经口气管插管非计划性拔管31例临床分析

Clinical analysis of 31 cases of unplanned extubation in ICU orotracheal intubation patients

目的分析经口气管插管非计划性拔管原因及特点,探讨预防对策。方法 6将31例经口气管插管非计划性拔管发生原因的频次进行统计;再将每例病员存在原因按只有一个原因分为一类(单因素),存在两个原因的分为一类(双因素),存在三个或以上原因的分为一类(多因素),统计三类病员比例;同时统计经口气管插管非计划性拔管发生时间段及再次插管率。结果 31例经口气管插管非计划性拔管原因中医护操作不当2人次,肢体约束不当12人次,插管固定不当10人次,病员未镇静6人次,病员镇静不充分20人次,发生在每日唤醒中12人次;31例病员中单因素占13%,双因素占45%,多因素占42%;31例病员中68%发生在白天,32%发生在夜间;31例病员中有84%需再次气管插管,16%无需气管插管。结论病员镇静不充分、肢体约束不当、每日唤醒、插管固定不当、病员未镇静等为经口气管插管非计划性拔管常见原因;及时进行系统呼吸功能及气道评估,减少拔管延迟;强调重点时段、常见原因的综合预防可降低经口气管插管非计划性拔管发生率。

Objective To analyze the reason and feature of unplanned extubation in orotraeheal intubation patients and the prevention of it. Methods Retrospective analysis was made on 31 cases of unplanned extubation in ICLI from Nov 2006 to Oct 2,011. These cases were divided into single factor group, two factor group and multiple factor group. Time and rate of reintubation in these cases were analyzed systematically. Results The factors caused unplanned extubation in these 31 cases included improper operation （2）, inappropriate restraint （12）, inappropriate fixed intubation （10）, unsedated （6）, adequate sedation （20）, awakening （12）. In 31 cases, there was 13% of single factor, 45% of double factor and 42% of multiple factor. In 31 cases, 68% existed during the day, and 32% existed at night. In 31 cases, 84% patients needed re-intubation, the rest did not. Conclusion The common reason caused unplanned extubation included inappropriate restraint, inappropriate fixed intubation, unsedated, adequate sedation, awakening. Assessment of respiratory function and airway, reducing extubation delay and comprehensive prevention from common reasons during focus sessions were helpful to reduce occurrence of unplanned extubation in orotracheal intubation patients.