气管切开术在严重烧伤患者中的应用体会

Application of tracheotomy in severe burned patients

目的探讨颜面部烧伤合并吸人性损伤患者行气管切开术的适应证、手术时机和相关注意事项。方法对178例颜面部烧伤患者合并吸人性损伤行气管切开术的患者作回顾性总结。结果178例患者均于伤后0．5—49h内行气管切开术。重度吸人性损伤的病死率（38．2％）明显高于轻（8．3％）、中度（8．0％）组。早期开放气道可预防突发急性喉头水肿窒息，而且有利于气道分泌物的排出。结论对于颜面部烧伤合并吸人性损伤的患者，尽早行气管切开术，可防止呼吸道梗阻，减少并发症，降低死亡率。

Objective To explore the indications, timing and special concerns of tracheotomy in the treatment of head burn with inhalation injury. Methods A total of 178 patients with head burn and inhalation injury underwent tracheotomies. Results Tracheotomy was performed in all the 178 patients within 0.5 -49 h. The mortality of severe inhalation injury（38.2% ）was significantly higher than that of mild （ 8.3% ） and moderate（ 8.0% ） groups. Our study showed that opening the airway could help remove upper airway blockage and discharge the excretion of the air duct, and it was necessary to perform the preventive tracheotomy in the patients with moderate and severe inhalation injury. Conclusion Earlier tracheotomy in burned patients with inhalation injury can reduce the incidence of upper airway obstruction crisis,complications and mortality.