总结严重烧伤建立人工气道后气道梗阻识别与急救对策，以期提高疗效。

回顾性分析2011年2月至2015年2月郑州市第一人民医院烧伤科严重烧伤建立人工气道34例患者的临床资料，按照不同的治疗方法将患者分成观察组和对照组，各17例。对照组患者伤后立即给予吸氧、雾化等常规治疗；观察组患者伤后则先总结气道梗阻的原因，对气道内压力过高，呼吸机不能有效通气则考虑给予支气管镜检查等综合改善通气治疗。比较两组患者住院时间，气道再次梗阻发生率，吸痰、痰痂形成、刺激性咳嗽、气道黏膜损伤发生率，血氧饱和度、动脉氧分压、呼吸、脉搏，用力肺活量(FVC)、第一秒量(FEV1)、最高呼气流速(PEF)。应用SPSS15.0统计软件，相关指标比较采用t检验与χ²检验。

观察组的住院时间为(30.1±9.0) d显著短于对照组的(41.4±11.7) d，差异有统计学意义(t＝8.677，P＝0.032)；对照组气道再次梗阻发生率为41.18%，观察组为11.76%，两组比较差异有统计学意义(χ²＝8.946，P＝0.011)；对照组吸痰、痰痂形成、刺激性咳嗽、气道黏膜损伤发生率分别为47.06%、41.18%、64.71%、58.82%，观察组分别为11.76%、11.76%、17.65%、17.65%，比较差异均有统计学意义(P值均小于0.05)。对照组治疗后血氧饱和度、动脉氧分压、呼吸、脉搏分别为(89.68±8.45)%、(92.34±6.82)mmHg、(95.46±5.62)次/min、(95.46±5.62)次/min；观察组相对应分别为(95.34±7.23)%、(98.94±5.23)mmHg、(78.34±7.23)次/min、(16.46±1.67)次/min，治疗后观察组显著优于对照组，差异均有统计学意义(P值均小于0.05)；对照组治疗后FVC、FEV1、PEF分别为(3.01±0.61)、(2.24±0.81)、(7.11±1.41)L；观察治疗后相对应分别为(4.11±0.32)、(4.11±0.32)、(8.21±1.52)L，差异均有统计学意义(P值均小于0.05)。

早期气道梗阻识别并及时有效地通畅呼吸道能降低严重烧伤建立人工气道后气道梗阻的发生率，缩短住院时间，改善患者的肺功能。

To summarize the prevention and treatment of airway obstruction after severe airway injury in order to improve the effect.

The clinical data of 34 patients with severe air burns were analyzed retrospectively in department of burns, Zhengzhou First People′s Hospital from February 2011 to February 2015. According to different treatment methods, the patients will were divided into the observation group and the control group, 17 cases in each group. The control group were given the conventional treatment immediately after the injury, such as oxygen, atomization. The observation group after the injury, the reasons for airway obstruction was summarized firstly, the airway pressure was too high, ventilator could not be effective, ventilation was considerd to give the comprehensive improvement of ventilation treatment such as bronchoscopy. The length of hospital stay, the incidence of airway obstruction again, sucking phlegm, sputum scab formation, irritating cough, incidence of airway mucosa damage, blood oxygen saturation, arterial oxygen partial pressure, respiration, pulse, forced vital capacity (FVC), the first second (FEV1), the highest expiratory flow (PEF) were compared between the two groups. Using SPSS15.0 statistical software, relevant indicators were analyzed by t test and Chi-square test.

The length of hhospital stay was (30.1±9.0) d in the observation group was significantly shorter than that the control group (41.4±11.7) d, difference was statistically significant (t=8.677, P=0.032). The incidence of airway obstruction in the control group and observation group were 41.18%, 11.76%, the difference was statistically significant(χ²=8.946, P=0.011). The incidence of aspiration, sputum scab formation, irritating cough and airway mucosal injury in the control group were 47.06%, 41.18%, 64.71%, 58.82%, 11.76%, 11.76%, 17.65% and 17.65% respectively in the observation group, the differences were statistically significant(P values were all less than 0.05). After treatment, the oxygen saturation, arterial oxygen pressure, respiration and pulse in the control group were (89.68±8.45)%, (92.34±6.82) mmHg, (95.46±5.62) times/min, (95.46±5.62) times/min. The oxygen saturation, arterial oxygen pressure, respiration and pulse in the observation group were (95.34±7.23) %, (98.94±5.23) mmHg, (78.34±7.23) times/min, (16.46±1.67) times/min. There were significant differences between the two groups before and after treatment (P values were all less than 0.05). After treatment, the levels of FVC, FEV1 and PEF in the control group were (3.01±0.61), (2.24±0.81), (7.11±1.41) L. The levels of FVC, FEV1 and PEF in the observation group were (4.11±0.32), (4.11±0.32), (8.21±1.52) L, there were significant differences between the two groups (P values were all less than 0.05).

Early identification of airway obstruction and timely and effective airway can reduce the incidence of airway obstruction after severe airway injury, shorten the hospital stay and improve the lung function of patients.