摘要
目的 探讨中、重度吸人性损伤患者早期气管切开后拔管的适宜时机、后期并发症及其处理方法.方法收集整理笔者单位2000年1月-2009年1月收治的150例吸人性损伤患者病案资料.患者中男105例、女45例,中度吸人性损伤129例,行气管切开109例;重度吸人性损伤21例,均行气管切开.（1）分别统计中、重度吸人性损伤气管切开患者中,伤后2周内和2周后拔管者因窒息而再置管率、肺部感染率;统计所有中、重度患者伤后1周内病死率.（2）对后期气管切口封闭后频繁出现咳嗽、声嘶及呼吸功能降低的患者,给予药物化痰、祛痰及口服抗生素加静养等保守治疗.统计分析其中30例中度及10例重度患者伤后3个月内随访期间纤维支气管镜检查结果（气管狭窄、肉芽肿形成、声带麻痹发生率）及肺功能检查情况[第1秒用力呼气容积（FEV1）].对数据行t检验或χ2检验.结果伤后2周内拔管的中度吸人性损伤患者再置管率为21.4%（15/70）,2周后拔管的中度患者再置管率为8.0%（2/25）,二者水平接近（χ2=1.52,P＞0.05）;2周后拔管的中度患者肺部感染率为60.0%（15/25）,明显高于2周内拔管中度患者的30.0%（21/70）,χ2=7.04,P＜0.05.不同时期拔管的重度患者之间,此2项指标比较结果与中度患者相似.伤后1周内重度患者病死率明显高于中度患者（χ2=11.90,P＜0.05）.随访期间,中、重度患者气管狭窄发生率均为100.0%,但重度患者肉芽肿形成率及声带麻痹发生率明显高于中度患者（χ2值分别为4.59、13.47,P值均小于0.05）.中度患者伤后1、2、3个月FEV1均明显高于重度患者（t值分别为5.48、12.10、6.25,P值均小于0.05）,伤后3个月时达健康人水平.结论中、重度吸人性损伤行气管切开术的患者,伤后2周内与2周后拔管各有利弊,具体拔管时机应结合患者自身情况采取个性化原则进行权衡;患者后期易出现呼吸系统并发症
Objective To investigate the appropriate extubation time and treatment of late complications after early tracheotomy in patients with moderate or severe inhalation injury. Methods One hundred and fifty patients （ 105 males and 45 females） with inhalation injury were admitted to our hospital from January 2000 to January 2009. Among them, 109 out of 129 cases with moderate inhalation injury received early tracheotomy, and all 21 cases with severe inhalation injury received early tracheotomy. Data were collected for analysis as follows： （ 1 ） incidence of re-intubation due to suffocation and pneumonia incidence after extubation within 2 weeks or after 2 weeks post inhalation injury （PⅡ）, and mortality rate within the first week after injury were recorded. （2） Conservative treatments including expectorant, oral antibiotics, and absolute bedrest were recommended for patients who had severe cough, hoarseness or poor pulmonary function after late extubation and closure of tracheostomy wound. Fiberoptic bronchoscopy findings （ tracheostenosis degree, granuloma formation rate, vocal cord paralysis rate） and pulmonary function index （ FEV1 ） data were collected and analyzed in 30 cases with moderate inhalation injury and 10 cases with severe inhalation injury within 3 months after injury for follow-up. Data were processed with t test or chi-square test. Results There was no obvious difference in the rate of re-intubation after extubation in patients with moderate inhalation injury between those done within 2 weeks PⅡ （ 15/70, 21.4% ） and those done after 2 weeks PⅡ （2/25, 8.0% ） （ x 2 = 1.52, P 〉 0.05 ）. Pneumonia incidence in patients of moderate inhalation injury with extubation within 2 weeks PⅡ （21/70, 30.0% ） was lower than those with extubation after 2 weeks PⅡ （15/25, 60.0% ） （x 2= 7.04, P 〈 0.05）. Levels of above-mentioned indexes in patients with severe inhalation injury extubated in diffferent stages were similar to those of patients with moderate in
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2011年第2期131-134,共4页
Chinese Journal of Burns
关键词
烧伤
吸入性
气管切开术
插管法
气管内
并发症
Burns, inhalation
Tracheotomy
Intubation, intratracheal
Complications
