急诊有创呼吸支持方法的选择

Selection of the traumatic airway management in emergency department

目的：观察在急诊抢救危重患者的呼吸阶梯化管理中应用有创呼吸支持方法的效果。方法：对1994～2004年期间292例急诊抢救患者的呼吸阶梯管理进行统计分析和实施有创呼吸支持方法调查,并比较四种有创呼吸支持方法差异。结果：本组病例有创呼吸支持方法采用气管切开术203例(69．5%)、气管穿刺导入气管套管术58例(19．8%)、环甲膜穿刺术25例(8．6%)、气管穿刺旋切术6例(2．1%)。使用呼吸机占95例(32．5%)。神经系统卒中、严重创伤、呼吸道烧伤患者应及时使用有创呼吸支持方法。在可以预见插管困难、失败的可能性增大或患者病情逐渐加重、恶化等情况下应及时使用有创呼吸支持方法。气管切开术常需两个人以上操作,15～30min完成。气管穿刺导入气管套管术只需单人操作,一般在3～5min内完成,出血少,损伤小,对生命体征影响微小,术中术后并发症少,伤口愈合快。皮下气肿、脱管、管堵、出血是气管切开术后最常见的并发症。结论：急诊抢救中对有创呼吸支持方法的选择是急诊抢救流程中的关键环节,有助于危重患者的呼吸阶梯化管理,可以有效地帮助提高危重患者呼吸管理效果,提高抢救成功率。

Objective:To investigate the effects of different treatment techniques for traumatic airway manage- ment to rescue patients in respiratory distress with stepwise restoration of airway(SRA).Methods:From 1994 to 2004,292 patients who had undertaken operative maneuvers for restoration of airway in the emergency room were retrospectively reviewed.Results:Four kinds of operative techniques,including tracheostomy in 203 cases (69.5%),percutaneous tracheal intubation in 58 cases(19.8%),thyrocricotomy in 25 cases(8.6%),and percuta- neous rotatory tracheostomy in 6 cases(2.1%),and among them ventilator was used in 95 cases.The traumatic airway control measures were used to the patients with stroke,serious trauma,and respiratory tract burns.The traumatic respiratory support measures were used when difficulty or failure of endotracheal intubation was foreseen and the patients were in a critical condition.Usually two persons were necessary for tracheostomy,and it could be finished in 15—30 minutes.Percutaneous tracheotomy was operated by only one doctor,and only 3—5 minutes were necessary with less bleeding and trauma,and little influence no vital signs.The complications after tracheos- tomy included subcutaneous emphysema,inadvertent fallin off of tracheostomy tube,obstruction of tracheostomy tube,and bleeding after tracheostomy.Conclusions:The selection of the traumatic respiratory support measures is an important step in emergency treatment,it can improve the effect and efficiency of airway control.