摘要
目的:探讨早期实施呼吸支持策略在救治急性中毒危重患者转运中的临床应用。方法:收集本急救中心2007年1月-2016年10月进行抢救转运的急性中毒并且伴有急性呼吸衰竭的危重患者共15例的临床资料进行回顾性分析,观察患者的治疗模式选择,血液pH值,PaO_2,PaCO_2,SpO_2的数值等情况。结果:15例入组患者中,有机磷农药中毒9例,占60.00%;镇静催眠药中毒3例,占20.00%;鼠药中毒2例,占13.33%;氯氮平中毒1例,占6.67%;其中1例因为入院治疗后出现3个器官的同时衰竭,抢救无效而死亡,中毒的原因为服用鼠药。15例入组患者中,SIMV+PSV+PEEP模式10例,Bi PAP+PSV+PEEP模式3例,CPAP+PSV模式2例,所有患者上机时间1~12 min,平均(22.67±7.13)min,15例患者全部根据病情给予了氧疗、机械通气和气管插管操作,其中4例进入医院ICU 72 h后进行了气管切开和机械通气操作,3例进入医院ICU后在全身症状支持的基础上进行了腹膜透析的操作,9例进入医院ICU先后出现了多器官功能障碍以及肺部感染症状,14例通过机械通气治疗并且治愈的患者在进行通气前和进入医院ICU前的血气检测结果表明:pH值、PaO_2、PaCO_2、SpO_2比较差异均有统计学意义(P<0.05)。结论:对急性中毒并发急性呼吸衰竭的危重患者,在早期实施呼吸支持策略,能够在转运过程中迅速改善患者的各项生命体征,减少呼吸衰竭发生率,提高抢救成功率。
Objective： To explore the clinical application of early implementation of respiratory support strategy in the treatment of patients with critical acute poisoning.Method： The clinical data of 15 patients with acute poisoning and acute respiratory failure who were rescued and transported from January 2007 to October 2016 in our emergency center were analyzed retrospectively, we observed the treatment mode choice of the patients, blood pH, PaO2, PaCO2, SpO2 values and so on of patients were compared.Result： Among 15 patients, 9 cases （ 60.00% ） were organophosphorus pesticide poisoning, 3 cases （ 20.00% ）were sedative hypnotics poisoning, 2 cases （ 13.33% ） were poisoned by rat poisoning, 1 case （ 6.67% ） was Clozapine intoxication.One patient died because of the failure of three organs at the same time after hospitalization, the reason for the poisoning was rodenticide.15 patients, 10 patients were treated with SIMV＋PSV＋PEEP, 3 patients were treated with BiPAP＋PSV＋PEEP and 2 patients were treated with CPAP＋PSV.All patients were on the machine for 1-12 min, the average was （ 22.67 ± 7.13 ） min. 15 patients were treated according to the condition, four patients underwent tracheotomy and mechanical ventilation after 72 hours of ICU admission to the hospital.Three patients entered the hospital ICU and underwent peritoneal support on the basis of systemic symptoms after oxygen therapy, mechanical ventilation and tracheal intubation. Dialysis operation, nine patients into the hospital ICU had appeared multiple organ dysfunction and pulmonary infection symptoms, 14 patients treated by mechanical ventilation and cured patients before ventilation and before entering the hospital ICU blood gas examination results showed： pH, PaO2, PaO2, and SpO2 were all significantly different （P〈0.05） .Conclusion： Acute respiratory failure in patients with acute critically ill patients in the early implementation of respiratory support strategies, in the process of transport can rapidly improve the patient＇s vital signs, reduce the probability of occurrence of respiratory failure and improve the success rate of rescue.
出处
《中国医学创新》
CAS
2017年第11期41-44,共4页
Medical Innovation of China
关键词
呼吸支持
急性中毒
呼吸衰竭
Respiratory support
Acute poisoning
Respiratory failure
