烟雾弹致吸入性肺损伤60例的分级管理与救治

Classification management and treatment of 60 patients with inhalation lung injury caused by smoke bombs

目的探讨烟雾弹致吸入性肺损伤的分级管理与救治。方法选取2016年3月至2016年8月在我院门诊及住院治疗的因烟雾弹引起吸入性肺损伤患者60例,根据支气管镜下吸入性肺损伤程度分为轻度、中度和重度三组,对患者采取分级管理,给予吸氧、解除支气管痉挛、呼吸机辅助通气、预防感染、抗炎、抗氧化及体外膜肺氧合(ECMO)支持等治疗,观察治疗效果以及患者胸部CT及气管镜下表现。结果 60例患者中,治愈54例(90.00%),好转5例(8.33%),死亡1例(1.67%)。轻度吸入性肺损伤患者肺部症状出现好转时间和肺部病变基本吸收时间分别为(6.54±1.54)d和(12.17±3.24)d,均明显短于中度和重度吸入性肺损伤患者(P<0.05);中度吸入性肺损伤患者肺部症状出现好转时间和肺部病变基本吸收时间分别为(11.63±1.31)d和(23.54±3.65)d,明显短于重度吸入性肺损伤患者(P<0.05)。结论积极采取分级管理,联合应用开放气道、机械通气、糖皮质激素及体外膜肺氧合等手段能有效救治烟雾弹致吸入性肺损伤患者,同时能够合理分配医疗资源,对突发情况进行及时有效处理,提高医师及护理人员工作效率,为临床治疗提供理论依据。

Objective To investigate the classification management and treatment of inhalationlung injury cause by smoke bombs.Methods From March 2016 to August 2016,it selected 60 patients with inhalation lung injury caused by smoke bombs in our hospital.According to the degree of inhalation lung injury under bronchoscopy,the patients were divided into three groups:mild,moderate and severe.They were treated with classification management,oxygen inhalation,relief of bronchial spasm,mechanical ventilation,prevention of infection,extracorporeal membrane oxygenation and others treatment.Their therapeutic effect and chest CT and bronchoscopic manifestations were observed.Results 54 were cured(90.00%),5 were improved(8.33%),and 1 case of death reported(1.67%).Their pulmonary improvement time and basic absorption time of lung lesions were(6.54±1.54)d and(12.17±3.24)d in the mild group,which were significantly shorter than those in the moderate and severe group(P<0.05).Their pulmonary improvement time and basic absorption time of lung lesions were(11.63±1.31)d and(23.54±3.65)d in the moderate group,which were significantly shorter than those in the severe group(P<0.05).Conclusion Active classification management combined with open airway,mechanical ventilation,glucocorticoid,extracorporeal membrane oxygenation and other means can effectively treat patients with inhalation lung injury cause by smoke bombs.At the same time,medical resources can be rationally allocated,and timely and effective treatment of emergencies can be carried out to improve the efficiency of doctors and nurses,and to provide theoretical basis for clinical treatment.