Clinical Evaluation Of Early Assessment Of Severity Of Inhalation Lung Injury Induced By Smoke Bomb

Objectives:The Arterial Blood gas analysis?PH,PaO₂,PaCO₂?,Blood routine?leukocyte,neutrophils percentage?,blood CRP,chest CT radiologist score?RADS?,bronchial wall thickness?BWT?of right upper lobe bronchial trunk and bronchoscopic score for the first time in patients with inhalation lung injury induced by smoke bomb were analyzed.To explore the prognostic indicators of smoke bomb-induced inhalation lung injury in early stage,the relationship between smoke bomb-induced inhalation lung injury and the severity of the disease and the occurrence of acute respiratory distress syndrome?ARDS?in patients undergoing tracheal intubation ventilation.Methods:A retrospective single-center study was conducted to select 59 patients with inhalation lung injury caused by smoke bomb in our hospital from March 2016 to August 2016.All patients completed at least one bronchoscopic examination during outpatient or inpatient treatment in our hospital to determine the presence of inhalation lung injury.Within 24 hours of onset,blood gas analysis,blood routine,C-reactive protein and chest CT scan were performed.The correlation between arterial blood gas analysis?PH,PaO₂,PaCO₂?,blood routine?white blood cells,percentage of neutrophils?,blood C-reactive protein,chest CT radiologist score?RADS?,bronchoscopic score,bronchial wall thickness?BWT?of the right upper lobe bronchial trunk and the severity of the disease was analyzed.Logistic analysis and ROC curve were used to compare the diagnostic value of these indicators in predicting ARDS patients undergoing tracheal intubation and ventilator-assisted ventilation.Results:1.The results of arterial blood gas analysis showed that there was no significant difference in PH and PaCO₂ between mild group,moderate group and severe group?P>0.05?.In terms of PaO₂,there was significant difference between mild group and severe group,moderate group and severe group?P<0.05?,while there was no significant difference between mild group and moderate group?P>0.05?.2.The percentage of WBC and neutrophil in mild group was significantly lower than that in moderate group and severe group?P<0.001?;the percentage of WBC and neutrophil in moderate group was significantly lower than that in severe group?P<0.001?;the difference between mild group and severe group,moderate group and severe group was significant?P<0.01?;and the difference between mild group and moderate group was not significant?P<0.01?.Academic significance,P=0.134.3.RADS score and bronchoscopic score in mild group were significantly lower than those in moderate group and severe group?P<0.001?;RADS score and bronchoscopic score in moderate group were significantly lower than those in severe group?P<0.001?.Different degrees of inhalation lung injury can be observed by chest CT and bronchoscope.The manifestations of bronchoscope and chest CT have their own characteristics.Among them,one patient with mild inhalation lung injury under bronchoscope quickly developed to ARDS with tracheal intubation and ventilator-assisted ventilation.Two patients with mild inhalation lung injury on chest CT images did not undergo bronchoscopy on the first day of admission,and severe inhalation injury on the fourth day after bronchoscopy.The main airway stenosis remained after active treatment.4.The average bronchial wall thickness of all patients at admission was?2.35+1.43?mm.The bronchial wall thickness of mild group,moderate group and severe group were?1.82+0.39?mm,?2.68+0.88?mm and?6.39+1.57?mm,respectively.The results showed that the bronchial wall thickness of patients with inhalation lung injury in mild,moderate and severe groups was significantly different?P<0.001?,and the difference between two groups was significant?P<0.001?.5.Arterial blood gas analysis?pH,PaO₂,PaCO₂?,blood routine?white blood cell,neutrophil percentage?,blood CRP,chest CT radiologist score?RADS?,bronchoscopy score,bronchus of the right upper lobe bronchus trunk Wall thickness?BWT?was used to evaluate the prognosis?invasive mechanical ventilation of ARDS?.The area under the ROC curve?AUC?was 0.420,0.889,0.666,0.891,0.864,0.914,1.000,0.991,0.986,respectively.P values were 0.598,0.010,0.271,0.010,0.016,0.006,0.001,0.001,0.001.It is suggested that among these early indicators,RADS,BWT and FOB scores have higher value in prognosis of patients.6.Multivariate logistic analysis showed that chest CT score,bronchoscopic score and bronchial wall thickness were independent factors affecting the severity and prognosis of inhalation lung injury.Thoracic CT radiologist score?RADS?is more valuable in early assessment of the prognosis of smoke bomb-induced inhalation lung injury.Conclusions:PaO₂ and blood routine?white blood cells,neutrophils percentage?within 24 hours of admission were correlated with CRP and the severity of inhalation lung injury induced by smoke bomb.Thoracic CT radiologist score?RADS?,bronchoscopic score and right upper lobe bronchial trunk bronchial wall thickness?BWT?can be used as early assessment indicators of the severity of smoke bomb-induced inhalation lung injury.The value of RADS in early assessment of the prognosis of smoke bomb-induced inhalation lung injury is higher.