目的：大面积烧伤患者，特别是头颈部烧伤患者气管切开的时机以及气管切开指征需要进一步研究和探讨。方法：选择头颈部大面积烧伤患者，根据患者气管切开情况分为预防性和紧急性气管切开。对比两组患者气管切开手术时间以及手术指征。结果：预防性气管切开有57例，紧急气管切开有46例。其中预防性气管切开中度和重度吸入性损伤有41例，占71.93%；紧急气管切开中重度吸入性损伤患者有24例，占52.17%。预防性气管切开的手术时间是(5.51±1.28) h，紧急气管切开手术时间是(24.80±4.67) h。结论：中重度头颈部大面积烧伤患者要尽早进行预防性气管切开。没有进行预防性气管切开的患者发生气道损伤后24 h是气道梗阻的高发时间，应该要密切患者是否出现如呼吸道有大量粘稠分泌物，口鼻内有大量血清样渗出以及吸氧治疗，PaO2升高不明显， “鱼嘴状”口唇以及颈部焦痂形成等应该考虑为患者进行气管切开手术治疗。
The timing and indications of tracheotomy for the large head and neck areas burns patients
Objective: Review our clinical experiences in the treatment of large area burn. Discuss the timing and the indications of tracheotomy for the large area burn patients. Methods: By different tracheotomy timing the large area burn patients were divided into preventive and emergency tracheotomy. The tracheotomy operation time and the operation indications of two group patients were compared. Results: The preventive tracheotomy had 57 cases, while the emergency tracheotomy had 46 cases. The preventive tracheotomy for moderate and severe inhalation injury were 41 cases, 71.93%; emergency tracheotomy group with severe inhalation injury were 24 cases, 52.17%. The timing of preventive tracheotomy was (5.51+1.28) h, while the emergency tracheotomy operation time is (24.80+4.67) h. Conclusion: Severe large area burn patients should take the preventive tracheotomy. It’s high possibility that 24 h after injury the large area burn patients would have the airway obstruction. The indications for the tracheotomy are: a large number of respiratory sticky secretions, nose with large number of serum exudation and although during the oxygen therapy, the PaO2 of the patient was still not elevated. And the “fish mouth” lips and neck Escher formation also are the important operation indications for tracheotomy.