A 75-year-old woman is evaluated in the emergency department after falling from a barstool while decorating her Christmas tree. Imaging reveals right rib fractures from 1 to 12, with a segment of flail chest, in addition to pulmonary contusion. She is admitted to the ICU for respiratory monitoring.
Which of the following is the best option to improve this patient’s pulmonary status?
A. Epidural analgesia
B. Morphine, as patient-controlled analgesia
C. Surgical fixation of rib fractures
D. Morphine, as needed, and IV acetaminophen
E. Analgesia with intrapleural catheter
答案解析:
肋骨骨折引起的肺挫伤的处理主要涉及肺挫伤的治疗。主要因素是疼痛控制，最好通过硬膜外镇痛、肋间神经阻滞或椎旁阻滞来实现。胸部理疗也是必不可少的。近年来，手术固定在胸部损伤和连枷胸患者中越来越受欢迎，并显示出改善力学、快速摆脱机械通气和快速恢复工作的好处。然而，这些都是小型的单中心观察性研究。在严重的连枷胸无法脱离呼吸机的情况下，可以考虑这种方式。尚未确定将受益于早期预防性骨折固定的患者亚组。
正确答案：A
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