保护性机械通气在烧伤合并重度吸入性损伤救治中的应用
烧伤；吸入性损伤；机械通气；高碳酸血症,,烧伤；吸入性损伤；机械通气；高碳酸血症,1一般资料,2机械通气指征,3保护性机械通气,4统计学处理
摘要： 目的 探讨保护性机械通气在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12例患者采用低潮气量、低PEEP和“允许性高碳酸血症”的保护性通气模式。分别在机械通气前和通气后2小时、1、3、7天行动脉血气分析，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，除1例肺大泡患者出现气胸外，未见其他并发症发生。结论 对烧伤合并重度吸入性损伤患者采用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的发生。关键词：烧伤；吸入性损伤；机械通气；高碳酸血症
Application of protective ventilation in treatment of burned patients with severe inhalational injury
CAO Weihong,CHAI Jiake,LI Ligen,et al.
(Clinical Department of Burn Iinstitute,First Affiliated Hospital of General Hospital of PLA,Beijing 100037,China)
Abstract: Objective To explore the importance of protective ventilation in the treatment of the burned patients with severe inhalational injury.Methods Twelve 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,central venous pressure and chest X ray were detected before and 2h,1,3,7,14d after ventilation.Results The oxygenation (PaO2,SPO2) was ameliorated dramatically after the ventilation.The heart rates and central venous pressure showed little changes under the condition of permissive hypercapnia.No complication was found during the ventilation except for the aerothorax in 1 case with pneumatocele.Conclusion Protective ventilation is effective in the treatment of the burned patients with severe inhalational injury,which can prevent the occurrence of ventilation-associated lung injury effectively. ......
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