摘要
连枷胸主要通过胸内压与胸骨旁肌力的失衡产生矛盾运动,浮动胸壁出现的呼吸窘迫与低氧血症主要是因肺挫裂伤所致的肺实质损害,并非来自反常呼吸。连枷胸是一种多见的胸部钝性伤,常合并肺实质的损伤,易引起急性呼吸窘迫综合征(ARDS)及呼吸衰竭。本文深入地分析连枷胸的病理生理最新进展,结合当前的研究现状重点对连枷胸和肺挫伤的内固定和机械通气的适应证及硬膜外麻醉镇痛等进行综述。良好的镇痛、软化胸壁良好的固定、呼吸机辅助是治疗连枷胸和肺挫伤的关键。
The paradoxical movement of flail chest is set by the imbalance between forces related to pleural pressure and that generated by parasternal intercostal muscle. The respiratory distress and hypoxemia are not induced by flail status,but by the underlying lung parenchymal lesions,and contusion is viewed as the primary pathophysiologic problem. Flail chest is an uncommon consequence of blunt trauma. It is most often accompanied by a significant underlying pulmonary parenchymal injury and can be a life-threatening thoracic injury. It is easy to induce acute respiratory distress syndrome （ ARDS ） and respiratory failure. The purpose of this article was to analyze and discuss the latest progresses in the pathophysiology and treatment of flail chest. The indications and contraindications of operative fixation, mechanical ventilation and pain relief with epidural analgesia were summarized. Strategies of easing pain, favourable fixation of flail chest and assistant treatment of mechanical ventilation are also key measures for treating traumatic flail chest and pulmonary contusion.
出处
《创伤外科杂志》
2009年第3期193-195,共3页
Journal of Traumatic Surgery
关键词
胸部损伤
连枷胸
肺挫伤
机械通气
thoracic trauma
flail chest
pulmonary contusion
mechanical ventilation
