紧急气管内插管抢救呼吸衰竭578例剖析.docVIP

紧急气管内插管抢救呼吸衰竭578例剖析 　　摘要：目的 探讨紧急气管内插管的技术特点、可能并发症及其预防，以提高紧急气管内插管成功率和抢救成功率。方法 回顾分析我院自2008年2月～2015年7月急救气管插管抢救578例呼吸衰竭患者的临床资料，对其完成插管所需时间、次数、抢救成功率等进行分析。结果 完成插管次数与时间：一次插管成功531例、2次插管成功34例、3次插管成功13例。2 min内完成插管479例，成功率82.8%；2～5 min内完成插管86例，成功率14.8%；5～10 min内完成插管7例，成功率1.2%。总成功率为98.9%。困难插管16例，经可视喉镜或纤支镜插管后均成功；出现低血压46例，心搏骤停3例。结论 气管插管术是畅通气道和呼吸支持最有效的方法，临床医生熟练掌握紧急气管插管流程，减少插管并发症，采取预见性气管插管可显著提高急危重症患者的抢救成功率。 　　关键词：气管插管；急救；呼吸衰竭 　　Abstract：Objective To investigate the technical characteristics and possible complications of emergency endotracheal intubation， and to improve the success rate and success rate of emergency treatment. Methods The clinical data of 578 cases of respiratory failure patients with respiratory failure in our hospital from July 2015 to February 2008 were analyzed retrospectively. Results The number and time of intubation were： 531 cases of successful intubation， 2 cases of successful intubation and 3 cases of successful intubation in 13 cases. 479 cases were completed in 2 minutes， the success rate was 82.8%. 2 cases were completed in 86 to 5 minutes， the success rate was 14.8%. 5 cases were completed in 7 to 10 minutes， the success rate was 1.2%. The overall success rate was 98.9%. 16 cases of difficult intubation， the visual laryngoscope or bronchoscope after intubation was successful； hypotension in 46 cases， 3 cases of cardiac arrest. Conclusion Tracheal intubation is the most effective method for the treatment of airway and respiratory support， and it is effective to reduce the complications and improve the success rate of emergency treatment. 　　Key words：Endotracheal intubation； First aid； Respiratory failure 　　紧急气管内插管术是挽救呼吸衰竭患者生命的一项重要技术，也是临床医生必须熟练掌握的基本技术。我科自2002年以来对578例呼吸衰竭患者给予紧急经口气管插管术，效果满意，现总结如下。 　　1 资料与方法 　　1.1一般资料 2008年2月～2015年7月我院急救行紧急气管插管患者共578例，其中男341例，女237例。年龄6～89岁，平均46.5岁。病因有：急性脑血管病265例、慢性阻塞性肺病173例、各种中毒76例、心脏骤停35例、其他29例。 　　1.2紧急气管内插管方法 ①患者取仰卧位，清除口腔异物，使口腔、咽、喉三条轴线呈一致走向；②选择大小合适的喉镜及气管导管，将所需物品（呼吸气囊、注射器、开口器、舌垫、胶布等）备齐放在患者右侧肩部上方；③操作者位于患者头顶部，左手持喉镜，沿患