Clark W R, Bonaventura M, Myers W, Kellman R
Department of Surgery, State University of New York Health Science Center, Syracuse.
J Burn Care Rehabil. 1990 Mar-Apr;11(2):121-34. doi: 10.1097/00004630-199003000-00006.
According to criteria established to define patients with smoke inhalation, the airway management of all victims of smoke and burns (1974 to 1984; n = 805) was reviewed. Fourteen percent of all patients were intubated (n = 117); patients intubated on the day of injury (n = 41) were more likely to extubate themselves or have technical problems with the endotracheal tube. Twelve percent of patients with smoke inhalation without burns required endotracheal intubation versus 62% of those with burns. An endotracheal tube was required for a median of 5 days. Tracheotomies were performed in 48 patients: 40% of those intubated and 6% of all patients. The mean postburn day for tracheotomy was day 15. There was no difference in the mortality rate for patients with an endotracheal tube only and those who had a tracheotomy as well: 42% and 37%, respectively. The prolonged length of stay for patients with a tracheotomy relates to the severity of the burn. Tracheotomy was not the cause of death in any patient. The strategy of grafting the neck before tracheotomy was used successfully in eight patients.
根据已确立的用于定义烟雾吸入患者的标准，回顾了所有烟雾和烧伤患者（1974年至1984年；n = 805）的气道管理情况。所有患者中有14%（n = 117）进行了气管插管；受伤当天进行气管插管的患者（n = 41）更有可能自行拔管或出现气管内导管的技术问题。无烧伤的烟雾吸入患者中有12%需要气管插管，而有烧伤的患者中这一比例为62%。气管内导管使用的中位时间为5天。48例患者进行了气管切开术：气管插管患者中的40%以及所有患者中的6%。气管切开术的平均烧伤后天数为第15天。仅使用气管内导管的患者与同时进行气管切开术的患者的死亡率没有差异，分别为42%和37%。气管切开术患者住院时间延长与烧伤严重程度有关。气管切开术并非任何患者的死亡原因。在8例患者中成功采用了在气管切开术前对颈部进行植皮的策略。
