气管插管术前快速补液对呼吸衰竭合并低血容量状态的影响  

The rapid infusion impact on the prognosis of hypovolemic state respiratory failure before tracheal intubation

作　　者：杨建中[1] 李文超[1] 彭鹏[1] 张晓霞[1] 艾克柏尔[1] 玉素甫江[1] 米也塞尔[1] 高冉冉[1] 

机构地区：[1]新疆医科大学第一附属医院急救中心EICU,新疆乌鲁木齐830011

出　　处：《中国急救医学》2013年第4期322-325,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨呼吸衰竭合并低血容量状态患者气管插管术前进行容量实验，并进行快速补液对其出现低血压的判断及预后的影响。方法收集我院2009—01—2012—06就诊于急救中心拟行气管插管术并考虑低血容量状态的呼吸衰竭患者308例，按照低血容量休克指南所定分级，2名医师根据患者血压、脉压、心率、尿量和神经系统症状情况确定是否进行容量试验和快速补液，并按照是否在气管插管前行容量试验及快速补液分为两组。组1为气管插管前未进行容量试验和快速补液组（n；161）；组2为气管插管前进行容量试验并快速补液组（n=147）。记录两组患者年龄、性别、BMI值、既往疾病、气管插管术前后补液量、收缩压、舒张压、心率、血乳酸浓度及呼吸频率等指标，同时观察术后是否发生低血压及发生低血压后恢复时间等参数。结果在两组年龄、性别、BMI值均无显著差异的情况下，两组患者在气管插管后的收缩压、舒张压、心率、呼吸频率、m乳酸（Lac）、术前术后补液量、发生低血压后恢复时间、低血压发生的例数均差异有统计学意义（P〈0．05）。应用Logistic模型进行分析结果显示，术前未行补液患者出现低血压风险是补液患者的12．874倍，患者发病至就诊时间短的患者发生低血压风险降低。结论容量试验可以快速判断呼吸衰竭是否合并低血容量状态，在呼吸衰竭合并低血容量状态的患者气管插管前进行适量补液可以减少插管后出现低血压的发生率。Objective Discuss the rapid infusion in hypovolemic state respiratory failure patients, before tracheal intubation, hypotension judgment and the impact of prognosis. Methods Collected the hypovolemic state respiratory failure patients with tracheal intubation, treatment in the emergency center of the first affiliated hospital of Xinjiang medical university from January 2009 to June 2012, divided into two groups according to whether do the capacity test and the rapid infusion. Capacity test and the rapid infusion not give before tracheal intubation in group 1 and group 2 give capacity test and the rapid infusion before tracheal intubation. Record the age, gender, BMI, previous disease, before tracheal intubation and postoperative systolic blood pressure, diastolic blood pressure, heart rate, Lac, respiratory rate and other indicators. And record after tracheal intubation, whether the incidence of hypotension, recovery time after the occurrence of hypotension, preoperative fluid volume and other parameters. Results In the case of two groups of age, gender, BMI value there was no significant difference, two groups of patients with systolic blood pressure after tracheal intubation, diastolic blood pressure, heart rate, respiratory rate, blood lactic acid, Preoperative and postoperative fluid volume, shock recovery time, the shock of the number of cases showed a significant difference （P 〈 0.05）. The Logistic model analysis, patients with shock after tracheal intubation, the rehydrate one is 12. 874 times of without ones. Patients with short onset treatment time are less with shock. Conclusion Capacity test can quickly determine whether the respiratory failure combined with hypovolemic state; the hypovolemic state respiratory failure patients, rehydrate can reduce the hypotension after tracheal intubation.

关 键 词：快速补液 呼吸衰竭 低血容量 气管插管 

分 类 号：R473.5[医药卫生—护理学]