47例重症连枷胸行肋骨环抱器内固定术的护理.docVIP

47例重症连枷胸行肋骨环抱器内固定术的护理 　　DOI：10.16662/j.cnki.1674-0742.2017.09.144 　　[摘要] 目的 探?47例重症连枷胸经肋骨环抱器内固定治疗的护理体会，总结临床护理经验。 方法 对2012年6月―2016年6月莒县人民医院收治的47例重症连枷胸，做好术前急救准备，术后从维持有效通气，保持呼吸道通畅，加强引流管管理及功能锻炼等护理过程进行回顾性分析总结。结果 该组术后1～2 d拔除胸腔闭式引流，延迟拔管7例，呼吸机通气治疗16例，并发肺部感染1例，死亡2例（复合伤），影像检查45例骨折端均复位满意，治愈出院。结论 加强术前准备，完善术后护理，能有效降低其并发症发生，促进患者康复。 　　[关键词] 连枷胸；环抱器内固定；护理 　　[中图分类号] R47 [文献标识码] A [文章编号] 1674-0742（2017）03（c）-0144-03 　　Nursing of Rib Embracing Fixator in 47 Cases with Serve Traumatic Flail Chest 　　ZHANG Xiu-gui 　　Department of Nursing， Juxian People’s Hospital， Juxian， Shandong Province， 276500 China 　　[Abstract] Objective To study the nursing experience of Rib embracing fixator in 47 cases with serve traumatic flail chest and summarize the clinical nursing experience. Methods 47 cases of patients with serve traumatic flail chest admitted and treated in our hospital from June 2012 to June 2016 were given the preoperative emergency preparation， after operation， the nursing measures of maintaining the effective ventilation， maintaining the airway patency， strengthening the management of drainage tube and functional exercise were retrospectively analyzed and summarized. Results Closed thoracic drainage was removed in 1 to 2d after operation， and there were 7 cases with delayed extubation， 16 cases with ventilative therapy with respiration machine， 1 case with lung infection and 2 cases died （combined injury）， and the image examination showed that the reset of 45 cases was satisfactory， and the patients were cured and discharged. Conclusion We should enhance the preoperative preparation and improve the nursing after nursing， which can effectively reduce the occurrence of complications and promote the recovery of patients. 　　[Key words] Traumatic flail chest； Rib embracing fixator； Nursing 　　连枷胸是胸部创伤中常遇到的重症之一，病情复杂多变，其病死率达12%～50%[1]。它因胸壁大片软化，出现反常呼吸，使两侧胸膜腔的压力失去平衡，纵膈随呼吸来回摆动，加上伴随的肺挫伤和骨折后疼痛导致呼吸效能减低，引起通气功能受损，造成严重的呼吸和循环衰竭。随着科技和诊治手段的进步，特别是近年来开展的各种肋骨骨折内固定技术使连枷胸死亡率降低[2]。但该手术是一项新技术，这对临床护理工