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病例男,34岁,全身火焰烧伤7 h 后入院。室内受伤,伤后无尿。查体:体温35.5℃、脉搏140次/min、呼吸40次/min。意识清楚,烦躁,有声嘶、喘鸣,口唇肿胀、鼻毛烧焦,口咽部红肿、有黑色粉尘。两肺呼吸音低,有干鸣,心音低钝,肢端冰凉,足背动脉搏动消失。创面分布于面、颈、躯干、四肢。入院诊断:火焰烧伤80%,深Ⅱ度40%、Ⅲ度40%,中度吸入性损伤、烧伤休克。立即行抗休克、抗感染。伤后10 h 自述呼吸困难,有张口呼吸、鼻翼煽动,立即行气管切开、胸部焦痂切开减张,呼吸困难缓解,但呼吸道分泌物多。伤后12 h 休克复苏。创面外涂1%SD-Ag。伤后19 h
Male, 34 years old, admitted to hospital after 7 h of flame burn. Indoor injury, no urine after injury. Physical examination: body temperature 35.5 ℃, pulse 140 beats / min, breathing 40 beats / min. Consciousness, irritability, hoarseness, wheezing, swollen lips, burnt nose, swollen oropharyngeal, black dust. Low breath sounds of both lungs, dry Ming, low heart sound blunt, cold extremities, foot dorsal artery pulse disappeared. Wound distribution in the face, neck, trunk, limbs. Admission diagnosis: flame burn 80%, deep Ⅱ degree 40%, Ⅲ degree 40%, moderate inhalation injury, burn shock. Immediate anti-shock, anti-infection. Respiratory dysfunction 10d after injury, Zhang mouth breathing, nasal incitement, tracheotomy immediately, thoracic eschar incision and relaxation, difficulty breathing, but more respiratory secretions. Shock recovery 12 h after injury. The wound was coated with 1% SD-Ag. 19 h after injury