摘要
目的探讨保护性机械通气在大面积烧伤合并重度吸入性损伤临床治疗中的效果。方法 22例大面积烧伤合并重度吸入性损伤患者采用保护性通气模式,分别观察:①通气前及通气后1 h、1 d、3 d、7 d患者心率(HR)、血氧饱和度(SPO2)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、中心静脉压(CVP)的变化;②22例患者的临床治疗效果。结果①22例患者行保护性机械通气后,机体的缺氧情况有效改善,SPO2、PaO2通气后1 h即恢复正常,与通气前相比,HR通气后明显下降(P<0.05);通气前过度通气致PaCO2低于正常,保护性机械通气后PaCO2略高于正常,但CVP在通气前后无明显变化。②22例患者经保护性机械通气后缺氧情况改善,因经济原因好转后出院2例,后期因感染并发多器官功能不全综合征(MODS)死亡2例,其余18例患者全部治愈,治愈好转率90.91%;保护性机械通气治疗过程中未出现与呼吸机治疗相关的并发症。结论保护性机械通气在烧伤合并重度吸入性损伤患者临床治疗中效果满意,能有效改善缺氧,并可有效预防呼吸机相关性肺损伤的发生。
Objective To explore the clinical effects of protective ventilation in treatment of extensively burned patients with severe inhalational injury.Methods 22 cases extensively burned patients with severe inhalational injury were hospitalized,and the protective ventilation was performed.The changes of blood gas（SPO2,PaO2,PaCO2）,heart rate（HR）and central venous pressure（CVP）were detected before and 1 h,1 d,3 d,7 d after protective ventilation.The clinical effects of all the cases were observed.Results①The oxygenation（SPO 2,PaO2）of all the cases were ameliorated remarkably 1 h after protective ventilation.Compared with that before ventilation,HR decreased significantly after protective ventilation（P0.05）.PaCO2 decreased before ventilation,then increased after ventilation.CVP showed little changes under the condition of permissive hypercapnia.②Two cases discharged from hospital after improvement for financial trouble.Two cases died due to multiple organ dysfunction syndrome（MODS）.Eighteen cases were cured finally.The rate of healing and improvement was 90.91%.No complication was found during the ventilation.Conclusion Protective ventilation is effective in the treatment of the extensively burned patients with severe inhalational injury.The oxygenation of patient is ameliorated remarkably.Protective ventilation can prevent the occurrence of complication of ventilation-associated lung injury effectively.
出处
《安徽医科大学学报》
CAS
北大核心
2011年第9期943-946,共4页
Acta Universitatis Medicinalis Anhui
基金
安徽省卫生厅科研基金(编号:09A067)
关键词
烧伤
吸入性
呼吸
人工
通气机
机械
burns
inhalation
respiration
artificial
ventilator mechanical
