Rue L W, Cioffi W G, Mason A D, McManus W F, Pruitt B A
US Army Institute of Surgical Research, Ft Sam Houston, Tex.
Arch Surg. 1993 Jul;128(7):772-8; discussion 778-80. doi: 10.1001/archsurg.1993.01420190066009.
To study a cohort of patients treated at the same institution and to compare that patient population with that of a previous report documenting the comorbidity of inhalation injury and pneumonia. Specifically, we wanted to determine whether there had been an improvement in survival of patients suffering inhalation injury.
A retrospective review.
The US Army Institute of Surgical Research, Ft Sam Houston, Tex, a 40-bed burn intensive care referral unit.
One thousand two hundred fifty-six thermally injured patients treated between January 1985 and December 1990.
A comparison of pneumonia frequency and ultimate survival of the current cohort of patients as compared with a previously generated stepwise logistic analysis predicting mortality on the basis of 1980 to 1984 patient data.
Of 1256 burned patients admitted between 1985 and 1990, there were 330 identified as having inhalation injury. These patients were older (35.0 vs 26.6 years) and had more extensive burns (41.1% vs 18.3%) and a higher mortality (29.4% vs 5.0%) than did the patients without inhalation injury. When compared with a mortality predictor generated from 1980 through 1984 patient data, patients in the most recent period had a lower mortality than predicted (29.4% vs 41.4%). Patients with less severe injury (positive xenon scan, negative results of bronchoscopy; n = 85), although having a similar incidence of pneumonia (13.1% vs 19.5%) as the same group from 1980 through 1984, accounted for the most improvement in survival. The 3.6% mortality was significantly less than the predicted rate of 15.7%. Patients with positive results of bronchoscopy (n = 245) also showed some improvement in outcome from that predicted (38.3% vs 50.2%) despite no change in the rate of pneumonia (46.9% vs 48.5%). Further improvement in survival was realized in those patients supported with high-frequency ventilation. Although their age (33.9 vs 36.3 years), burn size (46.0% vs 45.5%), and duration of intubation (16.8 vs 15.1 days) were similar to those of conventionally treated patients, mortality was significantly less than predicted (16.4% vs 40.9%) and less than that in patients treated with conventional ventilation (16.4% vs 42.7%).
The improvement in survival of patients with inhalation injury represents the aggregate effects of the general improvement and outcome of all burned patients, the prevention of pneumonia by high-frequency ventilation, and the reduced mortality from the pneumonias that did occur.
研究在同一机构接受治疗的一组患者，并将该患者群体与之前一份记录吸入性损伤和肺炎合并症的报告中的患者群体进行比较。具体而言，我们想确定吸入性损伤患者的生存率是否有所提高。
回顾性研究。
德克萨斯州萨姆休斯顿堡的美国陆军外科研究所，一家拥有40张床位的烧伤重症监护转诊单位。
1985年1月至1990年12月期间接受治疗的1256名热烧伤患者。
将当前这组患者的肺炎发生率和最终生存率与之前根据1980年至1984年患者数据生成的预测死亡率的逐步逻辑分析结果进行比较。
在1985年至1990年收治的1256名烧伤患者中，有330名被确定为有吸入性损伤。这些患者比没有吸入性损伤的患者年龄更大（35.0岁对26.6岁），烧伤面积更广（41.1%对18.3%），死亡率更高（29.4%对5.0%）。与根据1980年至1984年患者数据生成的死亡率预测模型相比，最近一段时间的患者死亡率低于预测值（29.4%对41.4%）。损伤较轻的患者（氙扫描阳性，支气管镜检查结果阴性；n = 85），尽管肺炎发生率与1980年至1984年的同一组患者相似（13.1%对19.5%），但其生存率改善最为明显。3.6%的死亡率显著低于预测的15.7%。支气管镜检查结果阳性的患者（n = 245）尽管肺炎发生率没有变化（46.9%对48.5%），但其预后也比预测的有所改善（38.3%对50.2%）。接受高频通气支持的患者生存率进一步提高。尽管他们的年龄（33.9岁对36.3岁）、烧伤面积（46.0%对45.5%）和插管时间（16.8天对15.1天）与接受传统治疗的患者相似，但其死亡率显著低于预测值（16.4%对40.9%），也低于接受传统通气治疗的患者（16.4%对42.7%）。
吸入性损伤患者生存率的提高代表了所有烧伤患者总体改善和预后的综合影响、高频通气预防肺炎以及已发生肺炎导致的死亡率降低。
