中华烧伤杂志
中華燒傷雜誌
중화소상잡지
16
2014年
3期
199-202
,共4页
张涛%李孝建%邓忠远%张志%汤文彬%陈宾%鲍强%何梦龙
張濤%李孝建%鄧忠遠%張誌%湯文彬%陳賓%鮑彊%何夢龍
장도%리효건%산충원%장지%탕문빈%진빈%포강%하몽룡
烧伤%呼吸系统%并发症
燒傷%呼吸繫統%併髮癥
소상%호흡계통%병발증
Burns%Respiratory system%Complications
目的 探讨严重烧伤后呼吸系统并发症分布及防治经验. 方法 收集笔者单位烧伤ICU 2005年1月-2012年12月收治的922例重度、特重度成年烧伤患者的病历资料,统计各年度转院患者情况、烧伤总面积大于50％ TBSA患者情况、呼吸系统并发症分布和处理情况、患者死亡情况.对部分数据行x2检验. 结果 本组患者中转院患者除2007年占71.2％、2010年占40.2％外,其余年份均在50.0％左右;而烧伤总面积大于50％ TBSA患者及呼吸系统并发症患者(x2=2.637,P＞0.05)各年比例无明显变化.有523例患者出现呼吸系统并发症,以喉头水肿(50.9％,266例)、肺部感染(21.6％,1 13例)、ARDS(11.9％,62例)为主,且均无明显上升趋势(x2值分别为6.132、6.319、0.016,P值均大于0.05).其中36例未进行积极救治;487例行呼吸机辅助呼吸,包括228例行气管切开者;且各年的构成比接近.死亡15例患者,其中与呼吸系统并发症直接相关的有5例(喉头水肿2例、ARDS 3例),另10例因脓毒症或脓毒症引发的MODS而死亡. 结论 严重烧伤患者呼吸系统并发症的发生率较高.最常见的为喉头水肿,其次为肺部感染和ARDS.预防性气管切开、机械通气、抗感染、创面处理等是防治呼吸系统并发症的有效措施.
目的 探討嚴重燒傷後呼吸繫統併髮癥分佈及防治經驗. 方法 收集筆者單位燒傷ICU 2005年1月-2012年12月收治的922例重度、特重度成年燒傷患者的病歷資料,統計各年度轉院患者情況、燒傷總麵積大于50％ TBSA患者情況、呼吸繫統併髮癥分佈和處理情況、患者死亡情況.對部分數據行x2檢驗. 結果 本組患者中轉院患者除2007年佔71.2％、2010年佔40.2％外,其餘年份均在50.0％左右;而燒傷總麵積大于50％ TBSA患者及呼吸繫統併髮癥患者(x2=2.637,P＞0.05)各年比例無明顯變化.有523例患者齣現呼吸繫統併髮癥,以喉頭水腫(50.9％,266例)、肺部感染(21.6％,1 13例)、ARDS(11.9％,62例)為主,且均無明顯上升趨勢(x2值分彆為6.132、6.319、0.016,P值均大于0.05).其中36例未進行積極救治;487例行呼吸機輔助呼吸,包括228例行氣管切開者;且各年的構成比接近.死亡15例患者,其中與呼吸繫統併髮癥直接相關的有5例(喉頭水腫2例、ARDS 3例),另10例因膿毒癥或膿毒癥引髮的MODS而死亡. 結論 嚴重燒傷患者呼吸繫統併髮癥的髮生率較高.最常見的為喉頭水腫,其次為肺部感染和ARDS.預防性氣管切開、機械通氣、抗感染、創麵處理等是防治呼吸繫統併髮癥的有效措施.
목적 탐토엄중소상후호흡계통병발증분포급방치경험. 방법 수집필자단위소상ICU 2005년1월-2012년12월수치적922례중도、특중도성년소상환자적병력자료,통계각년도전원환자정황、소상총면적대우50％ TBSA환자정황、호흡계통병발증분포화처리정황、환자사망정황.대부분수거행x2검험. 결과 본조환자중전원환자제2007년점71.2％、2010년점40.2％외,기여년빈균재50.0％좌우;이소상총면적대우50％ TBSA환자급호흡계통병발증환자(x2=2.637,P＞0.05)각년비례무명현변화.유523례환자출현호흡계통병발증,이후두수종(50.9％,266례)、폐부감염(21.6％,1 13례)、ARDS(11.9％,62례)위주,차균무명현상승추세(x2치분별위6.132、6.319、0.016,P치균대우0.05).기중36례미진행적겁구치;487례행호흡궤보조호흡,포괄228례행기관절개자;차각년적구성비접근.사망15례환자,기중여호흡계통병발증직접상관적유5례(후두수종2례、ARDS 3례),령10례인농독증혹농독증인발적MODS이사망. 결론 엄중소상환자호흡계통병발증적발생솔교고.최상견적위후두수종,기차위폐부감염화ARDS.예방성기관절개、궤계통기、항감염、창면처리등시방치호흡계통병발증적유효조시.
Objective To discuss the distribution of the respiratory complications in severely burned patients and the prevention and treatment experience against them.Methods Medical records of 922 adult patients with severe or extremely severe bum hospitalized in our burn ICU from January 2005 to December 2012 were screened and retrospectively analyzed,including patients transferred from other hospitals,patients with total burn area above 50％ TBSA,the distribution and treatment of respiratory complications,and the mortality.Data were processed with chi-square test.Results The constituent ratio of patients transferred to our hospital was 71.1％ in 2007 and 40.2％ in 2010,while it remained about 50.0％ in the other years.The ratios of patients with total burn area larger than 50％ TBSA and that of patients with respiratory complications (x2 =2.637,P ＞ 0.05) showed no significant changes each year.Among these 922 burn patients,523 patients suffered respiratory complications,among which laryngeal edema (50.9％,266 cases),pulmonary infection (21.6％,113 cases),and ARDS (11.9％,62 cases) were the main components,with no significant change each year (with x2 values respectively 6.132,6.319,0.016,P values above 0.05).Among the patients with respiratory complications,except for 36 were not treated actively,487 were treated by ventilator among which 228 had undergone tracheostomy,and the constituent ratios in the 8 years were close.Fifteen patients died,with 2 died of laryngeal edema,3 of ARDS,and 10 of sepsis or MODS as a result of sepsis.Conclusions Patients with severe burns were at high risk of respiratory complications,among which laryngeal edema was common,followed by pulmonary infection and ARDS.Prophylactic tracheostomy,mechanical ventilation,wound therapy,and anti-infection were all effective measures of prevention and treatment against these complications.
