创伤患者急诊气管插管的成功分析：一个大型成年创伤转诊中心的10年经验

背景对于多数麻醉医师来讲急诊气道管理是必须掌握的一项重要技术，我们总结了一个一级创伤中心10年来的经验，评估创伤患者入院后24小时内气管插管的结果。方法通过该中心1996年7月至2006年6月的创伤登记、质量管理记录、收费系统记录，得出入院后1小时内、24小时内需要插管的患者人数，并且回顾每个气管切开患者的医疗记录，了解其特征和无法进行经口或经鼻插管的原因。结果所有插管都在一名处理创伤经验丰富的麻醉医师的指导下进行。研究期间，标准插管法为直接喉镜下快速诱导插管。入院后1小时内，6088名患者进行插管，其中21名患者（0．3％）最终行气管切开。入院后24小时内，累计32000名患者进行插管，共31名行气管切开。意外的困难气道是气管切开的主要因素。31名患者中有4名死于外伤，无人死于插管失败。结论由经验丰富的麻醉医师指导，直接喉镜下快速诱导气管插管是有效的急诊气道管理方法，以其为核心的急诊气道管理规则使得气道管理成功率很高。

BACKGROUND： Emergency airway management is a required skill for many anesthesiologists. We studied 10 yr of experience at a Level 1 trauma center to determine the outcomes of tracheal intubation attempts within the first 24 h of admission. METHODS： We examined Trauma Registry, quality management, and billing system records from July 1996 to June 2006 to determine the number of patients requiring intubation within 1 h of hospital arrival and to estimate the number requiring intubation with the first 24 h. We reviewed the medical record of each patient in either cohort who underwent a surgical airway access procedure （tracheotomy or cricothyrotomy） to determine the presenting characteristics of the patients and the reason they could not be orally or nasally intubated. RESULTS： All intubation attempts were supervised by an anesthesiologist experienced in trauma patient care. Rapid sequence intubation with direct laryngoscopy was the standard approach throughout the study period. During the first hour after admission, 6088 patients required intubation, of whom 21 （0. 3%） received a surgical airway. During the first 24 h, 10 more patients, for a total of 31, received a surgical airway, during approximately 32 000 attempts （0. 1%）. Unanticipated difficult upper airway anatomy was the leading reason for a surgical airway. Four of the 31 patients died of their injuries but none as the result of failed intubation. CONCLUSIONS： In the hands of experienced anesthesiologists, rapid sequence intubation followed by direct laryngoscopy is a remarkably effective approach to emergency airway management. An algorithm designed around this approach can achieve very high levels of success.