急诊有创呼吸支持方法的临床研究  

Invasive respiratory support in the emergency department

作　　者：果应菲[1] 何忠杰[1] 张宪[1] 彭国球[1] 马俊勋[1] 赵晓东[1] 党伟[1] 刘波[1] 袁晓玲[1] 张建波[1] 

机构地区：[1]解放军总医院304急救部,北京100037

出　　处：《中华急诊医学杂志》2005年第10期846-848,共3页Chinese Journal of Emergency Medicine

摘　　要：目的观察在急诊抢救危重患者的呼吸阶梯化管理中应用有创呼吸支持方法的效果。方法总结1994年至2004年中对实施有创呼吸通路方法的292例急诊抢救患者相关临床资料并进行统计分析,比较环甲膜穿刺术、气管切开术、气管穿刺导入气管套管术、气管穿刺旋切术四种有创呼吸支持方法。结果采用气管切开术203例(69.5%)、气管穿刺导入气管套管术58例(19.8%)、环甲膜穿刺术25例(8.6%)、气管穿刺旋切术6例(2.1%);使用呼吸机占95例(32.5%)。常规气管切开术常需两个人以上操作,15～30min完成;气管穿刺导入气管套管术只需单人操作,最快可在90s以内完成,一般在3～5min内完成,出血少,损伤小,对生命体征影响小,术中术后并发症少,伤口愈合快。结论急诊快速建立有创呼吸通路应该视病情紧急程度按时间标准决定选择不同的方法。从速度由快到慢顺序是:环甲膜穿刺术、气管穿刺导入气管套管术、气管穿刺旋切术、气管切开术;从安全可靠性推荐:气管穿刺导入气管套管术、气管穿刺旋切术、气管切开术、环甲膜穿刺术。Objective To investigate effect of the invasive respiratory support on emergency patients in the series stepby-step breathing management （SSBM）. Methods Tracheotomy, percutaneous tracheotomy, thyrocficocentesis , percutaneous revolving tracheotomy were studied in the emergency mepartment in patients admitted from 1994 to 2004. Results The invasive respiratory support included tracheotomy in 203 patients（69.5 % ）, percutaneous tracheotomy in 58 patients（ 19.8 % ）, thyrocficocentesis in 25 patients （ 8.6 % ）, percutaneous revolving tracheotomy in 6 patients （ 2.1% ）, 95 case were put on the ventilator.Tracheotomy was performed by two or more doctors and finished in 15 ~ 30 minutes; percutaneous tracheostomy was operated by only one doctor and finished in 3 ~ 5 minutes and even less than 90 s. Conclusion The selection of the invasive respiratory support measures is an important step of the emergency resuscitation algorithm. We recommend, in terms of rapidity is thyrocricocentesis, percutaneous tracheostomy , percutaneous revolving tracheotomy, tracheotomy ; in terns of safety and reliability is percutaneous tracheotomy, percutaneous revolving tracheotomy, tracheotomy, thyrocricocentesis.

关 键 词：急诊治疗 有创呼吸支持 呼吸阶梯化管理 气管切开术 环甲膜穿刺术 

分 类 号：R459.7[医药卫生—急诊医学]