Pruitt B A, Cioffi W G, Shimazu T, Ikeuchi H, Mason A D
U.S. Army Institute of Surgical Research, Brooke Army Medical Center, Fort Sam Houston, TX 78234-5012.
J Trauma. 1990 Dec;30(12 Suppl):S63-8. doi: 10.1097/00005373-199012001-00015.
Inhalation injury, present in approximately one third of burned patients treated at burn centers, increases mortality by a maximum of 20% in relation to age and extent of burn. The development of animal models of inhalation injury has made possible the identification of both the airway and vascular responses evoked by smoke inhalation. Inflammatory occlusion of terminal bronchioles and necrosis of the endobronchial mucosa render the airway and pulmonary parenchyma susceptible to infection and the resulting pneumonitis further increases mortality. Early diagnosis, best achieved by endoscopic bronchoscopy and 133xeon ventilation perfusion scan, permits timely application of high-frequency ventilation that appears to reduce the incidence of pneumonia and to decrease mortality. Pharmacologic agents give promise of ameliorating the deleterious changes of the vasculature. The recent advances in understanding inhalation injury have identified the research needed to further improve patient salvage.
吸入性损伤在烧伤中心接受治疗的烧伤患者中约占三分之一，相对于烧伤的年龄和范围，其死亡率最高可增加20%。吸入性损伤动物模型的建立使得识别烟雾吸入引起的气道和血管反应成为可能。终末细支气管的炎性闭塞和支气管内膜坏死使气道和肺实质易受感染，由此导致的肺炎会进一步增加死亡率。早期诊断最好通过内镜支气管镜检查和133氙通气灌注扫描来实现，这能够及时应用高频通气，而高频通气似乎可以降低肺炎的发生率并降低死亡率。药物有望改善血管系统的有害变化。在理解吸入性损伤方面的最新进展已经明确了进一步提高患者救治成功率所需的研究方向。
