烧伤合并吸入性损伤行气管切开术的时机和指征

Indications and time of tracheotomy in burn patients with inhalation injury

目的 探讨烧伤合并吸入性损伤后气管切开的时机和指征。 方法 回顾性分析 1 989年 1月～2 0 0 0年 1 2月间 1 74例烧伤合并吸入性损伤患者的临床资料。 结果 全部患者入院后早期接受气管切开治疗。年龄 1 0～70岁 ,烧伤面积 3 %～ 1 0 0 % ,死亡 4 1例 ( 2 3 .6% )。伤后 8小时内气管切开者 1 0 2例 ,9～ 1 6小时 2 7例 ,1 7～ 2 4小时 2 1例 ,2 5～ 4 8小时 1 0例 ,伤后 4 9小时以上 1 4例。纤维支气管镜检查诊断为轻度损伤 3 0例 ,中度损伤 69例 ,重度损伤 75例。 结论 对密闭环境下头面部深度烧伤合并吸入性损伤者可适当放宽气管切开术的指征 ,伤后 2 4小时内气管切开具有预防和治疗作用。

Objective To determine indications and time of tracheotomy in the burned patients with inhalation injury. Methods A retrospective case study was performed in 174 burn patients with inhalation injury from January 1989 to December 2000. Results All patients initially underwent tracheotomy and bronchofiberscopy after admission. The range of age was 10 to 72 years,and percent of total burned body surface was 3% to 100%.Forty -one of 174 patients were dead. One hundred and two tracheotomies were performed within 8h postburn,twenty-seven within 9h to 16h,twenty-one within 17h to 24h,ten within 25h to 48h,and fourteen more than 49h postburn.When examined by bronchofiberscopy,Thirty of 174 patients were mild inhalation injury,sixty-nine were moderate,and seventy-five were severe. Conclusion The indications of tracheotomy in the patients suffered from severe burned face and neck combined with inhalation injury in close space should be wide.Tracheotomy has significant preventive and therapeutic effects within 24 hours postburn.