Objective To compare the effects of high frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation (CMV) whith or without pulmonary surfactant(PS) supplement on water vapour inhalation injury.Methods New Zealand rabbits model of severe acute lung injury with acute respiratory failure caused by steam inhalation was established.Then the animals were treated by CMV，HFOV，CMV+PS or HFOV+PS，respectively while animals in control group did not ventilated and supplemented with PS.Femoral arterial blood samples were obtained at 1，2，3，4 h after treatment for blood gas analysis.4 h after treatment ,the lowest lobe of right lung was weighed for calculating wet-to-dry weight ratio (W/D).Four different parts including dependent areas and non-dependent areas of the middle lobe of right lung were excised for histological observation.Results (A) After ALI established PaO2 in the five groups decreased below 60mmHg (Plt;0.01) but intergroup differences were found.Meanwhile the change of PaCO2 showd no statistical significance(Pgt;0.05).(B) PaO2 in the four treatment groups had increased since one hour after treatmentand sustained at favorite levels during treatment period.PaO2 in the HFOV and HFOV+PS groups were higher than those in CMV and CMV+PS groups,respectively (Plt;0.01，Plt;0.05).PaO2 in the CMV+PS group at 2 h and HFOV+PS group at 2 h and 3 h were significantly higher than those in corresponding non-PS groups at the same timepoints (Plt;0.05).P（A-a）O2 in the HFOV and HFOV+PS groups were lower than those in CMV and CMV+PS groups (Plt;0.05).P（A-a）O2 in the two groups with PS at 2 h，3 h and 4 h t were statistically lower than those in the two corresponding groups without PS (Plt;0.05).The pH and PaCO2 as well as circulatory function in the four groups were not significantly different at different treatment timepoints (Pgt;0.05).(C) Lung W/D was not different between CMV and HFOV groups (Pgt;0.05)，or CMV+PS and HFOV+PS.But lung W/D in the two groups treated with PS showed statistically decrement than that in non-PS groups (Plt;0.05).(D) Histological injury score was lowest in HFOV+PS group and highest in CMV group.Conclusion HFOV combined with exogenous PS supplement can improve arterial oxygenation and alleviate pulmonary edema and injury，which may be a optimal method for the treatment of acute lung injury with acute respiratory failure caused by water vapour inhalation.
目的 比较经皮扩张气管切开术（PDT）和开放式气管切开术（OT）在成批吸入性损伤患者中的应用效果。 方法 采用前瞻性随机性研究方法，将2006年1月－2010年12月收入三峡大学人民医院重症医学科的4批34例吸入性损伤患者，分为PDT组（n=17）和OT组（n=17），比较两组的手术时间、出血量、并发症，观察手术前后的平均动脉压（MAP）、心率（HR）、呼吸频率（R）、动脉血氧分压（PaO2）和动脉血二氧化碳分压（PaCO2）。 结果 PDT组与OT组手术时间分别为（7.0 ± 1.9）、（18.0 ± 11.4）min，差异有统计学意义（P=0.000）；PDT组与OT组出血量分别为（7.0 ± 4.4）、（19.0 ± 12.1）mL，差异有统计学意义（P=0.001）；两组患者气管切开前及切开后的MAP、HR、R、PaO2和PaCO2差异无统计学意义（P＞0.05）；PDT组发生出血并发症1例，OT组发生出血、皮下气肿、纵隔气肿及切口感染等并发症共6例，PDT组并发症发生率低于OT组，差异有统计学意义（P=0.034）。 结论 PDT在救治成批吸入性损伤患者时比OT更快地建立人工气道，而出血量、并发症发生率均低于OT，值得推广应用。
【摘要】 目的 探讨吸入性损伤气管切开置管，导管脱出的原因及正确的护理方法，提高护士对患者的预见性护理能力。 方法 对2005年1月-2011年3月收治的158例吸入性损伤气管切开患者，其中9例术后发生导管脱出的原因及护理对策进行回顾性总结。 结果 9例患者发生导管脱出的主要原因有导管选用不当、剧烈咳嗽、系带过松、气囊充气不足或气囊破裂、切口过大，以及自行拔出。9例发生脱管时间不一，最短于气管切开术后第1天，最长于术后15 d，8例经予以紧急处理而尚未影响后续治疗，1例因缺氧时间太长而死亡。 结论 充分认识吸入性损伤患者气管切开脱管原因，并采取预见性的观察及护理措施，可减少脱管发生，确保患者安全。【Abstract】 Objective To explore the reasons and correct nursing methods of placing endotracheal tubes and tubes prolapsing after incision of trachea for inhalation injury. Methods The clinical data of nine patients with endotracheal tubes prolapse after incision of trachea out of 158 patients suffering from incision of trachea for inhalation injury from January 2005 to March 2011 were retrospectively analyzed. Results The reasons of nine patients suffering from endotracheal tubes prolapse included tubes incongruity, severe cough, too slack bridles, insufficiency and break of aerocysts, too large incision and extraction by themselves. The prolapse time of nine patients was different. The shortest time was postoperative one day, the longest one was postoperative 15 days. Eight patients were treated emergently and healed normally. One patient died of long oxygen deficiency. Conclusions The reasons of endotracheal tubes prolapse after incision of trachea are sufficiently recognized. Predictable observing and nursing methods may decrease the incidence rate of tubes prolapse.
目的:探讨烧伤合并吸入性损伤患者行预防性气管切开的时机和可行性, 以提高治疗中、重度吸入性损伤的疗效。方法:对80例烧伤合并气道吸入性损伤患者的临床资料进行回顾性研究,按气管切开手术不同时机分为预防性气管切开组70例与紧急气管切开组10例。70例在烧伤后(5.2±2.1)h行气管切开术,和10例在烧伤后(23.24±2.36) h行气管切开术。比较两组患者相关生命体征、血氧分压、氧饱和度、呼吸频率及预后情况。结果: 预防性气管切开组气管切开术70例患者,解除上呼吸道梗阻、改善缺氧状况69例,死亡1例。紧急气管切开组10例,死亡6例。预防性气管切开组与紧急气管切开组比较死亡率有明显降低(Plt;0.01)。结论:烧伤合并中、重度吸入性损伤应及早进行预防性气管切开术,防止呼吸道梗阻,减少并发症,降低死亡率,手术时机选择在伤后5小时内为宜。
ObjectiveTo summarize the experiences of artificial airway management for inhalation injury patients undergoing tracheotomy. MethodsA retrospective analysis was made on the clinical data of 16 patients with inhalation injury who accepted artificial airway implantation after tracheotomy from January 2012 to October 2014. Certain measures were taken for the patients such as timely sputum suction in a correct way, effective airway moist, timely airway lavage, strict aseptic operation, reasonable position management, dynamic observation and health education. ResultsFifteen patients were cured, and one died. Among the cured patients, there were one case of catheter change due to blocked sputum, and one case of catheter outward portion sliding depth adjusting. ConclusionStrengthening artificial airway management after tracheotomy is the key to keep airway unobstructed, to prevent complications, and to guarantee the safety and a speedy recovery of patients.
Objective To explore the application effect of recumbent rehabilitation exercise combined with oscillatory positive expiratory pressure training in pulmonary rehabilitation of patients with moderate to severe inhalation injury. Methods Fifty-seven patients with moderate-to-severe inhalation injuries admitted to the Department of Burns and Plastic Surgery of the People’s Hospital of North Jiangsu Province from January 2021 to March 2023 were selected by convenience sampling. The patients were randomly divided into Group A, Group B, and Group C. Group A received conventional treatment, Group B received the recumbent rehabilitation exercise on the basis of Group A, and Group C received the concussive expiratory pressure training on the basis of Group B. The three groups were compared before and after the intervention with respect to forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), sputum properties, sputum difficulty, sputum viscosity, average daily sputum output, Borg shortness of breath score, and 1-minute sitting and standing test. Results The improvement values of FEV1, FVC, sputum viscosity, average daily sputum discharge, Borg shortness of breath score, and 1-minute sit-to-stand test were compared among the three groups after intervention, and the differences were statistically significant (all P<0.05). The improvement values of Borg shortness of breath score, and 1-minute sit-to-stand test in group B were significantly better than those in group A (all P<0.05). The improvement values of FEV1, FVC, and sputum properties in group C were significantly better than those in group A (all P<0.05), Coughing difficulty, sputum viscosity, total average daily sputum expectoration, Borg shortness of breath score, and 1-minute sit-to-stand test improvement values were significantly better than those of group A (all P<0.05). Improvement values of FEV1, average daily sputum expectoration, and Borg shortness of breath score in group C were significantly better than those of group B (all P<0.05). Conclusion For pulmonary rehabilitation of patients with moderate-to-severe inhalation injuries, prone rehabilitation exercises combined with oscillatory positive expiratory pressure training can effectively improved the patients’ exercise capacity and respiratory function, and improve their quality of life.