重症监护病房危重患者急救插管前预氧合方式的比较研究  

Comparative Study on Preoxygenation for Emergency Tracheal Intubation in Severe Patients

作　　者：许治华[1] 蒋涵[1] 汪彦[1] 贾超[1] 

机构地区：[1]绵阳市中心医院重症医学科,四川绵阳621000

出　　处：《华西医学》2015年第11期2054-2058,共5页West China Medical Journal

基　　金：四川省卫生厅科研课题(130445)~~

摘　　要：目的观察不同预氧合方式在重症监护病房(ICU)危重患者急救插管中的效果。方法 2013年6月-2014年1月,按随机化原则将入住综合ICU需紧急行气管插管的患者40例分为4组,每组10例,分别为较普通吸氧组(A组)、面罩-球囊预氧合组(B组)、无创呼吸机预氧合组(C组)、麻醉充气面罩-有创呼吸机预氧合组(D组)。A组入ICU后立即进行快速气管插管;B组中当面罩-球囊预氧合后脉搏血氧饱和度(Sp O2)达90%行气管插管;C组中当无创呼吸机预氧合后Sp O2达90%行气管插管;D组中当麻醉充气面罩-有创呼吸机预氧合Sp O2达90%行气管插管。记录B、C、D组患者达到目标预氧合(Sp O2≥90%)所需要的时间,预氧合前及插管成功后即刻动脉血气分析,插管成功后即刻Sp O2,插管后并发症发生情况。结果 1预氧合前,4组患者各项基本指标比较差异无统计学意义(P>0.05),C组和D组患者达到目标预氧合所需要的时间明显低于B组(P<0.05)。2预氧合后,B、C、D组的Sp O2明显高于A组(P<0.05),C、D组的动脉血氧分压(Pa O2)和动脉血氧饱和度(Sa O2)均高于B组(P<0.05)。3插管后即刻,B、C、D组的Sp O2、Pa O2和Sa O2高于A组(P<0.05),C、D组Sp O2、Pa O2和Sa O2高于B组(P<0.05),D组Pa O2高于C组(P<0.05)。4 D组的腹胀发生率明显低于B、C组(P<0.05)。结论在急救插管前进行预氧合较直接气管插管可以提高患者的血氧水平;在预氧合的方式中,麻醉充气面罩-有创呼吸机预氧合方式的疗效和安全性较好。Objective To observe the effect of different preoxygenation methods for emergency intubation in severe patients in intensive care unit（ICU）. Methods Prospective randomized study was performed in the intensive care unit between June 2013 and January 2014. Forty patients were randomly divided into 4 groups： group A（control group, n=10）, group B（bag-valve-mask preoxygenation group, n=10）, group C（noninvasive ventilator-mask preoxygenation group, n=10）, and group D（invasive ventilator-mask preoxygenation group, n=10）. Standardized rapid sequence intubation was performed without preoxygenation in group A; preoxygenation was performed by using a bag-valve-mask rose pulse oxygen saturation（Sp O2） to 90% before a rapid sequence intubation in group B; preoxygenation was performed by using noninvasive ventilator through a face mask rose Sp O2 to 90% before a rapid sequence intubation in group C; and preoxygenation was performed by using invasive ventilator through a face mask rose Sp O2 to 90% before a rapid sequence intubation in group D. We recorded the time when Sp O2 was more than or equal to 90% in group B, C, and D, and arterial blood gases and complications were observed. Results There was no significant difference in the basic indexes before preoxygenation among the four groups（P〈 0.05）. The time of the patients in group D and C was significantlylower than that of group B. The arterial oxygen saturation（ Sa O2） and arterial oxygen partial pressure（Pa O2） in the group C and D were higher than those in group B after preoxygenation（P〈 0.05）. After intubation, Sp O2 in group B, C and D was significantly higher than that in group A（P〈 0.05）. At the same time, Sp O2 in group C and D was higher than that in group B（P〈 0.05）; Pa O2 and Sa O2 in group C and D were higher than in those in group A and B（P〈 0.05）; Sa O2 in group D was higher than that in group B（P〈 0.05）. The incidence of abdominal distension in group D was significantly lower than that of g

关 键 词：急救插管 预氧合 重症监护 

分 类 号：R459.7[医药卫生—急诊医学]