重型和危重型COVID-19患者实施气管插管的临床经验

Tracheal intubation in patients with severe and critical COVID-19: analysis of 18 cases

目的对18例实施气管插管的重型和危重型新型冠状病毒肺炎(COVID-19)患者进行临床分析。方法采用回顾性研究方法,对这18例COVID-19患者的气管插管情况进行分析。记录患者的年龄、性别、插管前意识状态、给氧方式等基本信息。由实施气管插管的麻醉医生评估并记录患者的插管条件。记录患者麻醉诱导前及插管后的基本生命体征变化。结果患者平均年龄70.39±8.02岁,插管前15例(83.33%)患者进行了无创呼吸机治疗,13例患者(72.22%)插管前意识状态是清醒的。麻醉诱导后,患者的血压、心率有显著下降(P<0.05)。患者气管插管条件的优良率为94.44%,一次插管成功率为100%。目前有死亡5例,有1例已行气管切开,有12例患者仍在ICU行气管插管机械通气治疗,其中1例患者机械通气效果差,目前已行ECMO辅助。共16名临床经验丰富的麻醉医生参与了气管插管操作,插管时均采取三级防护,目前尚未发生医务人员感染的情况。结论对于有气管插管指征的重型和危重型新冠肺炎患者,建议早期插管,给予有创呼吸支持,增加患者的救治机会。插管过程中需谨慎使用麻醉药物,加强医务人员的防护,最大化保障患者和医务人员的安全。

Objective To analyze the clinical characteristics of patients with severe or critical coronavirus disease 2019(COVID-19) receiving tracheal intubation. Methods We analyzed clinical characteristics of 18 severely or critically ill patients with COVID-19 undergoing tracheal intubation. The general demographic and clinical data of the patients including their age,gender, pre-intubation state of consciousness and the ventilation mode were recorded. The anesthesiologists performing the tracheal intubation procedure evaluated and recorded the tracheal intubation conditions of the patients. The changes in the vital signs of the patients before anesthesia induction and after intubation were recorded. Results The average ages of these patients were 70.39 ± 8.02 years. Fifteen patients(83.33%) received non-invasive ventilation before tracheal intubation, and 13 patients(72.22%) were conscious before tracheal intubation. After induction of anesthesia, the blood pressure and heart rate of the patients decreased significantly(P<0.05). Most of the patients(94.44%) were in excellent or good conditions for tracheal intubation, and the first-attempt success rate of tracheal intubation was 100%. Five patients died within 3 weeks following the intubation. Tracheotomy was performed in one patient. Twelve patients were still on endotracheal mechanical ventilation in the intensive care unit, and one of them received ECMO treatment due to poor oxygenation. A total of 16 experienced anesthesiologists participated in tracheal intubation, all with third-level protection during the operation, and no medical staff infection has been detected so far. Conclusion For patients with severe and critical COVID-19 and indications of tracheal intubation, we recommend early intubation with invasive respiratory support to improve the treatment efficacy and reduce the mortality. Anesthetic agents should be used carefully during tracheal intubation to ensure patients’ safety. The medical staff should have a high-level protection during the intubation to maximally ensure their safety.