特重烧伤复合肺爆震伤的临床观察和治疗

目的 探讨特重度烧伤伴肺爆震伤的诊断和治疗方法。方法 总结和分析一批16例特重烧伤伴肺爆震伤患者的临床资料。结果 16名伤员在伤后7~10d均出现肺爆震伤表现,X线表现多样,5例并发急性呼吸窘迫综合征,全部并发肺部感染。14例治愈,2例死亡,所有伤员创面愈合良好。结论 本组伤员肺爆震伤的临床表现迟,症状重,持续时间长;肺部感染与胸腔积液发生率高;胸部X线表现多样,与肺部感染不易鉴别。治疗上应重点防治多器官功能不全,调整胶体液和晶体液的比例,应用低潮气量肺保护性通气结合肺复张策略,加强对呼吸机相关性肺炎的防治,控制肺部及创面感染,改善微循环,保护重要脏器功能及加强营养支持都是有效的治疗方法。

Clinical observation and treatment of extensive severe burn accompanied by blast injury of the lungs

Objective To elaborate on the diagnosis and treatment of blast injury of the lungs in extensively burned patients. Methods The clinical data of 16 patients with blast injury of the lungs and extensive burns were analyzed. Results The clinical manifestations of blast injury of the lungs were observed 7-10 days after the injury, with variable manifestations in chest X-ray. Five patients developed acute respiratory distress syndrome, and all the patients experienced pulmonary infection. Fourteen cases were finally cured, and 2 died of severe blast injury of the lungs and severe systemic infection. The burns healed well in all the surviving patients. Conclusions These patients often have delayed onset of clinical manifestation, severe symptoms of long duration, with high rate of pulmonary infection and pleural effusions, and variable manifestations in chest X-ray easily confused with pulmonary infections. Attention should be given to management of multiorgan dysfunction syndrome and adequate transfusion. Low tide volume lung-protective ventilation strategy and lung recruitment measures may prove beneficial. Prevention and management of ventilator-associated pneumonia, pulmonary infection and wound infection, along with improvement of microcirculation, organ function protection and intensive nutrition support, are effective treatments for patients with blast injury of the lungs and extensive burns.