严重烧伤患者救治中呼吸机的使用  

Application of respirator in treating severely burned patients

作　　者：沈洪兴[1] 陈玉林[1] 郇京宁[1] 夏照帆[1] 刘世康[1] 葛绳德[1] 方之扬[1] 

机构地区：[1]第二军医大学长海医院烧伤科

出　　处：《第二军医大学学报》1998年第S1期26-28,共3页Academic Journal of Second Military Medical University

摘　　要：目的：探讨呼吸机使用在救治严重烧伤患者中的重要性，分析烧伤临床使用呼吸机的时机和预警指标。方法：回顾性地调查了我科近４年来收治的所有烧伤患者中年龄１６～６５岁、烧伤总面积＞５０％的６９例病例，比较前、后２年呼吸机使用状况与救治效果的关系，并从不同呼吸道管理病例临床特点中推测使用呼吸机的预警指标。结果：近２年呼吸机使用率明显增高，开始使用呼吸机的时间明显提前，使用时间明显延长，病例存活率显著提高。使用呼吸机的病例中，死亡组患者Ⅲ度烧伤面积、吸入性损伤程度明显高于存活组，辅助呼吸前ＰａＯ２最低值明显低于存活组，呼吸机成功救治了８０％不伴有吸入性损伤的严重烧伤患者。气管切开并使用呼吸机病例的年龄最高、总／Ⅲ度烧伤面积最大、吸入性损伤比例最高、程度最重。使用呼吸机可发生皮下气肿、气道狭窄和血管破裂大出血等并发症。结论：呼吸机在严重烧伤患者救治中发挥着日益重要的作用，吸入性损伤和Ⅲ度烧伤面积是预测呼吸机使用的关键因素，早用早停可最大程度发挥呼吸机救治作用。Objective: This study was undertaken to evaluate the importance of respirator utilization and analyze its timing and forecasting indicators in treating severely burned patients. Methods: Recent 4 years hospitalized patients in our department were retrospectively investigated. In those who were 16～65 years old and TBSA>50%, respirator application and treating effectiveness were compared between the first and the later 2 years. Forecasting indicators of using respirator were inferred from the analysis of the characteristics of the patients requiring different respiratory management. Results: Respirator using was more frequent, earlier and longer in recent 2 years significantly, resulting in higher survival rate. Among those using respirator, the dead cases had larger full-thickness burned area, more severe inhalation injuries and lower pro-ventilation PaO_2 value than the survival cases. 80% of severely burned patients without inhalation injury survived by respiratory support. The total and full-thickness burned area, the morbidity and degree of inhalation injury were highest and most severe in those requiring tracheostomy and mechanical ventilation. However, complications such as subcutaneous emphysema, stenosis and large volume hemorrhage of respiratory tract might be owing to using respirator. Conclusion: Respirator is playing increasingly important therapeutic role in severely burned patients. Full-thickness burned area and the degree of inhalation injury are key factors forecasting respirator application. Early utilization and early weaning of respirator are expected to have more therapeutic significance and lower morbidity of complication.

关 键 词：呼吸机 吸入性损伤 烧伤 

分 类 号：R644.05[医药卫生—外科学]