients returning to work at 6 months. In this review we will examine the state of art as it currently exists with regard to the management of pain associated with rib fractures. Included in this overview will be a brief review of the anatomy of the thorax and some important physiologic concepts, the latest trends in pharmacologic and noninvasive means of managing rib pain, a special section on epidural anesthesia, some other alternative invasive methods of pain control, and a review of the recent literature on rib plating. Finally, a practical, easy to follow guideline, to manage the patient with pain from rib fractures will be presented.
肋骨骨折在所有创伤中的发生率为 15%，在胸部创伤患者中的发生率为 60%。孤立性肋骨骨折不会危及生命，但可能非常疼痛，导致肋骨固定，呼吸功能受限。肋骨固定限制了患者深呼吸的能力，导致肺不张，肺不张导致分泌物清除不良，分泌物清除不良导致肺炎。肺炎是肋骨骨折患者发生呼吸衰竭的常见途径。值得注意的是，在老年人中，每根肋骨骨折使肺炎的发病率增加 27%，死亡率增加 19%。从公共卫生的角度来看，肋骨骨折具有长期影响，只有 59%的患者在 6 个月内恢复工作。在这篇综述中，我们将检查目前关于肋骨骨折相关疼痛管理的最新技术状态。这篇综述将包括对胸部解剖结构和一些重要生理概念的简要回顾、管理肋骨疼痛的最新药物和非侵入性方法趋势、硬膜外麻醉的专门部分、一些其他替代侵入性疼痛控制方法，以及对肋骨板固定的最新文献的回顾。最后，将提出一种实用的、易于遵循的指南，以管理肋骨骨折引起疼痛的患者。
