急诊重症医学科气管插管相关不良事件应急处理分析  

Emergency management of tracheal intubation-related adverse events in Emergency Critical Care Department

作　　者：吴海燕[1] 顾朝丽[1] 张利远[1] Wu Haiyan;Gu Chaoli;Zhang Liyuan(Department of Emergency,Nantong First People’s Hospital,Nantong 226001,China)

机构地区：[1]南通市第一人民医院急诊科,江苏南通226001

出　　处：《中华卫生应急电子杂志》2020年第2期88-91,共4页Chinese Journal of Hygiene Rescue(Electronic Edition)

摘　　要：目的分析急诊重症医学科气管插管相关不良事件,提高医护人员预防与应急处理能力。方法回顾性分析2015年1月至2018年12月南通市第一人民医院急诊重症医学科3个部门(急诊ICU、急诊内科监护室、综合ICU)气管插管患者发生不良事件及发生后的应急处理。共纳入392例经口气管插管患者,其中男性204例,女性188例;年龄16~93岁,平均(54.62±6.28)岁。采取调整导管位置、彻底清除气道分泌物、简易呼吸器加压给氧、重新气管插管或经皮扩张气管切开等处理方法,比较不良事件发生前后生命体征的变化。鼓励非惩罚性上报不良事件,分析不良事件种类、时间分布、年度分布、科室分布、原因分布。结果 392例经口气管插管患者发生不良事件53例,发生率为13.5%。其中综合ICU 1例患者气管导管置换时发生插管困难,考虑喉头水肿,家属放弃气管切开等进一步治疗;另1例重度肥胖患者困难气道,请麻醉师协助经口气管插管后气囊漏气,家属拒绝再次插管或气管切开,放弃治疗。其余51例经现场迅速处理,生命体征指标恢复到不良事件发生前的状态,未发生严重后果。结论急诊重症医学科经口气管插管不良事件发生率较高,积极预防和现场快速判断、正确处理,可以减轻患者痛苦,防止严重后果发生。Objective To analyze the adverse events related to endotracheal intubation in the emergency department of critical medicine, and to improve the ability to prevent and handle the emergency.Methods Using retrospective research methods, the adverse events and post emergency treatment of endotracheal intubation patients from January 2015 to December 2018, in three departments (emergency ICU, emergency medical monitoring unit and comprehensive ICU) in an emergency intensive care unit of Nantong First People’s Hospital were surveyed. A total of 392 patients were enrolled, including 204 males and 188 females, aged from 16 to 93 years, with an average of (54.62±6.28) years. The changes of vital signs before and after the adverse events were compared by adjusting the position of the catheter, thoroughly clearing the airway secretions, adding oxygen to the mask simple respirator, re-intubation or percutaneous dilation tracheotomy. Non punitive reporting of adverse events were encouraged, and the type, time distribution, annual distribution, department distribution and cause distribution of adverse events were analyzed.Results There were 53 adverse events in 392 patients with tracheal intubation, and the incidence rate was 13.5%. One patient with comprehensive ICU experienced difficulty in intubation during tracheal tube replacement. Considering laryngeal edema, family members gave up tracheotomy and further treatment. Another patient with severe obesity had difficulty with airways, and the anesthesiologist was requested to assist with balloon leakage after intubation. The family refused to intubate or tracheostomy again, and gave up treatment. The remaining 51 cases were quickly processed on the spot, and the vital signs indicators returned to the state before the adverse event, without serious consequences.Conclusion The incidence of adverse events related to oral tracheal intubation in the emergency and critical medicine department is relatively high. Active prevention and rapid on-site judgment and correct treatment

关 键 词：气管插管 不良事件 应急处理 

分 类 号：R459.7[医药卫生—急诊医学]