重复气管插管对相关并发症的影响  

Effect of Repetitive Endotracheal Intubation on Relevent Complications

作　　者：郭旋[1] 董士民[1] 卞晓华[1] 秦延军[1] 闫雁[1] 

机构地区：[1]河北医科大学第三医院急诊科,石家庄050017

出　　处：《临床误诊误治》2017年第2期55-58,共4页Clinical Misdiagnosis & Mistherapy

基　　金：河北省卫生厅青年科技课题项目(1020140042)

摘　　要：目的探讨重复气管插管对患者即时并发症及住院期间并发症的影响。方法选取2012年1月—2014年12月在河北医科大学第三医院急诊科重症监护病房(ICU)和ICU行床旁紧急气管插管287例,按照气管插管次数不同分为非重复气管插管组(229例)和重复气管插管组(58例)。观察比较两组即时并发症、住院期间并发症及相关观察指标。结果两组年龄、性别、伴随疾病及插管前急性生理学与慢性健康评定标准II(APACHEⅡ)评分、序贯器官衰竭估计(SOFA)评分等一般资料比较差异均无统计学意义(P>0.05)。非重复气管插管组即时并发症低氧血症、食管插管及心律失常发生率低于重复气管插管组,差异有统计学意义(P<0.05)。非重复气管插管组呼吸机相关性肺炎(VAP)发生率低于重复气管插管组,差异具有统计学意义(P<0.05)。两组28 d存活率、ICU滞留时间、机械通气48 h APACHEⅡ评分及机械通气48 h SOFA评分比较差异无统计学意义(P>0.05)。结论重复气管插管会增加即时并发症发生率和VAP发生率,故临床上应尽量减少气管插管次数。Objective To investigate effect of repetitive endotracheal intubation on adverse events during intubation and complications during hospitalization. Methods A total of 287 patients undergoing intubation during January 2012 and December 2014 in intensive care unit （ICU） were divided into non repetitive endotracheal intubation group （n = 229） and re- petitive endotracheal intubation group （n = 58）. Adverse events during intubation, complications during hospitalization, and relevant indexes were observed in two groups. Results There were no significant differences in general indexes such as age, gender, comorbidity, acute physiology and chronic health evaluation II （APACHE II） score and sequential organ failure as- sessment （SOFA） score before intubation between two groups （P 〉0.05）. Incidence rates of hypoxemia, esophagus intubation and arrhythmia during intubation in non repetitive endotracheal intubation group were significantly lower than those in re- petitive endotraeheal intubation group （P 〈 0. 05）. Incidence rate of ventilator-associated pneumonia （VAP） was significantly lower in non repetitive endotracheal intubation group than that in repetitive endotracheal intubation group （P 〈 0. 05 ）. There were no significant differences in survival rate within 28 d, ICU stay time, APACHE Ⅱ and SOFA scores after 48 h of mechanical ventilation between two groups （P 〉 0. 05）. Conclusion Repetitive endotracheal intubation can increase incidence rates of adverse events during intubation and VAP, and therefore clinicians should try to reduce intubation frequency.

关 键 词：重复气管插管 并发症 

分 类 号：R459.7[医药卫生—急诊医学]