成批大面积烧伤合并烟雾吸入性肺损伤的救治分析  

Acute Lung Injury after Extensive Burn Merging Smoke Inhalation:Treatment in 32 Cases of Early Stage

作　　者：孙亚楠[1] 刘晓虹[1] 孙树[1] 

机构地区：[1]中国医科大学附属第一医院普通外科烧伤科,沈阳110001

出　　处：《中国医科大学学报》2016年第5期464-466,共3页Journal of China Medical University

基　　金：辽宁省临床能力建设项目(青年)(LNCCC-D01-2015)

摘　　要：目的总结成批大面积烧伤合并烟雾吸入性肺损伤的早期救治经验,为进一步提高临床早期救治成功率提供参考。方法选择2014年11月至12月我科参与救治的因矿井爆炸所致大面积烧伤合并烟雾吸入性肺损伤患者32例,对其早期救治、分流及预后情况(伤后1个月)进行分析。结果 32例患者中,2例在休克期因呼吸衰竭死亡。休克期后(伤后第3日)对患者进行分流,19例就地治疗,11例病情相对稳定者分流至附近医院。1个月后随访结果显示:就地治疗重患死亡2例,其余28例患者伤后1个月内均存活。结论除早期积极抗休克、气管切开、抗感染、创面切痂植皮手术及营养支持外,在抗休克治疗结束后,及时分流伤情允许的患者至有救治条件的附近医院,是此次救治成批大面积烧伤合并烟雾吸入性肺损伤获得成功的关键。Objective To summarize the treatment experience of extensive burn merging smoke inhalation acute lung injury （SIALI） in 32 early stage cases, and to provide a reference for the further improvement of success rate in early stage. Methods A total of 32 cases of extensive burn merging SIALI resulting from mine explosion that received clinical treatment and triage from November to December in 2014 were enrolled for the study. In addition, the experience of triage and prognosis （after injured in a month） to guide therapy was analyzed. Results Two of the 32 patients died from respiratory failure in shock period, after shock period （ 3 days after injured）, 19 bad sufferers were cured in the local hospital, and the oth- er 11 cases in stable condition were triaged to the nearby hospital. 1 month follow-up results showed that： patients who received therapy in local hospi- tal, one died from MODS in 3 weeks, one died from kidney failure in 4 weeks. The other 28 patients were alive. Conclusion For these patients who suffering from extensive bum merging SIALI received therapy in early stage, we should not only schedule positive anti-shock, tracheetomy, antibiot- ics, escharectomy and nutritional support or other treatments, but also face to the challenge of lacking medical resources from too more patients. Thus, we suggest to triage the wounded to nearby hospital after anti-shock treatment, so as to improve the success rate in early stage.

关 键 词：成批烧伤 大面积烧伤 烟雾吸入性急性肺损伤 分流 灾难医学 

分 类 号：R644[医药卫生—外科学]