成人烧伤患者气道灌洗疗法专家共识（2026版）

中华医学会烧伤外科学分会; 中国医疗保健国际交流促进会烧伤医学分会

doi:10.3760/cma.j.cn501225-20260212-00080

成人烧伤患者气道灌洗疗法专家共识（2026版）

doi: 10.3760/cma.j.cn501225-20260212-00080

基金项目:

国家重点研发计划 2021YFA1101100

详细信息

通信作者：罗高兴,陆军军医大学（第三军医大学）第一附属医院全军烧伤研究所,创伤与化学中毒全国重点实验室,重庆 400038,Email：logxw@tmmu.edu.cn

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- 文章访问数: 52
- HTML全文浏览量: 10
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- 被引次数: 0
出版历程
- 收稿日期: 2026-02-12
- 网络出版日期: 2026-04-30

Expert consensus on airway lavage therapy for adult burn patient (2026 edition)

Funds:

Nationa Key Research and Development Program of China 2021YFA1101100

摘要

摘要: 气道灌洗疗法是烧伤患者清除气道分泌物和脱落组织的重要方法之一,包括纤维支气管镜灌洗与气道直接灌洗。为进一步提高临床医务人员规范、安全、有效地实施烧伤患者气道灌洗疗法,共识编写组以循证医学证据为基础,德尔菲法为指导,围绕成人烧伤患者气道灌洗疗法的适应证与禁忌证、操作前准备、操作时机与方案、监测及并发症管理等进行文献检索、质量评价、证据综合、专家函询,制订了《成人烧伤患者气道灌洗疗法专家共识（2026版）》,为临床实践提供参考。
- 烧伤 /
- 气道管理 /
- 气道阻塞 /
- 吸入性损伤 /
- 气道灌洗 /
- 专家共识
Abstract: Airway lavage therapy is an important method for clearing airway secretions and sloughed tissue in burn patients. It primarily includes fiberoptic bronchoscopy-guided lavage and direct airway lavage . To further improve the standardization, safety, and effectiveness of airway lavage therapy in burn patients, the consensus writing group, based on evidence from evidence-based medicine and guided by the Delphi method, conducted literature searches, quality evaluations, evidence synthesis, and expert consultations. They formulated the expert consensus on airway lavage therapy for adult burn patient (2026 edition), which provides a reference for clinical practice, covering topics such as indications and contraindications for airway lavage, pre-procedural preparation, timing and protocols of the procedure, monitoring, and management of complications.
- Burns /
- Airway management /
- Airway obstruction /
- Inhalation injury /
- Airway lavage /
- Expert consensus
执笔组收集专家组成员利益冲突情况,所有编写组成员声明不存在利益冲突。执笔组评估专家组成员的利益冲突严重程度,禁止存在利益冲突人员参与共识制订。无商业组织向本共识编写组支付费用,本共识制订过程中需要的资金均来自本文著录的基金项目,用以承担制订过程中的材料费、查新费、差旅费及项目组织实施费用等,且推荐意见未受资助影响

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参考文献(80)

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图 1 《成人烧伤患者气道灌洗疗法专家共识（2026版）》推荐意见流程图

注：SpO₂为脉搏氧饱和度

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Table 1. 澳大利亚Joanna Briggs Institute循证卫生保健中心证据级别系统（2014版）

证据分级	具体描述
1a	多项RCT的系统评价
1b	多项RCT及其他干预性研究的系统评价
1c	单项RCT
1d	准RCT
2a	多项类实验性研究的系统评价
2b	多项类实验性研究与其他低质量干预性研究的系统评价
2c	单项前瞻性有对照组的类实验性研究
2d	前后对照/回顾性对照的类实验性研究
3a	多项队列研究的系统评价
3b	多项队列研究与其他低质量观察性研究的系统评价
3c	单项有对照组的队列研究
3d	单项病例对照研究
3e	单项无对照组的观察性研究
4a	多项描述性研究的系统评价
4b	单项横断面研究
4c	病例系列研究
4d	个案研究
5a	对专家意见的系统评价
5b	专家共识
5c	基础研究/单项专家意见
注：RCT为随机对照试验

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Table 2. 澳大利亚Joanna Briggs Institute循证卫生保健中心证据推荐强度系统（2014版）

推荐强度	判断标准
强	明确显示干预措施利大于弊或弊大于利；高质量证据支持应用；对资源分配有利或无影响；考虑了患者的价值观、意愿和体验
弱	干预措施利大于弊或弊大于利,尽管证据尚不够明确；有证据支持应用,尽管证据质量不够高；对资源分配有利或无影响或有较小影响；部分考虑或并未考虑患者的价值观、意愿和体验

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Table 3. 基于纤维支气管镜检查的简明损伤评分

级别	损伤程度	表现
0	无损伤	无炭末沉着、红斑、水肿、支气管黏液溢、气管阻塞
1	轻度损伤	小范围炭末沉着,斑片状红斑,无充血水肿、支气管黏液溢、气管阻塞
2	中度损伤	中度炭末沉着、红斑、充血水肿、支气管黏液溢、气管阻塞
3	严重损伤	严重的炎症反应,黏膜破溃,大范围炭末沉着、充血水肿、支气管黏液溢、气管阻塞
4	巨大损伤	黏膜脱落、坏死,支气管腔闭塞

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Table 4. 纤维支气管镜灌洗操作中出血量分级及处理方式

出血量	处理方式
少量出血（<30 mL）	对于有或无人工气道患者,应降低回抽负压（<100 mmHg；1 mmHg=0.133 kPa）,调整纤维支气管镜位置至管腔中央,减少黏膜损伤,出血常可自行停止。若仍有出血,可经纤维支气管镜注入肾上腺素（稀释比为1∶10 000或1∶20 000,稀释液为生理盐水,总剂量不超过0.6 mg）
中等量出血（30~100 mL）	对于有或无人工气道患者,经纤维支气管镜局部注入4 ℃的生理盐水（每次50 mL）+同前剂量的肾上腺素,必要时局部注入凝血酶（1000 U/mL,5~10 mL）
大量出血（>100 mL）	对于无人工气道患者,采取头低位+出血侧卧位,经纤维支气管镜注入4 ℃的生理盐水、同前剂量的肾上腺素或凝血酶。随后快速吸引,清除血凝块,并予垂体后叶素雾化或静脉滴注。若活动性出血仍未能停止或出现低氧血症,立即予双腔气管插管或健侧气管插管单侧肺通气。必要时可采取球囊填塞止血、支气管动脉栓塞或外科手术治疗。对于有人工气道患者,采取头低位,调整气管插管位置,行健侧肺通气。快速抽吸,清除凝血块,并按前述方案予药物（如肾上腺素、凝血酶等）止血。若出血仍未停止,可考虑球囊填塞止血、支气管动脉栓塞或外科手术治疗。