救治56例小兒煙霧吸入性肺損傷的臨床體會

張素平+陳向堅

【摘要】 目的：探討小兒煙霧吸入性肺損傷的臨床特點及治療效果。方法：觀察56例煙霧吸入性肺損傷患兒治療前后臨床表現的變化，比較治療前后血常規、C-反應蛋白、血氣分析及影像學表現。結果：治療后患兒的臨床癥狀、體征及影像學表現均明顯好轉。治療后，外周血白細胞（WBC）、中性粒細胞（N）計數及C-反應蛋白（CRP）與治療前比較均有下降趨勢，差異均有統計學意義（P<0.05）。治療后的pH值高于治療前，差異有統計學意義（P<0.05）。治療后的PO2及PaCO2與治療前比較，差異均無統計學意義（P>0.05）。結論：由于吸入的煙霧可直接損害機體并可能導致各種嚴重并發癥，且由于小兒呼吸系統解剖、生理、免疫特點的特殊性，故煙霧吸入性肺損傷患兒，應及時脫離接觸，早期行有效聯合治療，從而確保患兒生命安全。

【關鍵詞】 小兒煙霧吸入； 肺損傷； 治療

Clinical Experience of Treating 56 Cases of Smoke Inhalation Lung Injury in Children/ZHANG Su-ping，CHEN Xiang-jian.//Medical Innovation of China，2017，14（22）：025-028

【Abstract】 Objective：To investigate the clinical characteristics and treatment effects of smoke inhalation lung injury in children.Method：The changes of clinical symptoms，signs were observed in 56 children of smoke inhalation lung injury，and the changes of routine blood test，C-reactive protein，blood gas analysis and imaging features were compared before and after treatment.Result：After treatment，the childrens clinical symptoms，signs and imaging manifestations were significantly improved.After treatment，the peripheral white blood cell（WBC），neutrophil count（N） and C-reactive protein（CRP） were decreased，compared with before treatment，the differences were statistically significant（P<0.05）.After treatment，pH was higher than before treatment，the difference was statistically significant（P<0.05）.After the treatment，PO2 and PaCO2 compared with before treatment，there were no significant differences（P>0.05）.Conclusion：Due to the inhalation of smoke can damage the body directly and may lead to kinds of serious complications，and because of the particularity of anatomy in respiratory system，physiological and immunological characteristics of children，so children with smoke inhalation lung injury，should be out of contact in time，cured by useful combined treatments，so as to ensure childrens life security.

【Key words】 Smoke inhalation in children； Lung injury； Treatment

First-authors address：Ningde Municipal Hospital，Ningde 352100，China

doi：10.3969/j.issn.1674-4985.2017.22.007

煙霧吸入性肺損傷是目前火災、爆炸等突發事故中造成患者死亡的主要原因之一。火災中的中毒氣體、顆粒等直接因素，可嚴重損傷呼吸道，而在缺氧環境的共同作用下使病情進展加劇，從而產生各種嚴重并發癥，可危及患兒生命，故給救治工作帶來極大的麻煩[1]。有研究表明，單是吸入性肺損傷就可使燒傷患者病死率增加20%，若吸入性損傷后合并肺部感染，則病死率增加60%[2]。故如何提高煙霧吸入性肺損傷救治成功率顯得尤為重要。2015年本市某區商廈一樓商行失火，煙霧熏至二樓幼兒園，其中56例患兒轉來本科室搶救治療。經及時撤離并積極及時有效的綜合治療，56例患兒均未出現嚴重并發癥及死亡病例。現將本科室治療小兒煙霧吸入性肺損傷的臨床體會報告如下。……