周金武 程哲 李泰昌

【摘 要】目的：观测儿童重症烧烫伤后早期气管切开术的安全性和有效性。方法：通过对我科2013～2015年（组Ⅰ）和2016～2018年（组Ⅱ）收治的两组儿童重症烧烫伤患儿早期气管切开适应证标准的不同，对比分析两组病例气管切开术的并发症发生率、气管切开术后24小时辅助通气的比例，治愈率。结果：儿童重症烧烫伤后早期气管切开术无致死性术中并发症，早期气管切开术后并发症少，明显改善通气、可减少辅助通气及镇静镇痛药，降低死亡率。结论：儿童重症烧烫伤后早期气管切开术并发症少，便于行辅助通气，减少呼吸困难或窒息时紧急气管切开术仓促及呼吸骤停的风险，儿童重症烧烫伤后早期气管切开术是安全、有效的。

【关键词】 儿童烧伤；气管切开术 ；并发症； 对比研究

【中图分类号】R365 【文献标志码】A 【文章编号】1005-0019（2018）17-208-01

Abstract Objective：To observe the safety and efficacy of early tracheotomy in children with severe burns. Methods：The indirect indications of early tracheotomy in children with severe burns and scald in our group from 2013 to 2015 （group I） and 2016 to 2018 （group II） were compared. The tracheotomy of the two groups was compared. The incidence of complications， the proportion of assisted ventilation 24 hours after tracheotomy， and the cure rate. Results：Early tracheotomy in children with severe burns had no fatal intraoperative complications. There were few complications after early tracheotomy， which significantly improved ventilation， reduced auxiliary ventilation and sedative analgesics， and reduced mortality. Conclusions：Early tracheotomy in children with severe burns and scalds has fewer complications， which is convenient for assisted ventilation， reducing the risk of rush and sudden cessation of emergency tracheotomy during dyspnea or asphyxia. Early tracheotomy after severe burns in children is Safe and effective.

Key words：Child burn Tracheotomy Complications Comparative study

儿童重症烧烫伤后，因早期重度休克、或有吸入性损伤、面颈部位深度烧伤，后期因感染性全身炎症反应、脓毒症性肺损伤或肺功能不全和急性呼吸窘迫综合征等，需要解除呼吸道梗阻或辅助通气，气管插管常用，长时间的气管插管副作用大，不利于儿童重症烧烫伤的救治[1]。本研究通过观察两个时期收治的两组儿童重症烧烫伤患儿早期气管切开适应证标准的不同，对比分析，观测儿童重症烧烫伤后早期气管切开术的安全性和有效性，报告如下：

1 资料与方法

1.1 临床资料 我科2013～2015年（组Ⅰ）和2016～2018年（组Ⅱ）收治的两组儿童重症烧烫伤患者126例……