手术室外紧急气管插管:肌松药是否必要的临床研究  

Clincal research of impacts of paralysis on complications associated with emergency tracheal intubation outside operating room

作　　者：刘芬[1] 赵文辉[1] 李声华[1] 

机构地区：[1]江汉大学附属医院麻醉科,湖北武汉430016

出　　处：《中国现代医学杂志》2007年第5期595-597,共3页China Journal of Modern Medicine

摘　　要：目的探讨手术室外紧急气管插管使用肌松药或不使用肌松药对插管成功率及并发症的影响。方法95例紧急气管插管,前瞻性收集有关资料,包括病人年龄、性别、诊断、插管适应证、插管前SpO2和BP、使用药物、插管次数、既定的各种气道和血流动力学并发症。统计学处理分别采用方差分析、χ2检验或确切概率法。SPSS11.5统计软件进行统计学处理。P<0.05认为差异有统计学意义。结果所有病人均完成气管插管,其中33例(34.7%)在肌松药(琥珀胆碱)辅佐下完成。使用琥珀胆碱组有87.9%例、未使用琥珀胆碱组58.1%例插管次数不超过2次(P<0.01)。使用琥珀胆碱组发生并发症例数(42.4%VS91.9%,P<0.01)、及低氧血症(18.2%VS74.2%,P<0.01)、心动过速(6.1%VS22.6%,P=0.04)、心动过缓(9.1%VS54.8%,P<0.01)、高血压(3.0%VS25.8%,P<0.01)、返流(6.1%VS50.0%,P<0.01)、食道插管(0.0%VS30.6%,P<0.01)、误吸(0.0%VS12.9%,P=0.04)发生率均明显低于未使用琥珀胆碱组。结论肌松药能提高手术室外紧急气管插管成功率,并减少并发症。[Objective] To investigate the effects of paralysis obtained by muscle relaxants administration on the rate of success and complications related to emergency tracheal intubation outside the operating room. [Methods] A total of 95 consecutive patients requiring emergent intubation were included. Prospective data were collected, ineluding age, gender, diagnoses, preintubation oxygen saturation and blood pressure, medication used for intubation, number of intubation attempts, and various immediate airway and hemodynamic-related complications based on a predetermined set of defined criteria. Data were analyzed using analysis of variance, X^2 tests and Fisher＇s exact probability tests where appropriate with SPSS 11.5. [Results] Translaryngeal tracheal intubation was accomplished in all patients. Paralysis was obtained by succinylcholine in 33 Of 95 （34.7%） patients. Intubations were successfully completed within two attempts in 87.9% of the paralyzed patients, and 58.1% of the nonparalyzed patients （P 〈0.01）, respectively. Patients in the paralyzed group had less likelihood of complications （42.4% vs 91.9%, P 〈0.01） and lower incidences of hypoxemia （18.2% vs 74.2%, P 〈0.01）, tachycardia （6.1% vs 22.6%, P =0.04）, bradycardia （9.1% vs 54.8%, P〈0.01）, hypertension （3.0% vs 25.8%, P 〈0.01）, regurgitation （6.1% vs 50.0%, P 〈0.01）, esophageal intubation （0.0% vs 30.6%, P〈0.01）, and aspiration （0.0% vs 12.9%, P =0.04）. [Conclusion] Muscle relaxants administration can increase intubation success rate and reduce complications of emergency tracheal intubation outside the operating room.

关 键 词：插管 急诊 并发症 

分 类 号：R605.97[医药卫生—急诊医学]