Tong Ya-lin, Miao Hong-cheng, Feng Xiao-yan, Yang Fu-wang, Zhu Jin-hong, Gong Zhen-yu, Deng Jian-jun, Jiang Xiao-chen, Zhu Fu-jun, Xin Hai-ming
Department of Burns and Plastic Surgery, the 181th Hospital of PLA, Guilin 541002, China.
Zhonghua Shao Shang Za Zhi. 2010 Feb;26(1):6-9.
To observe the preventive and therapeutic effect of advanced airway management on pulmonary infection in patients with inhalation injury after tracheotomy.
fourteen burn patients with inhalation injury admitted to our hospital from January 2001 to December 2004 were enrolled as control (C) group, and they were treated with conventional systemic therapy and management of airway. Twenty-seven burn patients with inhalation injury admitted to our hospital from January 2005 to October 2009 were enrolled as advanced (A) group, and they were treated with conventional systemic therapy and advanced airway management, including bedside isolation of airway, fixation of both oxygen supply tube and humidifying tube, humidification in specific body position, thinning of sputum, lavement of airway and procedural sputum elimination, steam inhalation combined with medicine, and suction of sputum with interrupted negative pressure. Result of bacterial culture of sputum (the 7th day after tracheotomy) and chest X-ray (at admission and the 7th day after tracheotomy), pulmonary infection, change in blood gas analysis index and oxygen saturation (SO(2)), (within 7 days after tracheotomy), and the number of patients curd in 2 groups were observed and compared.
(1) Positive result of bacterial culture of sputum was observed in 11 (78.6%) patients in C group and 12 (44.4%) patients in A group. The difference between them was statistically significant (chi(2) = 4.36, P < 0.05). The main bacterium detected was Pseudomonas aeruginosa. (2) Pneumonia was suspected in 7 patients (25.9%) in A group by chest X-ray, which was obviously fewer than that in C group (8 Cases, 57.1%, chi(2) = 3.87, P < 0.05). The result was in accordance with the diagnosis of pulmonary infection. (3) No CO(2) retention, SO(2) and PaCO(2) abnormality caused by asphyxia was observed in 2 groups, PaCO(2) value in A group was close to that in C group (t = 0.89, P > 0.05). (4) In C group, 9 (64.3%) patients were cured, 5 patients died of pneumonia, wound sepsis, and MODS. In A group, 25 (92.6%) patients were cured, 2 patients died of MODS. Number of cure was obviously larger in A group than in C group (chi(2)= 5.22, P < 0.05).
The advanced airway management has better effects on isolation and humidification of airway, and thinning, drainage, and elimination of sputum. And it can decrease the probability of blind suction and injury to airway, and it prevents pulmonary infection following tracheotomy.
观察改良气道管理对气管切开术后吸入性损伤患者肺部感染的防治效果。
选取2001年1月至2004年12月我院收治的14例吸入性损伤烧伤患者作为对照组（C组），采用传统全身治疗及气道管理。选取2005年1月至2009年10月我院收治的27例吸入性损伤烧伤患者作为改良组（A组），采用传统全身治疗及改良气道管理，包括床边气道隔离、氧气供应管与湿化管固定、特定体位湿化、痰液稀释、气道灌洗与程序性排痰、蒸汽吸入联合药物、间断负压吸痰。观察并比较两组患者气管切开术后第7天痰液细菌培养结果、入院时及气管切开术后第7天胸部X线片、肺部感染情况、气管切开术后7天内血气分析指标及血氧饱和度（SO₂）变化情况以及两组患者治愈人数。
（1）C组11例（78.6%）患者痰液细菌培养结果为阳性，A组12例（44.4%）患者痰液细菌培养结果为阳性。两组比较差异有统计学意义（χ² = 4.36，P < 0.05）。主要检出菌为铜绿假单胞菌。（2）A组胸部X线片怀疑有7例（25.9%）患者发生肺炎，明显少于C组（8例，57.1%，χ² = 3.87，P < 0.05）。结果与肺部感染诊断相符。（3）两组均未观察到因窒息导致的CO₂潴留、SO₂及PaCO₂异常，A组PaCO₂值与C组相近（t = 0.89，P > 0.05）。（4）C组9例（64.3%）患者治愈，5例患者死于肺炎、创面脓毒症及多器官功能障碍综合征（MODS）。A组25例（92.6%）患者治愈，2例患者死于MODS。A组治愈人数明显多于C组（χ² = 5.22，P < 0.05）。
改良气道管理在气道隔离与湿化、痰液稀释、引流及清除方面效果更佳，可降低盲目吸痰及气道损伤概率，预防气管切开术后肺部感染。
