Stone H H
J Pediatr Surg. 1979 Feb;14(1):48-52. doi: 10.1016/s0022-3468(79)80575-8.
Basic concepts have evolved from a 15-yr experience in the management of 101 children with inhalation injuries. Progression through three distinct clinical stages--bronchospasm (1--12 hr post-burn), pulmonary edema (6--72 hr), and bronchopneumonia (after 60 hr)--was often noted. Success in outcome appeared to depend upon treatment that conformed to the pathophysiologic state present, a pulmonary toilet being both thorough and aseptic, tracheotomy being reserved for true glottic or supraglottic airway obstructions, the sharp division of strangulating or suffocating constrictions caused by cervical or thoracic eschars, use of ventilators primarily to maintain arterial pO2 above 60 mm Hg and to reverse otherwise intractable pulmonary edema, corticosteroids being administered as a single intravenous bolus and only for overt bronchospasm, and parenteral antibiotic therapy being based upon sputum smears and cultures for established pneumonia alone, never as prophylaxis.
基本概念源自对101例吸入性损伤儿童长达15年的治疗经验。常可见到病程历经三个不同的临床阶段——支气管痉挛（烧伤后1至12小时）、肺水肿（6至72小时）和支气管肺炎（60小时后）。治疗效果的成功似乎取决于符合当前病理生理状态的治疗方法，肺部清理既要彻底又要无菌，气管切开术仅用于真正的声门或声门上气道梗阻，锐性分离由颈部或胸部焦痂引起的绞窄性或窒息性压迫，主要使用呼吸机维持动脉血氧分压高于60 mmHg并逆转其他难以控制的肺水肿，仅在明显支气管痉挛时单次静脉推注给予皮质类固醇，胃肠外抗生素治疗仅基于已确诊肺炎的痰液涂片和培养结果，绝不用作预防性用药。
