急诊内科危重病人气管插管时机与方法的探讨

Discussion of Method and Moment of Endotracheal Intubation in Deadly-ill Patients at Emergency Department

目的:总结急诊内科病人气管插管的特点,分析其治疗效果,并探讨其插管时机、方法与转归。方法:根据病人在急诊科治疗情况,将病人分成三组。第Ⅰ组23例,系到医院前已临床死亡;第Ⅱ组30例,经抢救无效在急诊科死亡;第Ⅲ组30例,经抢救病人在急诊科存活,后转入病房或急诊留观。结果:第Ⅰ组病人经口气管插管,抢救平均30分钟,无一例心跳呼吸恢复;第Ⅱ组虽经急诊CPR,但呼吸功能不能恢复正常,或因其原发病未能控制,最终在急诊科死亡;第Ⅲ组病人经口插管13例,经鼻插管17例,6例病人在急诊留观治疗后出院,12例病人经ICU或病房住院治疗后基本痊愈出院,另12例最终死亡。结论:急诊科所遇垂危病人,多数需气管插管者是由内科医师首诊实施。正确的插管方法和较高的成功率是直接影响病人转归的重要因素。

Objective: To Characterize emergency department(ED) airway management including right moment,methods and effects of these intubation. Methods: A total of 83 endotracheal intubation patients in ED were derided intothree groups according to the treatment results: 1 st group(n=23) was clinical death before arriving hospital; 2nd group(n=30) died in ED and 3rd group(n=30) survived after all rescue measures. Results: No one was resuscitated after allrescure measures proved in effected both of first and second group. In the third group, oral intubation were 13 cases andnasal intubation were 17 cases. All these patients survived in ED, 6 of them were discharged after short period in EDobservation room, other 24 cases were sent to ICU or special ward, 12 patients died of their original disease. Conclusions:Most ED intubations were performed by emergency physicians. The success of rescue vary by intubation moment and method.