烧伤合并吸入性损伤延迟复苏机械通气治疗探讨

Discussion about the therapy of mechanical ventilation for delayed fluid resuscitation incombined burn and inhalation injury

目的研究延迟复苏对烧伤合并吸人性损伤机械通气治疗的影响作用。方法对61例烧伤合并吸人性损伤患者的临床资料进行回颐陛瞬藏分为早期复苏组32例与延迟复苏组29例，对两组患者的机械通气时间、死亡率、并发症进行比较。结果延迟复苏组机械通气时间明显长于早期复苏组，死亡率以及机械通气相关性肺炎发病率均显著高于早期复苏组，两组间机械通气时间、死亡率以及机械通气相关性肺炎发病率的差异均有统计学意义（P〈0．05）。结论延迟复苏会延长烧伤合并吸人性损伤患者机械通气时间，增加死亡率和并发症；及时有效的液体复苏有助于减少并发症，降低烧伤合并吸人性损伤患者的死亡率。

Objective The purpose of the study was to investigate the effect of delayed fluid resuscitation on the therapy of mechanical ventilation in combined burn and inhalation injury. Methods 61 cases which underwent mechanical ventilation after a combination of extensive bums and inhalation damage had taken place were analyzed retrospectively. Patients were classified into one of two study groups according to the fluid resuscitation time, the immediately fluid resuscitation group of 32 （A,IFR）, the delayed fluid resuscitation group of 29 （B,DFR）. Comparison on ventilation time, mortality and complications between two groups was made respectively. Results The average ventilation time, incidence of pneumonia and mortality differed significantly between groups. There was a significant decrease in all overall the mean number of ventilator time, incidence of pneumonia and mortality in immediately fluid resuscitation （A,IFR） group （P 〈0.05）. Conclusion The delayed fluid resuscitation in combined bum and inhalation injury might aggravate the severe degree of damage, increases its incidence of mortality and ventilator-associated pneumonia rate, whereas immediately fluid resuscitation will help to reduce length of mechanical ventilation, reduce mortality and ventilator-associated pneumonia rate in patients who suffer combined burn and inhalation damage.