早期气管切开保护性机械通气在严重烧伤患者救治中的应用

目的总结早期气管切开保护性机械通气在严重烧伤患者救治中的临床应用效果。方法对32例严重烧伤患者早期行气管切开,采用小潮气量,低呼吸末正压,低吸气压力,适当延长吸气时间,必要时加反比通气以及＂允许性高碳酸血症＂的保护性通气模式,强化气道管理。分别在机械通气前和通气后2h、1、3、5d行动脉血气分析,并测定心率、中心静脉压变化,以及胸部X线检查。结果本组行机械通气后,其氧合指征血氧饱和度和动脉血氧分压明显改善,在＂允许性高碳酸血症＂状态下,患者心率、中心静脉压变化不明显。治疗期间未发生气胸、纵膈气肿等呼吸机相关性肺损伤和呼吸机相关性肺炎。结论严重烧伤患者采用早期气管切开保护性机械通气治疗效果理想,并可有效预防呼吸机相关性肺损伤和呼吸机相关性肺炎的发生。

Application of bronch-ectomy and protective mechanical ventilation in severely burned patients in their early stager.

Objective To summarize the clinical effects of bronch-ectomy and protective mechanical ventilation in the treatment of severely burned patients in their early stage.Methods 32 cases of severely burned patients were enrolled in the study and tracheotomy was adopted in their early stage.The protective ventilation,including low tidal volume,low positive end expiratory pressure,low inspiratory pressure,properly prolonging expiration time,inverse ratio ventilation（IRV） and permissive hypercapnia if necessary was performed in all the cases.The changes of blood gas,heart rate,and chest X ray were detected before and 2h,1d,3d,5d after ventilation.Results The oxygenation （SaO2 and PaO2） was ameliorated remarkably after the ventilation.The heart rate and central venous pressure showed little changes under the condition of permissive hypercapnia.No ventilator-associated lung in jury and ventilator associated pneumonia including pneumothorax,mediastinal emphysema,were found during the ventilation.Conclusion The effects of early bronch-ectomy and protective ventilation are satisfactory in the treatment of severely burned patients,which can prevent the occurrence of ventilator-association lung injury and ventilator associated pneumonia effectively.