切换至 "中华医学电子期刊资源库"

中华损伤与修复杂志(电子版) ›› 2018, Vol. 13 ›› Issue (06) : 410 -415. doi: 10.3877/cma.j.issn.1673-9450.2018.06.003

所属专题: 文献 指南共识

指南与共识

吸入性损伤临床诊疗全国专家共识(2018版)
中国老年医学学会烧创伤分会, 郭光华1,(), 朱峰2, 黄跃生3,(), 吴军4, 孙永华5, 夏照帆2, 付小兵6   
  1. 1. 南昌大学第一附属医院
    2. 海军军医大学第一附属医院
    3. 陆军军医大学(第三军医大学)第一附属医院
    4. 中山大学附属第一医院
    5. 北京积水潭医院
    6. 解放军总医院
  • 收稿日期:2018-10-09 出版日期:2018-12-01
  • 通信作者: 郭光华, 黄跃生

National experts consensus on clinical diagnosis and treatment of inhalation injury (2018 version)

The Burn and Trauma Branch of Chinese Geriatrics Society, Guanghua Guo1,(), Feng Zhu2, Yuesheng Huang3,(), Jun Wu4, Yonghua Sun5, Zhaofan Xia2, Xiaobing Fu6   

  1. 1. First Affiliated Hospital of Nanchang University
    2. First Affiliated Hospital of Naval Military Medical University
    3. First Affiliated Hospital of Army Medical University (Third Military Medical University)
    4. First Affiliated Hospital, Sun Yat-sen University
    5. Beijing Jishuitan Hospital
    6. People′s Liberation Army General Hospital
  • Received:2018-10-09 Published:2018-12-01
  • Corresponding author: Guanghua Guo, Yuesheng Huang
  • About author:

    Proof writing:

    Proof writing:

    Proof writing:

    Proof writing:

    Proof writing:

    Proof writing:

    Proof writing:

    Corresponding authors: Huang Yuesheng, 400038 Chongqing, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Email:
    Guo Guanghua, 330006 Nanchang, Department of Burns, the First Affiliated Hospital of Nanchang University, Email:
引用本文:

中国老年医学学会烧创伤分会, 郭光华, 朱峰, 黄跃生, 吴军, 孙永华, 夏照帆, 付小兵. 吸入性损伤临床诊疗全国专家共识(2018版)[J]. 中华损伤与修复杂志(电子版), 2018, 13(06): 410-415.

The Burn and Trauma Branch of Chinese Geriatrics Society, Guanghua Guo, Feng Zhu, Yuesheng Huang, Jun Wu, Yonghua Sun, Zhaofan Xia, Xiaobing Fu. National experts consensus on clinical diagnosis and treatment of inhalation injury (2018 version)[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2018, 13(06): 410-415.

吸入性损伤是由于热力、有毒或刺激性气体吸入引起的呼吸道和肺实质的损伤。目前临床对其认识仍较局限,缺乏有效的诊治规范。本文根据国内已形成的吸入性损伤诊治经验,结合国外的相关研究报道,从吸入性损伤的病理、病理生理改变,临床诊断和评估以及临床治疗等3个方面,系统介绍了吸入性损伤规范化的临床处理措施,为临床诊治提供参考。

Inhalation injury is caused by inhalation of heat, toxic or irritating gases which lead to respiratory and pulmonary parenchyma damage. At present, the clinical understanding about it is still limited and lack of effective diagnosis and treatment standard. Based on the experience of diagnosis and treatment of domestic inhalation injury, combined with reports of international researches, criteria (expert consensus) for inhalation injury were systematically discussed from pathological and pathophysiological changes, clinical diagnosis and evaluation, and clinical treatment, which provides reference for clinical diagnosis and treatment of patients inflicted with inhalation injury.

表1 基于FOB的吸入性损伤AIS分级系统
表2 吸入性损伤的RADS评分(分)
表3 急性呼吸窘迫综合征的柏林诊断标准
[1]
Tanizaki S. Assessing inhalation injury in the emergency room [J]. Open Access Emerg Med, 2015, 7:31-37.
[2]
Antonio AC, Castro PS, Freire LO. Smoke inhalation injury during enclosed-space fires: an update[J]. J Bras Pneumol, 2013, 39(3):373-381.
[3]
Enkhbaatar P, Pruitt BA Jr, Suman O, et al. Pathophysiology, research challenges, and clinical management of smoke inhalation injury[J]. Lancet, 2016, 388(10052):1437-1446.
[4]
Albright JM, Davis CS, Bird MD, et al. The acute pulmonary inflammatory response to the graded severity of smoke inhalation injury[J]. Crit Care Med, 2012, 40(4):1113-1121.
[5]
Mosier MJ, Pham TN, Park DR, et al. Predictive value of bronchoscopy in assessing the severity of inhalation injury[J]. J Burn Care Res, 2012, 33(1):65-73.
[6]
Patel PH. Calculated decisions: RADS (Radiologist′s Score) for smoke inhalation injury[J]. Emerg Med Pract, 2018, 20(3 Suppl):S3-S4.
[7]
王小亭,刘大为,于凯江,等. 中国重症超声专家共识[J]. 中华内科杂志,2016, 55(11):900-912.
[8]
床旁超声在急危重症临床应用专家共识组. 床旁超声在急危重症临床应用的专家共识[J]. 中华急诊医学杂志,2016, 25(1):10-21.
[9]
ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition[J]. JAMA, 2012, 307(23):2526-2533.
[10]
郭光华,孙威. 吸入性损伤气道内给药目标靶向治疗[J].中华烧伤杂志,2018, 34(7):445-449.
[11]
中国医师协会急诊医师分会,中国人民解放军急救医学专业委员会,北京急诊医学学会,等. 雾化吸入疗法急诊临床应用专家共识(2018)[J]. 中国急救医学,2018, 38(7):565-574.
[12]
Batchinsky AI, Burkett SE, Zanders TB, et al. Comparison of airway pressure release ventilation to conventional mechanical ventilation in the early management of smoke inhalation injury in swine[J]. Crit Care Med, 2011, 39(10):2314-2321.
[13]
Terragni PP, Rosboch GL, Lisi A, et al. How respiratory system mechanics may help in minimising ventilator-induced lung injury in ARDS patients[J] . Eur Respir J Suppl, 2003, 42 Suppl:S15-S21.
[14]
Sousse LE, Herndon DN, Andersen CR, et al. High tidal volume decreases adult respiratory distress syndrome, atelectasis, and ventilator days compared with low tidal volume in pediatric burned patients with inhalation injury[J]. J Am Coll Surg, 2015, 220(4):570-578.
[15]
Asmussen S, Maybauer DM, Fraser JF, et al. Extracorporeal membrane oxygenation in burn and smoke inhalation injury[J]. Burns, 2013, 39(3):429-435.
[16]
郭光华. 重度吸入性损伤的呼吸支持与治疗[J]. 中华烧伤杂志,2013, 29(2):134-138.
[17]
中华医学会重症医学分会. 中国成人ICU镇痛和镇静治疗指南[J/OL]. 中华重症医学电子杂志(网络版), 2018, 4(2):90-113.
[18]
Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit[J]. Crit Care Med, 2013, 41(1):263-306.
[19]
邱海波. 重症患者的镇痛和镇静:以疾病为导向[J]. 中华内科杂志,2013, 52(4):279-281.
[20]
Vincent JL, Shehabi Y, Walsh TS, et al. Comfort and patient-centred care without excessive sedation: the eCASH concept[J]. Intensive Care Med, 2016, 42(6):962-971.
[21]
Neamu RF, Martin GS. Fluid management in acute respiratory distress syndrome[J]. Curr Opin Crit Care, 2013, 19(1):24-30.
[22]
郭光华,朱峰. 重视功能性血流动力学监测在烧创伤重症监护中的应用[J]. 中华烧伤杂志,2014(4):291-294.
[23]
Chinese XDR Consensus Working Group, Guan X, He L, et al. Laboratory diagnosis, clinical management and infection control of the infections caused by extensively drug-resistant Gram-negative bacilli: a Chinese consensus statement[J]. Clin Microbiol Infect, 2016, 22 Suppl 1:S15-S25.
[24]
Rollins C, Huettner F, Neumeister MW. Clinician′s guide to nutritional therapy following major burn injury[J]. Clin Plast Surg, 2017, 44(3):555-566.
[25]
ISBI Practice Guidelines Committee, Steering Subcommittee, Advisory Subcommittee. ISBI practice guidelines for burn care[J].Burns, 2016, 42(5):953-1021.
[26]
Wu PE, Juurlink DN. Carbon monoxide poisoning[J]. CMAJ, 2014, 186(8):611.
[27]
Walker PF, Buehner MF, Wood LA, et al. Diagnosis and management of inhalation injury: an updated review[J]. Crit Care, 2015, 19:351.
[1] 杨水华, 何桂丹, 覃桂灿, 梁蒙凤, 罗艳合, 李雪芹, 唐娟松. 胎儿孤立性完全型肺静脉异位引流的超声心动图特征及高分辨率血流联合时间-空间相关成像的应用[J]. 中华医学超声杂志(电子版), 2023, 20(10): 1061-1067.
[2] 王得晨, 杨康, 杨自杰, 归明彬, 屈莲平, 张小凤, 高峰. 结直肠癌微卫星稳定状态和程序性死亡、吲哚胺2,3-双加氧酶关系的研究进展[J]. 中华普通外科学文献(电子版), 2023, 17(06): 462-465.
[3] 彭旭, 邵永孚, 李铎, 邹瑞, 邢贞明. 结肠肝曲癌的诊断和外科治疗[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 108-110.
[4] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[5] 李智铭, 郭晨明, 庄晓晨, 候雪琴, 高军喜. 早期乳腺癌超声造影定性及定量指标的对比研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 639-643.
[6] 张海涛, 康婵娟, 翟静洁. 胰管支架置入治疗急性胆源性胰腺炎效果观察[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 654-657.
[7] 杨雪, 张伟, 尚培中, 宋创业, 尚丹丹, 张蔚. 胆囊十二指肠瘘结石经瘘口排出后自愈一例报道[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 707-708.
[8] 孔博, 张璟, 吕珂. 超声技术在复杂腹壁疝诊治中的作用[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 670-673.
[9] 姜明, 罗锐, 龙成超. 闭孔疝的诊断与治疗:10年73例患者诊疗经验总结[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 706-710.
[10] 袁媛, 赵良平, 刘智慧, 张丽萍, 谭丽梅, 閤梦琴. 子宫内膜癌组织中miR-25-3p、PTEN的表达及与病理参数的关系[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1016-1020.
[11] 陆志峰, 周佳佳, 梁舒. 虚拟现实技术在治疗弱视中的临床应用研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 891-895.
[12] 李田, 徐洪, 刘和亮. 尘肺病的相关研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 900-905.
[13] 岳瑞雪, 孔令欣, 郝鑫, 杨进强, 韩猛, 崔国忠, 王建军, 张志生, 孔凡庭, 张维, 何文博, 李现桥, 周新平, 徐东宏, 胡崇珠. 乳腺癌HER2蛋白表达水平预测新辅助治疗疗效的真实世界研究[J]. 中华临床医师杂志(电子版), 2023, 17(07): 765-770.
[14] 周婷, 孙培培, 张二明, 安欣华, 向平超. 北京市石景山区40岁及以上居民慢性阻塞性肺疾病诊断现状调查[J]. 中华临床医师杂志(电子版), 2023, 17(07): 790-797.
[15] 符梅沙, 周玉华, 李慧, 薛春颜. 淋巴细胞免疫治疗对复发性流产患者外周血T淋巴细胞亚群分布与PD1/PD-L1表达的影响及意义[J]. 中华临床医师杂志(电子版), 2023, 17(06): 726-730.
阅读次数
全文


摘要