气管插管前预吸氧对危重患者复苏效果及预后的影响

Effect of preoxygenation before tracheal intubation on the resuscitation efficacy and prognosis of critically ill patients

目的:探讨气管插管前预吸氧对危重患者复苏效果及预后的影响。方法:将80例危重患者随机分为对照组(即刻插管)和实验组(面罩-机械通气、预吸氧气管插管)各40例,比较两组留置气管插管时间、一次插管成功率、插管过程中心律失常发生率、28 d病死率,插管成功机械通气1 h后动脉血气分析、呼吸力学、血流动力学参数。结果:实验组气管插管时间、一次性插管成功率、插管过程中心律失常发生率、28 d病死率与对照组比较差异有统计学意义(P<0.01);机械通气1 h后,实验组较对照组动脉血氧分压(PaO2)、改良氧合指数(PaO2/FiO2)、动脉血二氧化碳分压(PaCO2)及肺泡动脉血氧分压差(A-aD O2)、心率(HR)、中心静脉压(CVP)、平均动脉压(MAP)改善明显(P<0.05,P<0.01)。结论:预吸氧后气管插管能有效的早期开放气道,明显改善患者通气、换气功能,并使患者血流动力学趋于稳定,及时改善脑缺氧,提高CPCR存活率,减少致残率。

Objective：To explore the effect of preoxygenation before tracheal intubation on the resuscitation efficacy and prognosis of critically ill patients .Methods：80 critically ill patients were randomly divided into the control group （ with immediate intubation ） and the experimental group （ with mask-mechanical ventilation ,preoxygenation before tracheal intubation ） ,40 cases were in each group .The du-ration of tracheal intubation ,the success rate of one-time intubation,the incidence of arrhythmia in the process of intubation ,fatality rate within 28 days and the parameters of arterial blood gas analysis ,respiratory mechanics and hemodynamics after mechanical ventilation for one hour were compared between the two groups .Results：There were statistically significant differences in the comparison of the duration of tracheal intubation ,the one-time success rate of intubation ,the incidence of arrhythmia in the process of intubation and fatality rate within 28 days between the two groups （ P〈0.01）;compared those with the control group after mechanical ventilation for one hour ,PaO2 ,PaO2/FiO2,PaCO2 and A-aD O2,HR,CVP and MAP were significantly improved （P〈0.05,P〈0.01）.Conclusion：Preoxygenation before tra-cheal intubation can effectively set up airway at early stage and improve the pulmonary ventilation function so as to maintain the hemody -namics stable and increase the survival rate of the patients with CPCR .