Desai M H, Rutan R L, Herndon D N
Shriners Burns Institute, Galveston, Texas.
Postgrad Med. 1989 Dec;86(8):69-70, 73-6. doi: 10.1080/00325481.1989.11704496.
Inhalation injuries most often occur with cutaneous burns, and the likelihood of an inhalation injury increases incrementally with age of the patient and size of the burn. Damage to the pulmonary parenchymal tissue manifests as increased capillary permeability leading to excessive lung fluid formation and increasing hypoxia. An inhalation injury may be diagnosed using observation of indirect criteria in conjunction with fiberoptic bronchoscopy, xenon 133 radiospirometry, and/or measurement of extravascular lung water. Initially, carbon monoxide poisoning threatens the patient's oxygenation capacity. High-flow oxygen therapy reduces the half-life of carbon monoxide to an acceptable period. The patient proceeds through three stages: pulmonary insufficiency, pulmonary edema, and bronchopneumonia. Treatment is directed toward supporting oxygenation using endotracheal intubation with mechanical ventilation, humidification of inspired air, early mobilization, chest physiotherapy, antibiotics for documented infection, and adequate systemic hydration.
吸入性损伤最常与皮肤烧伤同时发生，且随着患者年龄的增长和烧伤面积的增大，发生吸入性损伤的可能性会逐渐增加。肺实质组织损伤表现为毛细血管通透性增加，导致肺内液体过度形成和缺氧加重。吸入性损伤可通过观察间接标准并结合纤维支气管镜检查、氙133放射性肺通气测定和/或血管外肺水测量来诊断。最初，一氧化碳中毒会威胁患者的氧合能力。高流量氧疗可将一氧化碳的半衰期缩短至可接受的时间段。患者会经历三个阶段：肺功能不全、肺水肿和支气管肺炎。治疗旨在通过气管插管机械通气支持氧合、湿化吸入空气、早期活动、胸部物理治疗、针对已证实感染使用抗生素以及充分的全身水化。
