摘要
目的 分析手术室外紧急气管插管相关并发症，并探讨与插管次数之间的关系。方法 前瞻性收集95例紧急气管插管患者有关资料，包括年龄、性别、诊断、插管适应证、插管前SpO2和BP、插管用药、插管次数、既定的各种气道和血流动力学并发症。结果所有病例均完成气管插管。71例（74．7％）发生各种并发症，包括低氧血症（54．7％）、低血压（23．2％）、高血压（17．9％）、心动过缓（38．9％）、心动过速（16．8％）、异位心律失常（2．1％）、食道插管（20．0％）、返流（34．7％）、误吸（8．4％）、心跳骤停（7．4％）。插管次数超过2次显著增加了并发症例数（29／30vs42／65，OR=15．88，95％CI=2．03-124．26）．并发症发生率：低氧血症（73．3％VS46．2％，OR=3．2，95％CI=1．25～8．25）、心动过缓（60．0％VS29．2％，OR=3．6．95％CI=1．47～8．98）、心动过速（30．0％vs10．8％，OR=3．6，95％CI=1．17～10．74）、返流（60．0％VS23．1％，0a=5．0，95％CI=1．98一12．68）、食道插管（46．7％VS7．7％，OR=10．5，95％CI=3．29～33．51）、误吸（20．0％VS3．1％，OR=7．9．95％CI：1．49。41．7）、心跳骤停（16．7％VS3．1％，OR=6．3，95％CI=1．15～34．62）。结论 手术室外紧急气管插管常伴有各种并发症，尤其插管次数超过2次时。提高快速插管成功率，控制插管次数，能降低并发症发生率。
Objective To investigate the immediate complications during emergency tracheal intubation outside the operating room and to explore the relationship between intubation attempts and the complications. Methods A total of 95 consecutive intubated patients were included. Prospective data were collected, including age, gender, diagnosis, intubation the indication, preintubation oxygen saturation and blood pressure, medication used for intubation, the number of intubation attempts, and various immediate airway and hemodynamics -related complications based on a predetermined set of defined criteria. Data were analyzed by the analysis of variance, X^2 tests and Fishers exact tests, and Logistic regression with SPSS 11.5. Results Translaryngeal tracheal intubation was accomplished in all the patients. Various complications were found in 71 patients {74.7% ）, including hypoxemia （54. 7% ）, hypotension {23.2% ）, hypertension （ 17.9% ）, bradycardia （ 38.9% ）, tachycardia （ 16.8% ）, dysrhythmia （ 2.1% ）, esophageal intubation （ 20.0% ）, regurgitation （34.7% ） ,aspiration （8.4% ） ,and cardiac arrest （7.4% ）. Intubation attempts beyond 2 was associated with significant increased risk of the complications （ 29/30 vs 42/65, OR = 15.88,95 % CI = 2.03 - 124.26）, hypoxemia （ 73.3 % vs 46.2%, OR = 3.2,95% C I = 1.25 ~8.25）, bradycardia （60.0% vs29.2% ,OR =3.6,95% CI = 1.47-8.98）., tachycardia （30.0% vs 10.8% ,OR =3.6, 95% CI=1.17-10.74）,regurgitation （60.0% vs 23.1% ,OR = 5.0,95% CI = 1.98 - 12. 68）, esophageal intubation （46.7% vs 7.7%, OR = 10. 5,95% CI=3.29 ~33.51）,aspiration （20.0% vs 3.1% ,OR =7.9,95% CI=1.49 -41.7） ,and cardiac arrest （16.7% vs 3.1% ,OR = 6.3,95% CI = 1.15- 34.62 ）. Conclusions Emergency tracheal intubation outside the operating room is associated with frequent unwanted complications ,especially in the patients receive three or more intubation attempts. To improve the speed and the immediate success rate of intubation and to limit intubation attempts can reduce complications associated with repeated intubation attempts.
出处
《中国急救医学》
CAS
CSCD
北大核心
2006年第9期651-654,共4页
Chinese Journal of Critical Care Medicine
关键词
插管
急诊
并发症
Intubation
Emergency
Complications
