重症监护室多发肋骨骨折患者胸腔镜内固定治疗时机分析

Analysis of thoracoscopic internal fixation in patients with multiple rib fractures in ICU

摘要:

目的 分析不同手术时机胸腔镜内固定对重症监护室（ICU）多发肋骨骨折（MRF）患者机体免疫因子、炎症因子、氧化应激因子、并发症以及骨折愈合的影响，评估不同手术时机的利弊。方法 回顾性分析2017年12月－2021年2月该院105例行胸腔镜内固定治疗的MRF患者的临床资料，据手术时机不同分为观察组（发病72 h内进行手术）和对照组（发病≥72 h进行手术），对比两组患者手术指标和术后短期恢复情况，记录术后7 d相关损伤指标、免疫因子、炎症因子和氧化应激因子水平，记录并发症发生率和术后3个月骨折愈合情况。结果 与对照组比较，观察组下床时间和拔管时间更早，疼痛时间和住院时间更短，术后合并伤程度评分更高，损伤严重程度评分（ISS）更低，差异均有统计学意义（P < 0.05）；术后7 d，两组患者CD4⁺、CD3⁺和CD4⁺/CD8⁺升高，且观察组高于对照组，两组患者CD8⁺降低，且观察组低于对照组，差异均有统计学意义（P < 0.05）；术后7 d，两组患者白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、超敏C反应蛋白（hs-CRP）、晚期氧化蛋白产物（AOPP）和丙二醛（MDA）降低，且观察组低于对照组，差异均有统计学意义（P < 0.05）；观察组并发症总发生率（3.64%）低于对照组（28.00%），差异有统计学意义（P < 0.05）；术后3个月观察组愈合率（87.27%）高于对照组（68.00%），差异有统计学意义（P < 0.05）。结论 与发病72 h后行胸腔镜内固定术比较，更早治疗能使ICU中的MRF患者术后恢复更快，能更快缓解机体应激、疼痛和炎症反应，减少胸肺损伤，解除免疫抑制，降低并发症发生率。

Abstract:

Objective To analyze the effects of thoracoscopic internal fixation in intensive care unit (ICU) patients with multiple rib fractures (MRF) at different surgical timings on the patient’s immunity, inflammatory factors, oxidative stress indicators, complications, and fracture healing, and to evaluate the pros and cons of different surgical timings.Methods The clinical data of 105 patients with MRF who underwent thoracoscopic internal fixation from December 2017 to February 2021 were retrospectively analyzed. According to the timing of the operation, they were divided into observation group (operation less than 72 h after onset) and control group (onset ≥ 72 h for surgery), the surgical indicators, short-term postoperative recovery were compared, and recorded related injury indicators [abbreviated injury scale (AIS), lung contusion score,combined injury score, injury severity score (ISS)], immune indicators, inflammatory factors, oxidative stress factors on the 7th day after surgery, complications, and fracture healing 3 months after surgery.Results Compared with the control group, the observation group had earlier time to get out of bed and extubation time, shorter pain time and hospitalization time, the postoperative combined injury score was higher, and the ISS was lower, the differences were statistically significant (P < 0.05); 7 days after surgery, CD4⁺, CD3⁺ and CD4⁺/CD8⁺ were increased in two groups, and observation group was higher than control group, CD8⁺ was decreased in two groups, and observation group was lower than control group, the differences were statistically significant (P < 0.05). Interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), high sensitive C-reactive protein (hs-CRP), advanced oxidative protein products (AOPP), and malondialdehyde (MDA) were all decreased in the two groups on the 7th day after operation, and the observation group were lower than those in the control group, the difference was statistically significant (P < 0.05). The total incidence of complications (3.64%) in the observation group was lower than that in the control group (28.00%), the difference was statistically significant (P < 0.05). The healing rate in the observation group (87.27%) was higher than that in the control group after 3 months (68.00%), the difference was statistically significant (P < 0.05).Conclusion Compared with advanced thoracoscopic internal fixation, early treatment can benefit ICU patients with MRF more. The main manifestation can be faster recovery after surgery, faster relief of body stress, pain, inflammatory reaction, chest and lung injury, and relief immunosuppression, and reduce the incidence of complications.