吸入性损伤综合治疗的病例分析

Effects of Complex Therapy on Severe Inhalation Injury

目的 本文通过病例分析 ,研究综合治疗对重度吸入性损伤的治疗作用。方法 本所 (全军烧伤研究所 ) 2 0 0 0年至 2 0 0 3年连续收治的 4172例烧伤病人中的吸入性损伤及急性呼吸功能衰竭 (ARF)病例进行回顾性研究。【结果】12 8例吸入性损伤病人中有 3 0例出现ARF ,其中 18例合并多器官功能不全综合症 (MODS) ,外源性肺表面活性物质 (PS)治疗 6例单纯ARF病例 ,肺功能明显改善 ,PaO2 /FiO2 从治疗前 ( 2 3 9± 3 3 )mmHg提高到 48h的 ( 3 17± 2 8)mmHg(P <0 0 1) ,DA -aO2 从治疗前 ( 14 2± 3 0 )mmHg降至 48h的( 95± 2 0 )mmHg(P <0 0 1) ,肺动态顺应性治疗前 ( 3 7± 9)ml/cmH2 O升至 ( 60± 12 )ml/cmH2 O(P <0 0 1) ;较常规治疗组肺功能明显增强。连续静脉 -静脉血液透析滤过 (CVVHDF)治疗ARF合并MOF病例 ,也改善了肺功能 ,PaO2 /FiO2 从治疗前 ( 175± 11)mmHg提高到 48h的 ( 3 13± 2 6)mmHg(P <0 0 1) ,DA -aO2 从治疗前 ( 192± 18)mmHg降至 48h的 ( 12 4± 2 1)mmHg(P <0 0 1) ,肺动态顺应性治疗前 ( 3 7± 15 )ml/cmH2 O升至 ( 61± 17)ml/cmH2 O(P <0 0 5 )。二治疗组病人的肺功能明显较常规治疗对照有明显改善。结论 气道小剂量灌洗、早期应用带湿化的PEEP机械性通气、增强肺上皮?

Objective To investigate effects of the complex therapy on severe inhalation injury. Methods The cases with inhalation injury and acute respiratory failure (ARF) of 4172 consecutive burn patients from Jan. 2000 to Feb. 2003 in our institute were studied retrospectively. Results 30 of the 128 patients with inhalation injury occurred acute ARF. 48 hours after the exogenous pulmonary surfactant (PS) was used to treat 6 cases with uncomplicated ARF, pulmonary function obviously ameliorated as compared with routine therapy. PaO 2 /FiO 2 rose from 239±33 mmHg to 317±28 mmHg(P<0 01), Alveolar-arterial difference (D A-a O 2) decreased from 142±30 mmHg to 95±20 mmHg(P<0 01)and dynamic compliance (C dyn ) rose from 37±9 ml/cmH 2O to 60±12 ml/cmH 2O(P<0 05) in 48 hours. Continuous veno-venous hemodiafiltration (CVVHDF) also improved the pulmonary function of ARF patients complicated with multipl organs dysfunction syndrome (MODS). PaO 2 /FiO 2 rose from 175±11 mmHg to 313±26 mmHg(P<0 01), D A-a O 2 decreased from 192±18 mmHg to 124±21 mmHg(P<0 01) and C dyn rose from 37±15 ml/cmH 2O to 61±17 ml/cmH 2O(P<0 05) in 48 hours. Compared with the routinely treated patients, the pulmonary functions of the patients in the two groups were significantly improved. Conclusions The complex treatment including small volume airway lavage, early application of moist air PEEP ventilation, reinforcement of sodium-water transport of alveolar cells, acceleration of PS secretion, exogenous PS and CVVHDF therapy can significantly improve the pulmonary function of severe inhalation injury patients with ARF and MODS.