老年呼吸衰竭合并低血容量患者气管插管前行快速补液的护理观察

Observation of rapid fluid infusion before tracheal intubation used in the elderly patients with respiratory failure complicated with hypovolemic state

目的观察及探讨老年呼吸衰竭合并低血容量患者气管插管术前给予快速补液对患者插管后的临床疗效及影响。方法采用前瞻性研究收集2011年1月至2013年11月在中国人民解放军第一○一医院急救中心救治的老年呼吸衰竭合并低血容量拟行气管插管术的患者104例,随机分为2组,1组于插管前在中心静脉压(CVP)及左室充盈压(LVFP)监测下行快速补液(补液组,52例),另1组仅给予常规治疗后气管插管(非补液组,52例),记录2组患者插管前后的血流动力学指标、呼吸频率、血气分析、肾功能指标,同时观察插管后的低血压发生率、低血压恢复时间、血管活性药物使用率、补液量及急性肾功能不全发生率。结果 2组插管前一般临床资料无统计学差异(P>0.05)。2组插管前血流动力学指标、呼吸频率、血气分析、肾功能及尿量比较无统计学差异(P>0.05),插管后2组上述指标比较均存在统计学差异(P<0.05);补液组插管后的低血压发生率、低血压恢复时间、补液量、血管活性药物使用率、急性肾功能不全发生率低于非补液组(P<0.05);多因素Logistic回归分析显示年龄、插管前是否快速补液、呼吸衰竭类型是插管后出现低血压的重要影响因素,其中未补液患者插管后发生低血压的风险是补液者的1.674倍(OR=1.674,P<0.05)。结论老年呼吸衰竭合并低血容量患者气管插管术前行快速补液的临床疗效良好,能够使患者插管后获得平稳的血流动力学,并能防止低血压及急性肾功能不全发生。

Objective To observe and study the clinical effect of rapid fluid infusion before tracheal intubation on the elderly patients with respiratory failure complicated with hypovolemic state. Methods By a prospective study, a total of 104 elderly patients with respiratory failure in hypovolemic state who need tracheal intubation were collected in emergency center from January 2011 to November 2013. The patients were randomly divided into two groups, one group received rapid fluid infusion according to CVP and LVFP before tracheal intubation （the infusion group, 52 cases） ; the other group received endotracheal intubation after conventional treatment （non-infusion group, 52 cases）. The hemodynamic parameters, breathing rate, blood gas analysis, indicator of renal function before and after intubation were recorded; and the incidence of hypotension, recovery time of hypotension, volume of rapid fluid infusion, usage rate of vasoactive drugs and incidence of acute renal insufficiency after intubation were observed. Results There were no statistical difference in general clinical data of the two groups before intubation （P〉0. 05 ）. No differences were found between the two groups in hemodynamic in- dex, breathing rate, blood gas analysis, renal function before intubation （P〉0. 05）, and there were statistical differences in these items after intubation between the two groups （ P〈0. 05 ）. The incidence of hypotension, volume of rapid fluid infu- sion, usage rate of vasoactive drugs and incidence of acute renal insufficiency after intubation in infusion group were lower than those in non-infusion group, and the recovery time of hypotension in infusion group was shorter than non-infusion group. Multivariable logistic regression analysis showed that age, rapid infusion before intubation, type of respiratory failure were the important factors of hypotension after intubation. The risk of hypotension in infusion group was 1. 674 times as much as non-infusion group （ OR = 1. 674, P〈0. 05）. Conclusions The clinical effect of rapid fluid infusion on the elderly with respiratory failure in hypovolemic state before tracheal intubation is effective, and rapid fluid infusion can provide the patients with stable hemodynamics to prevent the hypotension and acute renal insufficiency.