吸入性损伤气管切开时机选择初探

Primary study of tracheotomy time after inhalation injury

目的 探讨吸入性损伤气管切开的最佳时机 ,以提高治疗吸入性损伤的疗效。方法回顾性研究了 1985～ 1999年 76例吸入性损伤患者的临床资料 ,并以渗出高峰期出现时间为界分为6h内 ( 4 8例 ,简称 1组 )和 6h后 ( 2 8例 ,简称 2组 )气管切开两组。比较伤后数小时内血气变化及预后情况。结论 1组患者动脉血氧分压在伤后 6h后明显高于 2组 ,伤后 4 8h后二氧化碳分压明显低于 2组。 1组多器官衰竭 13例 ( 13/4 8) ,2组 15例 ( 15 /2 8) ;1组死亡 6例 ( 6 /4 8) ,生存 4 2例 ( 4 2 /4 8) ;2组死亡 13例 ( 13/2 8) ,生存 15例 ( 15 /2 8)。两组患者多器官衰竭、死亡人数及生存人数差异均有显著性 (P <0 0 1)。结果 中、重度吸入性损伤均为气管切开术适应证 ,吸入性损伤行气管切开术的最佳时机为伤后

Objective To investigate the way of improving clinical effects of inhalation injury Methods Seventy six patients with inhalation injury from 1985～1999 and their complete data were investigated retrospectively The patients were grouped according to their tracheotomy time within 6 hours (48 cases, called group one) or after 6 hours (28 cases,called group two) and the clinical effect were contrasted in the aspects of arterial partial pressure of blood and oxygen, partial pressure of carbon dioxide, multiple organ failure and death toll and cure situation Results Arterial partial pressure of blood and oxygen of the group one are obviously higher than those of the group two after 6 hours,while partial pressure of carbon dioxide are obviously lower than those of the group two after 48 hours The multiple organ failure cases of the group one are 13 (13/48) and the group two are 15(15/28) The death cases of the group one are 6(6/48) while the group two are 13(13/28) The survive cases of the group one are 42 (42/48), the group two are 15(15/28) There is remarkable difference ( P <0 01) in these aspects between the two groups Conclusion Moderate and severe inhalation injuries are all indication of tracheotomy , the most effective time of inhalation injury tracheotomy is within 6 hours after injury