Gartner R, Griffe O, Captier G, Selloumi D, Otman S, Brabet M, Baro B
Service des brûlés, hôpital Lapeyronie, 34295 Montpellier, France.
Pathol Biol (Paris). 2002 Mar;50(2):118-26. doi: 10.1016/s0369-8114(01)00275-9.
Respiratory injuries by smoke inhalation are one of the most frequent reasons for acute respiratory failure in burn victims. They are most often of chemical origin and are responsible of a 20 to 70% increase of the mortality compared to the mortality of patients with similar burn injuries, but without inhalation lesions. They are often associated to a certain degree to other factors of acute respiratory failure: superior air way obstruction by oedema in face and neck burns, thoracic expansion hindrance due to thoracic burns, lung trauma lesions by blast injury. The generalized inflammatory reaction due to the extent of burns and an initial inadequate resuscitation are worsening factors. The inflammatory process may be responsible of lung injuries similar to those induced by smoke inhalation, even when there is no inhalation. The treatment remains symptomatic and based on the oxygen therapy, mechanical ventilation, prevention of infections and maintain of homeostasis by hydroelectrolytic adequate resuscitation. The nitric oxyde associated to the almitrin allows in a certain number of cases to minimize intra pulmonary shunting and to normalize the VA/O ratio. The development of treatments allowing to modulate inflammatory mediators may lead to news therapies in the future.
吸入烟雾所致的呼吸道损伤是烧伤患者急性呼吸衰竭最常见的原因之一。这些损伤大多源于化学因素，与单纯烧伤但无吸入性损伤的患者相比，死亡率会增加20%至70%。它们常与急性呼吸衰竭的其他因素在一定程度上相关：面部和颈部烧伤引起的水肿导致上呼吸道梗阻、胸部烧伤阻碍胸廓扩张、爆炸伤导致肺创伤性损伤。烧伤范围引起的全身性炎症反应以及初期复苏不足是病情恶化的因素。即使没有吸入烟雾，炎症过程也可能导致与吸入烟雾所致类似的肺损伤。治疗仍以对症治疗为主，包括氧疗、机械通气、预防感染以及通过充分的水电解质复苏维持体内平衡。在一定数量的病例中，与烯丙哌三嗪相关的一氧化氮可使肺内分流最小化，并使VA/O比值正常化。能够调节炎症介质的治疗方法的发展可能会在未来带来新的治疗手段。
