吸入性损伤后预防性气管切开与紧急气管切开的临床研究

目的　探讨预防性气管切开的临床可行性。　方法　对 93例中度或重度吸入性损伤患者均行气管切开。气管切开前出现明显呼吸困难、血氧分压下降、血氧饱和度下降者为紧急气管切开组 (2 1例 ) ;气管切开前未出现明显通气、换气障碍者为预防性气管切开组 (72例 )。预防性气管切开组实施手术时间为伤后 (4 .31± 3.0 4 )h ,紧急气管切开组为伤后 (34.4 7± 2 .79)h。比较两组患者相关生命体征、血氧分压、氧饱和度、呼吸频率及呼吸机使用情况。　结果　紧急气管切开组血氧分压、血氧饱和度、呼吸频率、心率等术前均有明显的异常 ,术后得到显著改善 ,而预防性气管切开组相关生命体征较平稳。紧急气管切开组术后 2d内 2 0例使用呼吸机辅助呼吸 (95 .2 4 % )。预防性气管切开组术后 2d内 6 5例使用呼吸机辅助呼吸 (90 .2 8% )。　结论　对疑有中度以上吸入性损伤的患者应及早行预防性气管切开 ,尽量避免紧急气管切开。气管切开后建议早期使用呼吸机辅助呼吸。

Clinical study on the comparison of prophylactic with emergent tracheostomy after inhalation injury

OBJECTIVE: To compare prophylactic with emergent tracheostomy in 93 patients with inhalation injury, so as to explore the clinical significance of prophylactic tracheostomy. METHODS: Tracheostomy was applied in all patients with moderate and severe inhalation injury. The patients with obvious dyspnea, low oxygen pressure and decreased oxygen saturation before the operation were set to be emergent tracheostomy group (ET, n = 21), while those without dysfunction of ventilation and gas exchange, as prophylactic group (PT, n = 72). The average operation starting time was 4.31 +/- 3.04 PBH and 34.47 +/- 2.79 PBH in PT and ET groups, respectively. RESULTS: There were evident decrease of blood oxygen pressure and oxygen saturation and increase of respiratory and heart rates before the tracheostomy in ET group, but all these signs improved after the operation. In contrary, the vital signs in PT group exhibited stable perioperatively. Assisted respiration with respirator was applied in 20 cases (95.24%) in ET and in 65 cases (90.28%) in PT groups within 2 post-operative days (POD). CONCLUSION: Early and prophylactic tracheostomy should be advocated in patients suspected to be with moderate or severe inhalation injury. Emergent tracheostomy must be avoided and respiratory assistance should be employed as early as possible.