陈佳丽　　王晓琼　　蒋梦诗　　王珊　　林荣海

[摘要] 目的 探討机械通气序贯疗法治疗烧伤引起的吸入性急性肺损伤的临床疗效。 方法 选取我科2019年2—10月收治的82例烧伤引发的吸入性急性肺损伤的患者，将所有患者随机分为序贯组和对照组，两组患者均行气管插管，建立人工气道，序贯组在达到患者病情稳定、意识清楚、临床指标也符合一定要求后，拔管改为面罩无创通气。而对照组一直使用有创通气，并根据病情调整呼吸机参数。比较序贯治疗组拔管前与拔管24 h后血气分析结果的差异。并比较两组患者呼吸机相关肺炎（VAP）发生率、有创通气时间、总机械通气时间、住院时间、撤机成功率及病死率。 结果 序贯组患者30 d内死亡3例，病死率为6.97%，对照组病死率为23.08%，较对照组明显下降（P<0.05）。序贯组拔管前和拔管24 h后的血气分析比较，差异无统计学意义（P>0.05）;序贯组患者的VAP、有创通气时间、总通气时间、住院时间、撤机成功率以及病死率较对照组明显减少，差异有统计学意义（P<0.05）。 结论 序贯机械通气治疗吸入性肺损伤，显著降低了VAP发生率，有创机械通气时间，缩短了住院时间，降低病死率，提升患者生存空间，值得临床应用。

[关键词] 序贯疗法;机械通气;无创机械通气;烧伤;急性肺损伤

[中图分类号] 562.2          [文献标识码] B          [文章编号] 1673-9701（2021）10-0106-04

Observation on the efficacy of sequential mechanical ventilation on inhalation acute pulmonary injury induced by burn

CHEN Jiali   WANG Xiaoqiong    JIANG  Mengshi    WANG  Shan    LIN  Ronghai

Department of Critical Care Medicine， Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University， Linhai   317000， China

[Abstract] Objective To explore the clinical efficacy of sequential mechanical ventilation on inhalation acute pulmonary injury induced by burn. Methods A total of 82 cases of patients with burn-induced acute pulmonary injury were randomLy divided into the sequential group and the control group.Patients in the two groups were intubated and artificial airway was established.After the patients in the sequential group were in a stable condition，with clear consciousness， and the clinical indexes met certain requirements，the tube was removed and changed to mask non-invasive ventilation in the sequential group. In the control group，invasive ventilation was always used， and the ventilator parameters were adjusted according to the patient′s condition. The differences of blood gas analysis results before and 24 h after extubation in the sequential treatment group were compared. The incidence of ventilator-associated pneumonia（VAP）， invasive ventilation time， total mechanical ventilation time， hospitalization time， success rate of weaning and mortality rate were compared between the two groups. Results Three patients died within 30 d in the sequential group，with the mortality rate of 6.97%， which was significantly lower than 23.08% in the control group（P<0.05）.There was no statistically significant difference in blood gas analysis results before and after 24 h of extubation in the sequential group（P>0.05）.The VAP，invasive ventilation time， total ventilation time， hospitalization time，success rate of weaning of ventilator and mortality rate of patients in the sequential group were significantly lower than those in the control group，with statistically significant differences（P<0.05）. Conclusion Sequential mechanical ventilation can significantly reduce the incidence of VAP， shorten the hospitalization time， reduce the mortality rate and improve the living space of patients， which is worthy of clinical application.

[Key words] Sequential therapy; Mechanical ventilation; Noninvasive mechanical ventilation; Burn; Acute pulmonary injury

烧伤后，由于吸入性损伤、休克、感染等因素的影响，容易引起呼吸道乃至肺实质的急性肺损伤（Acute lung injury，ALI），临床上患者常出现肺容积减少、呼吸窘迫等癥状，严重者可发展为急性呼吸窘迫综合征（Acute respiratory distress syndrome，ARDS），而ALI/ARDS为临床重症之一，救治比较棘手[1]。临床表现以顽固性低氧血症和呼吸窘迫为特征，主要以改善通气、纠正缺氧为主要治疗措施，避免发生急性呼吸窘迫综合征，从而降低病死率。机械通气是改善缺氧状态的一种重要方法，能有效地改善患者预后，提高治愈率[2]。……