重症患者急救插管预氧合的临床研究  

The Clinical Study of Preoxygenation for Emergency Tracheal Intubation in Critically ill Patients

作　　者：孙东光[1] 李海波[2] 王怀泉[2] 田永刚[2] 谢宇颖[3] 

机构地区：[1]哈尔滨医科大学附属第一医院,黑龙江哈尔滨150001 [2]哈尔滨医科大学附属第二医院,黑龙江哈尔滨150086 [3]哈尔滨医科大学附属第四医院,黑龙江哈尔滨150001

出　　处：《现代生物医学进展》2014年第30期5951-5955,5887,共6页Progress in Modern Biomedicine

基　　金：黑龙江省自然科学基金项目(D200821)

摘　　要：目的:观察预氧合在ICU重症患者急救插管中的效果并探讨预氧合的最佳方式。方法:选择ICU内低氧血症成年危重患者28例,按入ICU顺序随机分为3组:A组(对照组,n=10),B组(气囊-面罩预氧合组,n=9)和C组(麻醉机-面罩预氧合组,n=9)。A组入室后即行快速气管插管,B组气囊-面罩预氧合5 min后行气管插管,氧流量为15 L/min。C组麻醉机-面罩预氧合5 min后行气管插管,氧流量为4 L/min。观察指标:持续脉搏血氧饱和度(SpO2),动脉血气分析及相关并发症。结果:三组在预氧合之前,各项基本指标比较无统计学差异。在预氧合后,B、C组的SpO2明显高于A组(P<0.05);在插管后即刻,B、C组的SpO2也显著高于A组(P<0.05),同时C组SpO2高于B组(P<0.05)。血气分析中,预氧合后,C组的PaO2和SaO2均高于A、B组(P<0.05);在插管后即刻,C组PaO2和SaO2高于A组,同时C组SaO2高于B组(P<0.05)。并发症的比较上,C组的腹胀发生率明显低于B组(P<0.05)。结论:ICU内急救插管前的预氧合能显著提高患者的血氧水平,效果明显好于直接气管插管;在预氧合的方式中,麻醉机-面罩的预氧合效果要优于常规使用的气囊-面罩,且并发症也较少。Objective： To determine the effectiveness ofpreoxygenation for emergency tracheal intubation in critically ill patients and to find out the better preoxygenation method. Methods： Prospective randomized study was performed in intensive care unit （ICU）. Twenty-eight hypoxemic critically ill patients were randomly assigned into 3 groups： group A （control group, n=l 0）, group B （bag-valve- mask preoxygenation group, n=9） and group C （anesthesia machine ventilator preoxygenation group, n=9）. Standardized rapid sequence intubation was performed without preoxygenation in group A; Preoxygenation was performed by using a bag-valve-mask driven by 15 L/min oxygen before a rapid sequence intubation in group B; Preoxygenation was performed by using anesthesia machine ventilator through a face mask driven by 4 L/min oxygen before a rapid sequence intubation in group C. Tracheal intubation were performed after 5rain preoxygenation in groups B and C. Pulseoximetry （SpO2）, arterial blood gases and complications were observed. Results： The three groups were similar in terms of age, gender, A I[ and arterial blood gases before preoxygenation. At the end of preoxygenation, SpO= was higher in the group B and C as compared with group A（P〈0.05 ）. After the intubation procedure, SpO2 values observed in group B and C were also higher than that in group A（P〈0.05 ）, and group C was better than group B（P〈0.05 ）. In arterial blood gases analysis, PaO2 and SaGE values observed were better in the group C as compared with group A and B after preoxygenation （P〈0.05）. And after the intubation procedure, PaO2 and SaG2 value were still better in the group C as compared with group A （P〈0.05）, SaG2 value was better in the group C than the group B （P〈0.05）. Regurgitations were observed with significant difference between B and C groups （P〈0.05）. Conclusions： For emergency tracheal intubation in critically ill patients in the ICU, preoxygenation is more effective than the rapid seq

关 键 词：预氧合 急救插管 ICU 

分 类 号：R459.7[医药卫生—急诊医学]