急性呼吸窘迫综合征患者气管插管后发生低血压的危险因素分析  

Risk Factors of Hypotension of Acute Respiratory Distress Syndrome Patient after Rapid Sequence Intubation

作　　者：李吉明[1] 杨建中[1] 李文超[1] 畅毅平 李雯莉[1] 高冉冉[1] 张晓霞[1] 彭鹏[1] 

机构地区：[1]新疆医科大学第一附属医院,乌鲁木齐830011

出　　处：《新疆医学》2016年第6期653-656,共4页Xinjiang Medical Journal

摘　　要：目的通探讨对急性呼吸窘迫综合征的患者实施紧急气管插管时血压下降的危险因素,为临床工作提供理论依据。方法采用前瞻性研究,纳入2014.1-2014.12月急性呼吸窘迫综合征插管106例患者,记录患者基本资料。根据患者是否出现低血压将患者分为两组:第一组为低血压组32例,收缩压下降至90mmHg或血压下降达40mmHg以上。第二组为对照组74例,气管插管前后血压在90mmHg以上并下降在40mmHg以内。同时记录患者气管插管前后的生命体征,实验室检查结果,采用单因素分析,得出导致插管患者出现血压下降的危险因素,在单因素分析的基础上,进行多因素Logistic回归分析确定血压下降与危险因素的相关性。结果单因素分析后有4个因素被认为是有意义的,包括插管前收缩压、插管前舒张压、体重、体重指数,对单因素分析结果进行Logistic回归分析,插管前收缩压、插管前舒张压、体重为急诊室急性呼吸窘迫综合征患者气管插管后发生低血压的独立危险因素。结论作为一名急诊科的临床医师,在准备给急性呼吸窘迫综合征患者实施急诊插管前,一定要首先考虑患者存在哪些危险因素会导致患者插管后发生低血压,并给予预先处置。Objective This study aimed to discuss the risk factors of hypotension of Acute respiratory distress syndrome patients after rapid sequence intubation （RSI）, in order to provide theoretical basis for clinic research. Methods Prospective study was adopted, acute respiratory distress syndrome patients＇ data after tracheal intubations over a 1-year period（Jan.-Dec.2014） were selected, basic information of patients were recorded. Patients were divided into 2 groups, Patients in the first group （32 cases） were the hypotension group, whose systolic blood pressure （SBP） was found to be greater than 90 mm Hg before RSI but less than 90 mmHg or the SBP drop 40mmHg in 30 minutes after RSI. Patients in the second group （74 cases） were deemed as the control group whose pre-SBP and post-SBP were greater than 90 mmHg or the SBP drop less than 40mmHg. The following variables were measured in the study, such as the initial vital signs, and laboratory tests. A risk model with multiple logistic regression was established based on significant findings from univariate analysis. Results After univariate analysis, there were 4 factors identified as significant findings including preintubation systolic pressure, preintubation diastolic pressure, body weight, BMI. Multiple logistic regression has demonstrated that patients＇ preintubation systolic pressure, preintubation diastolic pressure, body weight were dangerous factors related to postintubation hypotension among emergency department acute respiratory distress syndrome patients. Conclusion As a doctor of emergency department, you should take risk factors into serious consideration before emergency intubation, and give a thought of disposing in advance.

关 键 词：急性呼吸窘迫综合征 气管插管 低血压 危险因素 

分 类 号：R459.7[医药卫生—急诊医学]