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  • Title: [Analysis on treatment of extremely severe burn patients with severe inhalation injury in August 2nd Kunshan factory aluminum dust explosion accident].
    Author: Zhang YH, Guo GH, Shen GL, Han W, Zhao XY, Lin W, Huang CH, Xu J, Fan SW, Qian HG.
    Journal: Zhonghua Shao Shang Za Zhi; 2018 Jul 20; 34(7):455-458. PubMed ID: 30060347.
    Abstract:
    Objective: To summarize the measures and experience in diagnosis and treatment of extremely severe burn patients with severe inhalation injury in dust explosion accident. Methods: The medical records of 13 patients with extremely severe burn complicated with severe inhalation injury in August 2nd Kunshan factory aluminum dust explosion accident who were treated at the First Affiliated Hospital of Soochow University (hereinafter referred to as our hospital) on August 2nd, 2014, were retrospectively analyzed. All the patients were transferred to our hospital 3-8 hours after injury under the condition of inhalation of pure oxygen. Twelve patients underwent tracheotomy within 5 hours after admission, while 1 patient underwent tracheotomy before admission. All the patients were in ventilator-assisted respiration, with synchronized intermittent mandatory ventilation combined with positive end expiratory pressure. All the patients underwent thorax or limbs escharotomy on the second day after admission, so as to reduce the restrictive ventilatory dysfunction caused by the contraction of thorax eschar and the terminal circulation disorder caused by the contraction of limbs eschar. All the patients underwent electronic bronchoscopy within 48 hours after admission, airway secretion were cleared and airway lavage were carried out under electronic bronchoscope according to the patients' condition, and the sputum, lavage solution, pathological tissue were collected for microbiological culture. All the patients underwent chest X-ray examination on the second day after admission and reexamination as required. Patients were all treated with a combination of broad-spectrum antibiotics early after admission to control lung and systemic infection. One patient was treated with extracorporeal membrane oxygenation for acute respiratory distress syndrome 1 week after admission. Results: One patient suffered from cardiopulmonary arrest during tracheotomy, which recovered autonomous respiration and cardiac impulse after cardiopulmonary resuscitation. Three patients showed decreased pulse oxygen saturation (SpO(2)) within 48 hours after injury, and the SpO(2) returned to normal after sputum aspiration, scab removal and lavage under electronic bronchoscope. During the course of disease, bacteria were cultured from wound exudate of 7 patients, bacteremia occurred in 10 patients, and sputum microbiological culture results of 13 patients were positive. Eight of the 13 patients in this group survived, and 5 died. One patient died 19 days after injury, and 4 patients died 33-46 days after injury. The main cause of death was multiple organ dysfunction syndrome induced by severe septic shock eventually. Conclusions: For this batch of patients with extremely severe burn complicated with severe inhalation injury caused by dust explosion accident, the treatment and cure measures including early definite diagnosis and timely tracheotomy, the application of effective ventilation, the effective treatment of respiratory system complications, and rational use of antibiotics for the control of lung infection obtained quite good curative effect. 目的： 总结粉尘爆炸事故中特重度烧伤患者重度吸入性损伤的诊疗措施和经验。 方法： 回顾性分析苏州大学附属第一医院(下称笔者单位)于2014年8月2日救治的"八二"昆山工厂铝粉尘爆炸事故13例特重度烧伤合并重度吸入性损伤患者的病历资料。患者均在吸入纯氧状态下于伤后3~8 h转运至笔者单位。除1例患者在入院前行气管切开外，其余12例患者均在入院后5 h内行气管切开术；患者均应用呼吸机辅助呼吸，通气模式为同步间歇指令通气模式联合呼气末正压通气。患者均于入院后第2天切开胸廓或四肢焦痂，减轻胸廓焦痂收缩产生的限制性通气功能障碍及四肢焦痂收缩产生的末端循环障碍。患者均于入院后48 h内开展电子支气管镜检查，后根据病情需要于电子支气管镜下清除气道分泌物及灌洗，并取痰液、灌洗液、病变组织行微生物培养。患者均于入院后第2天行胸部X线检查并据病情需要复查。患者均于入院后早期联合应用广谱抗生素控制肺部及全身感染。1例患者于入院后1周因急性呼吸窘迫综合征行体外膜肺氧合治疗。 结果： 1例患者气管切开过程中呼吸心搏骤停，经心肺复苏后恢复自主呼吸及心脏搏动。伤后48 h内3例患者出现脉搏血氧饱和度(SpO(2))下降现象，经电子支气管镜下吸痰、取痂、灌洗治疗后SpO(2)恢复正常。病程中7例患者创面分泌物培养出细菌，10例患者出现菌血症，13例患者痰微生物培养阳性。本组13例患者存活8例，死亡5例，其中伤后19 d死亡1例，伤后33~46 d死亡4例，5例患者主要死亡原因均为严重感染性休克最终导致多器官功能障碍综合征。 结论： 针对本批粉尘爆炸所致特重度烧伤患者合并的重度吸入性损伤，早期明确诊断并及时行气管切开且采取有效的通气方式，积极有效处理呼吸系统相关并发症，合理应用抗生素控制肺部感染，取得了较好的治疗效果。.
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