纤维支气管镜诊断和治疗吸入性损伤

目的通过纤维支气管镜对吸入性损伤进行系统形态学观察,探讨纤维支气管镜下诊断吸入性损伤的形态学标准,早期诊断的可行性,以及纤维支气管镜在吸入性损伤的局部治疗作用。方法经过10年来144例临床应用纤维支气管镜诊治吸入性损伤体会,观察不同损伤程度的形态表现。结果得出镜下诊断和分类,早期(伤后8h 内)经纤维支气管镜诊断吸入性损伤的可行性及意义,借助纤维支气管镜对吸入性损伤局部进行吸引、刷洗、灌注等治疗的临床效果。结论纤维支气管镜在诊断治疗吸入性损伤中有其特殊地位和普及应用的必要性。     

纤维支气管镜诊断和治疗吸入性损伤

目的 通过纤维支气管镜对吸入性损伤进行系统形态学观察,探讨纤维支气管镜下诊断吸入性２的形态学标准,早期诊断的可行性以及纤维支气管镜在吸入性损伤的局部治疗作用。方法 经过１０年来１４４例临床应用纤维支气管镜诊治吸入性损伤体会,观察不同损伤程度的形态表现。结果 得出镜下诊断和分类,早期经纤维支气管镜诊断吸入性损伤的可行性及意义,借助纤维支气管镜对吸入性损伤局部进行吸引、刷洗、灌注等治疗的临床效果。结论     

纤维支气管镜在吸入性损伤的应用

吸入性损伤是当前烧伤的主要死亡原因之一。为了进一步观察了解吸入性损伤后患者的呼吸道损伤程度,自1997年2月～2000年11月我科对收治的大面积烧伤合并吸入性损伤的患者应用纤维支气管镜进行检查治疗,报告如下。 1 临床资料 1.1 一般资料:本组8例吸入性损伤,其中男性7例,女1例,平均烧伤面积36.4±15.5％,Ⅲ度烧伤为23.8±11.3％。8例患者中死亡2例,死亡率占25％。其中死于多脏器功能衰竭1例,死于气管内大出血1例。 1.2 临床特点:本组8例均有密闭空间烧伤史,6例火焰     

纤维支气管镜在吸入性损伤的临床应用21例

我科 198 6年 3月 1997年 5月收治大面积烧伤合并吸入性损伤 2 1例 ,应用纤维支气管镜进行检查与治疗 ,现将结果报告如下。临床资料本组 2 1例吸入性损伤合并大面积烧伤 ,其中男性 16例 ,女性 5例。平均烧伤 (6 9.2± 2 2 .5 ) %ＴＢＳＡ ,Ⅲ度烧伤为(4 3.6± 2 6 .3) %ＴＢＳＡ。 2 1例患者中死亡 8例 ,死亡率占38 1% ,其中死于菌血症 4例 ,多脏器功能衰竭 (Ｍ0ＳＦ) 3例 ,成人呼吸窘迫综合征 (ＡＲＤＳ) 1例。1.临床特点 :本组病例除躯干、四肢不同程度烧伤外 ,均有头面、颈部深Ⅱ度Ⅲ度烧伤 ,头发、睫毛、眉毛均烧焦 ,15例入院时存在轻重…     

严重体表烧伤合并吸入性损伤的治疗体会

目的:探讨严重体表烧伤伴吸入损伤的治疗方法.方法:对我科2007.2-2010.2收治的41例严重体表烧伤合并吸入性损伤患者的临床资料进行分析和总结.结果:该组患者治愈34例,死亡7例,死亡率17.1%.死亡病例均为重度吸入性损伤病人.结论:合理补液,加强烧伤创面处理,保持气道通畅和防治肺水肿、肺萎陷、肺部感染可提高严重体表烧伤伴吸入性损伤的治愈率.     

重组人表皮生长因子治疗吸入性损伤的临床观察

重组人表皮生长因子 (recombinanthumanepidermalgrowthfactor,rhEGF)具有促进表皮细胞生长、加速创面愈合、缩短愈合时间的作用 ,且无毒、无化学和物理刺激性 ,黏膜耐受性好。但rhEGF应用于吸入性损伤的治疗及促进气管黏膜愈合的作用尚鲜见报道。笔者应用rhEGF对本单位收治的 2 0例吸入性损伤患者进行治疗 ,结果表明rhEGF对吸入性损伤受损气管黏膜的愈合有一定促进作用。一、资料与方法1.病例选择 :选择本单位近 3年收治的烧伤面积小于5 0 %TBSA、合并吸入性损伤的患者 4 0例 ,均为男性 ,年龄 17 5 2岁。致伤原因 :火焰烧伤 32例 ,…     

支气管肺泡灌洗治疗重度吸入性损伤16例

重度吸入性损伤是烧伤早期死亡率高和影响预后的一个重要因素 ,及时诊断和治疗是救治成功的关键。 1996年 1月以来 ,我院共收治重度吸入性损伤 16例 ,利用纤维支气管镜进行支气管肺泡灌洗 (ＢＡＬ) ,取得了较好的临床效果 ,报告如下。1.临床资料 :本组 16例 ,其中男性 14例、女     

Comparison of virtual bronchoscopy to fiber-optic bronchoscopy for assessment of inhalation injury severity

PurposeCompare virtual bronchoscopy (VB) to fiberoptic bronchoscopy (FOB) for scoring smoke inhalation injury (SII).MethodsSwine underwent computerized tomography (CT) with VB and FOB before (0) and 24 and 48 h after SII. VB and FOB images were scored by 5 providers off line.ResultsFOB and VB scores increased over time (p < 0.001) with FOB scoring higher than VB at 0 (0.30 ± 0.79 vs. 0.03 ± 0.17), 24 h (4.21 ± 1.68 vs. 2.47 ± 1.50), and 48 h (4.55 ± 1.83 vs. 1.94 ± 1.29). FOB and VB showed association with PaO₂-to-FiO₂ ratios (PFR) with areas under receiver operating characteristic curves (ROC): for PFR ≤ 300, VB 0.830, FOB 0.863; for PFR ≤ 200, VB 0.794, FOB 0.825; for PFR ≤ 100, VB 0.747, FOB 0.777 (all p < 0.001). FOB showed 80.3% specificity, 77% sensitivity, 88.8% negative-predictive value (NPV), and 62.3% positive-predictive value (PPV) for PFR ≤ 300 and VB showed 67.2% specificity, 85.5% sensitivity, 91.3% NPV, and 53.4% PPV.ConclusionsVB provided similar injury severity scores to FOB, correlated with PFR, and reliably detected airway narrowing. VB performed during admission CT may be a useful screening tool specifically to demonstrate airway narrowing induced by SII.     

Fibreoptic bronchoscopy in routine clinical practice in confirming the diagnosis and treatment of inhalation burns

Fibreoptic bronchoscopy has been recently introduced to our practice, its value in the diagnosis and management of respiratory tract burns has been well established. The aim of the prospective study was to ascertain whether, in our routine clinical practice, a correlation could be shown between clinical and bronchoscopic diagnosis. The outcome of the study could support a rationale for introduction of this tool in other centers in Poland. In the period between 1 October 2001 and 30 June 2004, of the 1247 burn patients, that were hospitalized in our centre and admitted directly after burn, N=292 patients (59 women and 233 men) were included in the study. For clinical diagnosis, a clinical pathway was used, which includes a questionnaire probing for signs and symptoms of inhalation trauma. When on initial assessment there was a suspicion of inhalation trauma (>3/11 points), a prompt fibreoptic bronchoscopy was performed. Diagnoses of an inhalation burn was confirmed in 261/292 patients, of whom upon initial assessment an inhalation trauma was suspected. Clinical assessment showed that 62/261 scored 5/11, 57/261 scored 6/11, 122/261 had a score of 7/11 and 20/261 scored >7/11. In this group an upper respiratory tract burn was diagnosed in 111/261 cases, damage of the main respiratory tract in 130/261 cases, and an inhalation trauma of the lower respiratory tract was confirmed in 20/261 cases. Based on our findings we concluded that fibreoptic bronchoscopy was shown to be a useful method in our routine clinical practice to confirm diagnosis and treatment of inhalation burns. The high agreement between the clinical suspicion of inhalation injury and the incidence confirmed by bronchoscopy and biopsies, suggest that the clinical indicators we use are reliable. We noted that performing fibreoptic bronchoscopy in patients with acute breathing insufficiency, who are intubated and require high concentrations of oxygen, is not recommended.     

烧伤合并中重度吸入性损伤的早期救治

目的：为提高中重度吸入性损伤治疗水平,探讨中重度吸入性损伤早期救治的方法。方法：对32例烧伤合并中重度吸入性损伤患者实施“四早”救治方案,即：早期气管切开;早期充分给氧;早期气道湿化、灌洗;早期纤维支气管镜检查及治疗。32例患者中,烧伤面积〈30％TBSA16例,30％～50％TBSA10例,〉50％TB—SA6例;Ⅲ度烧伤面积〈10％TBSA17例,10％～20％TBSA6例,〉20％TBSA9例。救治过程中观察患者气道黏膜损伤情况及愈合时间,监测气道灌洗前后、纤支镜治疗前后30min患者的心率、呼吸频率及动脉血气变化,纤支镜治疗前后痰标本作细菌培养。结果：32例中治愈28例,死亡4例,2例死于急性呼吸窘迫综合征,2例死于肺部严重感染,病死率12．5％;气道的愈合与黏膜损伤程度密切相关,与损伤部位关系不明显;气道灌洗前后和纤支镜治疗前后,患者的动脉血氧饱和度、动脉血氧分压升高,心率、呼吸频率减慢,动脉血pH值降低;纤支镜肺泡灌洗后气道内病原菌明显减少。中重度吸入性损伤患者应用“四早”救治方案后,显著地提高了救治的成功率。结论：对中重度吸入性损伤患者按“四早”方案进行救治是有效可行的。     

高频喷射通气对吸入性损伤犬呼吸气流与气体交换的影响

目的观察犬吸入性损伤时呼吸气流对气体交换的影响。方法用三维粒子动态分析仪测定犬自主呼吸时吸气和呼气流速。将实验动物通入高压蒸气５秒后随机进行五种不同条件高频喷射通气，每种通气方式通气２０分钟，并根据公式Ｒｅ＝Ｖｒρ／η计算出雷诺数，同时采取动脉血标本，观察Ｐａ－ＣＯ２、ＰａＯ２、ＰＩＰ的变化。结果①自主呼吸时吸气为层流，呼气可能为层流，也可能为涡流；②高频喷射通气（ＨＦＪＶ）时呼气和吸气均为涡流；③高频双向喷射通气（ＨＦＴＪＶ）与ＨＦＪＶ相比，呼气流速显著增加（Ｐ＜０．０５），ＰａＣＯ２显著降低（Ｐ＜０．０５），呼气流速与ＰａＣＯ２呈负相关（ｒ＝－０．９２１６，Ｐ＜０．０５），同时吸气流速也有增加的趋势。结论ＨＦＪＶ可维持吸入性损伤犬正常通气，其机制可能与涡流有关。ＨＦＴＪＶ是在ＨＦＪＶ基础上增加了反向喷射气流，可以增进呼吸气体速度，促进ＣＯ２排除。     

部分液体通气对吸入性损伤犬的研究

目的 观察部分液体通气(PLV)对吸人性损伤犬呼吸力学、氧合和血流动力学参数的影响.方法 16条健康杂种犬经蒸气吸人造成重度吸入性损伤模型,随机分为对照组和实验组(n=8).实验组经气管导管缓慢注入氟碳液体(12ml/kg体重)行PLV治疗,治疗后30、60、90 min时测定两组犬血气、气道阻力、肺顺应性及血流动力学参数.结果 实验组Pa02呈进行性上升,在各时点与致伤后60 min比较差异有统计学意义(P＜0.05).与对照组比较,实验组各时点的PaO2稍有升高(P＞0.05).两组气道阻力、肺顺应性和血流动力学参数比较,差异均无统计学意义(P＞0.05).结论 PLV有利于吸入性损伤犬的动脉氧合,对血流动力学无明显不利影响.     

重度吸入性损伤的救治体会

目的　总结３０ 例重度吸入性损伤的治疗经验与失败教训。方法　从治愈与死亡病例中回顾与总结重度吸入性损伤的治疗经验。如：诊断明确即行气管切开、吸氧治疗，气道冲洗清除气道分泌物；皮质激素短期用于肺水肿或严重支气管痉挛时，鼓励病人咳嗽、深呼吸、翻身拍背、体位引流等。结果　本组３０ 例中治愈１４ 例，治愈率为４６－６％ ，死亡１６ 例，病死率为５３－３％ 。结论抓早、抓好各项治疗措施，重视并发症的防治，可提高此类病人的治愈率     

The impact of inhalation injury in patients with small and moderate burns

BackgroundInhalation injury is an independent risk factor of mortality in burn patients. The burn index (BI), which includes burn depth and size, also plays a role in predicting mortality. We aimed to establish a relationship between survival rate, inhalation injury, and BI.MethodsFrom 1997 to 2010, 21,791 burn patients from 44 hospitals were retrospectively reviewed. Kaplan–Meier and log-rank assessments were used for survival curve analysis. Chi-square, Fishers-exact test and odds ratio evaluations were used to assess the relationship between mortality rate, inhalation injury, BI. Two population proportion Z test was used to analyze the causes of death and morbidity. The significance level was set at 0.01.ResultsThe overall mortality rate was 2.1%. Inhalation injuries were found in 7.9% of the patients. The mortality rate of inhalation and non-inhalation injury group was 17.9% and 0.7%, respectively. The survival rate of the inhalation injury group was significantly lower than that of the non-inhalation injury group at BI 0–50. The patients with both inhalation injury and BI less than 50 had significant higher rate to die of pneumonia, respiratory failure, sepsis and wound infection. There was no significant difference when BI was larger than 50.ConclusionsInhalation injuries significantly reduced the survival rate, especially when the BI was less than 50. The possibility of pulmonary dysfunction and complications arising from inhalation injury should be considered even in patients who have small cutaneous burns associated with inhalation injuries.     

吸入性损伤后多器官衰竭

为探讨吸入性损伤后多器官衰竭的临床特点及其防治,对1977年1月至1991年8月4834例住院病人中366例吸入性损伤进行了回顾性分析。结果显示,4834例烧伤病人中发生 MOF 115例,发生率为2.38%;其中366例吸入伤76例发生 MOF,发生率达20.77%,占烧伤后 MOF 总数的2/3。吸入伤后 MOF 具有发生早、发生率和死亡率较高,呼吸系统并发症多,肺和心功能衰竭发生率高,重度休克较多,缺氧及酸中毒较严重等特点。认为吸入伤本身和休克是吸入伤后 MOF 的主要发病因素,及早采取有效措施防治吸入伤和休克,减轻或纠正组织器官的缺血和缺氧损害,是防治吸入伤后 MOF 的关键。