骨髓腔内输液在成人急救中的临床应用研究

Clinical application of intraosseous infusion to adult emergency patients

目的对于外周静脉穿刺失败的急救患者，使用骨髓腔内（intraosseous，IO）输液可能更安全，至少可以在患者循环血压稳定前作为一种过渡性的快速可靠的输液措施。文中拟通过与中心静脉置管（central venous catheterization，CVC）输液对比分析，探讨10输液作为一种替代输液途径在外周静脉穿刺失败的成人急救中的应用价值。方法成人急救患者，外周静脉穿刺失败2次或时间超过1．5min，即进行10和CVC输液，对比分析两者一次成功率、穿刺时间、观察10输液的速度以及并发症的发生率。结果36例患者中，8例在院外或转运途中未进行CVC穿刺，只进行10输液，一次成功率100％，平均穿刺时间2．2min；其余28例在急救室中同时进行10和CVC穿刺，IO输液一次成功率是96．4％（27／28），平均穿刺时间1．9min，CVC输液一次成功率为71．4％（20／28），平均穿刺时间8．6min。IO最大输液速度因人而异，波动在6～20ml／min，加压后可达50～125mlfmin。所有病例均未发现10输液相关并发症。结论10输液具有环境适应性强、操作简单、成功率高、安全可靠的特点，在外周静脉穿刺失败的成人急救中是有效的，可作为首选的替代输液途径。

Objective For emergency patients in whom peripheral venipuncture fails, intraosseous （IO） infusion may be a safer alternative, at least as a bridging procedure during ongoing resuscitation efforts until the patient is in a more stable condition. The aim of this study was to evaluate IO infusion for adult emergency patients by comparing it with central venous catheterization （CVC）. Methods We performed IO and CVC infusions for 36 emergency patients aged over 18 years with impossible peripheral intravenous catheterization. We compared the two procedures in the one-time success rate, puncture time, flow speed and complications. Results Among the 36 adult emergency patients, 8 received 10 infusion successfully on field first aid or during the transport process, while the other 28 underwent at once IO and CVC infusion, with the one-time success rate of 96.4% （27/28） and the mean puncture time of （1.9±0.7） min for IO, as compared with 71.4% （20/28） and （8.6 ＋2.9） rain for CVC （P〈0.05）. The highest flow rate of IO was 6 -20 ml/min, increased to 50 - 125 ml/min with a pressure bag. No IO-related complications were observed in any of the pa- tients. Conclusion The intraosseous infusion, with its advantages of safety, easy operation, high success rate and applicability to various conditions, can be used as a priority alternative to gain vascular access for adult emergency patients with impossible peripheral intravenous infusion.