Abstract:

Objective　To explore the pathogenesis and diagnosis and treatment methods of mediastinal emphysema, subcutaneous emphysema, and pneumothorax in children with severe burn during the perioperative period. Methods　On June 2, 2023, Chengcheng Hospital, Xiamen University admitted a child with severe burn who developed mediastinal emphysema, subcutaneous emphysema, and pneumothorax during the perioperative period. Anesthesia resuscitation and symptomatic management were retrospectively analyzed, and relevant literatures were reviewed. Results　The girl, 6-years-old, with body weight of 26 kg, was diagnosed as 22% of hydrothermal burns, degree Ⅱ-Ⅲ. The wounds were located in the head, face and neck, front and back trunk, right upper limb, and right lower limb. The main causes of mediastinal emphysema after pediatric severe burn were thick and difficult-to-expel sputum and high local alveolar pressure caused by various factors. Perioperative bedside X-ray and CT scans facilitated early diagnosis. The girl underwent perioperative bronchoscopy, bronchoalveolar lavage, and sputum aspiration to reduce airway pressure, and tension subcutaneous emphysema was managed with subcutaneous incision. The girl regained spontaneous breathing and was successfully extubated in the ICU without any anesthesia related complication during follow-up. Conclusions　Early diagnosis of mediastinal emphysema in children with severe burn during the perioperative period, combined with timely application of effective treatment methods, is conducive to a smooth perioperative transition for children.

Key words:

Burn, Children, Mediastinal emphysema, Subcutaneous emphysema, Pneumothorax, Perioperative period

摘要：

目的　探讨重度烧伤小儿围手术期发生纵隔气肿、皮下气肿、气胸的发病机制及诊疗方法。方法　厦门大学附属成功医院2023年6月2日收治小儿重度烧伤1例，患儿围手术期合并纵隔气肿、皮下气肿、气胸，回顾性分析麻醉复苏及对症处理，并复习相关文献。结果　患儿女，6岁，体重26 kg，以“热液烧伤22%，Ⅱ～Ⅲ度”为诊断，创面位于头面颈、前后躯干、右上肢、右下肢。小儿重度烧伤术后多种因素致痰液黏稠、不易排出、局部肺泡压力过高等为纵隔气肿主要诱因。围手术期床边X线及CT明确诊断，通过围手术期支气管镜检查、支气管灌洗吸痰降低气道压，皮下切开缓解张力性皮下气肿等。患儿自主呼吸恢复后拔除气管导管，术后随访无麻醉相关并发症。结论　小儿重度烧伤围手术期合并纵隔气肿应早期诊断，根据临床症状早期对症治疗有利于患儿围手术期平稳转归。

关键词:

烧伤, 小儿, 纵隔气肿, 皮下气肿, 气胸, 围手术期