不同人工气道在院外救护车内的应用

Effects of different kinds of artificial airway in prehospital ambulance

目的探讨院外急救车上心肺复苏（CPR）建立人工气道通气的最佳方法和对复苏成功率的影响。方法对院外急救车上发生心跳呼吸骤停患者318例，根据当时CPR时对患者随机建立人工气道的3种不同方法，将其分为3组，进行回顾性分析，A组68例，常规行气管导管插管；B组140例，盲插喉罩通气；C组110例，食管气管联合导管通气。结果B组建立人工通气需（26＋11．3）s，显著短于A组和C组【分别为（146±14．7）s和（81±16．5），均P〈0．05】。A组建立人工通气所需时间显著长于C组（P〈0．05）。盲插喉罩通气时间最短，其次是食管气管联合导管插管术，气管插管术最慢。B组一次插管成功率为100％，显著高于A组（60．3％，P〈0．05），与C组的差异无显著性（98．2％，P〉0．05）。B组与C组之间差异无统计学意义（P0．05）。A、B、C组三组复苏成功率分别为26．5％，25．7％和27．3％，相互间的差异无无统计学意义（均P〉0．05）。结论院外急救车上最好早期应用盲插喉罩或食管气管联合导管。

Objective To compare the effects in cardiopulmonary resuscitation of 3 kinds of artificial airway： conventional tracheal intubation, blind insertion of laryngeal mask, and esophageal-tracheal combined tube in prehospital ambulance.Methods 328 cases undergoing CPR in the prehospital ambulance were Randomly divided into 3 groups： Group A （n=68） undergoing conventional tracheal intubation, Group B （n=140） undergoing blind insertion of laryngeal mask, and Group C （n= 110） undergoing insertion of esophageal-tracheal combined tube. The time needed to establish artificial airway, one-time success rate of insertion, and resuscitation success rate were compared among these 3 groups. Results The time needed to establish artificial airway of Group B was （26±11.3） s, significantly shorter than those of Groups A and C[（146±14.7）s and （81±16.5）s respectively, both P〈0.05].The time needed to establish artificial airway of Group A was significantly longer than that of Group C （P〈 0.06）. The one-time success rate of insertion of Group B was 100%, significantly higher than that of Group A （60.3%, P〈0.05）, but not significantly different from that of Group C （98.2%, P〉0.05）. There were not significant differences in the resuscitation success rate among these 3 groups （26.5%, 25.7% and 27.3%）. Conclusion blind insertion of laryngeal mask is the best choice for CPR in prehospital ambulance, followed by insertion of esophageal tracheal combitube.