大面积烧伤患者气管切开原因及时机分析

Large area burn patients with tracheostomy causes and time analysis

目的分析探究大面积烧伤患者气管切开原因与时机。方法选取本院收治的302例大面积烧伤且行气管切开术患者,111例患者有头部颈部烧伤,行气管切开术,76例有大面积烧伤并吸入性损伤,行气管切开术,87例安静状态下呼吸频率大于30/min,经皮血氧饱和度小于90%,行气管切开术,28例出现急性呼吸窘迫综合征(ARDS),行气管切开术。结果 59例大面积烧伤伴有头部颈部烧伤者行气管切开术后有4例因多器官功能障碍(MODS)死亡,占1.32%;128例面积烧伤并吸入性损伤患者行气管切开术后5例因多器官功能障碍综合征死亡,5例因脓毒血症死亡,占3.31%;87例客观呼吸梗阻者行气管切开术后有3例因窒息死亡,3例因多器官功能障碍死亡,占1.99%;28例急性呼吸窘迫综合征行气管切开术后1例因窒息死亡,占0.33%。302例大面积烧伤患者有21例死亡,占6.95%。结论大面积烧伤者多数因呼吸梗阻行气管切开术,吸入性损伤程度是决定大面积烧伤患者行气管切开术时间的关键因素,大面积烧伤者,尤其是头部颈部烧伤者未行气管切开术的,在受伤24h应严密观察,如有客观呼吸梗阻现象,应立即行气管切开术。

Objective To analyze and explore large area burn patients with tracheotomy reason and time. Methods In 302 patients, 111 patients had head neck burn for tracheal surgical operation, 76 cases had large area burn injury and aspiration for tracheal surgical operation, 87 patients （quiet condition breathing rate more than thirty times/min, the skin blood oxygen saturation was less than 90%） for tracheotomy operation, and 28 cases with ARDS for tracheal sur- gical operation. Results Fifty nine patients with large area burn head neck burn survivors intake pipe surgical opera- tion after 4 cases had been multiple organ dysfunction （MODS） kill, accounted for 1.32%; Area of 128 cases of burn and aspiration injury patients after tracheotomy in 5 patients had because of multiple organ dysfunction syndrome death, 5 cases had for sepsis death, accounting for 3.31%; 87 cases of objective respiratory obstruction after tracheoto- my on the 3 cases had suffocated, 3 cases had for multiple organ dysfunction death, accounting for 1.99%; And 28 cases of acute respiratory distress syndrome after tracheotomy in 1 case had suffocation death, accounting for 0.33%. In 302 patients, 21 cases died, accounting for 6.95%. Conclusion Most large area burn survivors for respiratory ob- strnction line tracheotomy, aspiration damage degree is decided to large area burn patients tracheotomy time key fac- tors, large area burn survivors, especially the head neck not burn survivors do tracheotomy, 24 h in injury should be close observation, such as an objective respiratory obstruction phenomenon, it should immediately do tracheotomy.