早期气管切开低潮气量机械通气在面颈部深度烧伤合并重度吸入性损伤救治中的应用

目的 探讨早期气管切开低潮气量机械通气在面颈部深度烧伤合并重度吸入性损伤救治中的重要性.方法 对烧伤合并重度吸入性损伤的9例患者早期气管切开并采用低潮气量机械通气、低PEEP和"允许性高碳酸血症"的通气模式.分别在机械通气前和通气后6h、1d、5d行股动脉血气分析,并测定心率、中心静脉压变化,以及胸部X线检查.结果 早期气管切开机械通气后,其氧合指征PaO2和SPO2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,未见其他并发症发生.结论 对面颈部深度烧伤合并重度吸入性损伤患者采用早期气管切开低潮气量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的发生

Application of bronchectomy and hypovolumic ventilation in facial deep burned patients with severe inhalation injury in their early stage

Objective: To explore the importance of hypovolumic ventilation in the treatment of the facial deep burned and severe inhalational injury.Methods: Nine facial deep Burned patients with severe inhalational injury were enrolled in the study.The protective ventilation,including low tidal volume,low positive end expiratory pressure and permissive hypercapnia was performed in all the cases.The changes of blood gas,heart rate,and chest X ray were detected before and 6h,1d,5d after ventilation.Results: The oxygenation(spo2 pao2)was ameliorately remarkably after the ventilation.The heart rate and central venous pressure showed little changes under the condition of permissive hypercapnia.No complication was found during the ventilation.Conclusion: Protective ventilation is effective in the treatment facial deep burns with severe inhalation injury,which can prevent the occurance of ventilation-association lung injury effectively.