镇静联合顺式阿曲库铵快速诱导插管在急诊科的应用研究

Application of rapid induction of intubation by sedatives combined with cis-atracurium in the emergency department

目的:研究镇静联合顺式阿曲库铵快速诱导插管在急诊科的应用效果。方法:将2017年10月15日至2019年4月15日在长治市人民医院急诊科就诊的符合纳入标准的52例需要气管插管的危重症患者,依据患者入组时间顺序编号,再按照随机数字表法分为A、B两组,每组26例。A组予以镇静药+顺式阿曲库铵行快速诱导插管,B组仅予以镇静药诱导插管。比较两组患者插管的成功率、成功插管所需要的时间;比较两组患者气管插管前后心率、平均动脉压、指脉氧浓度以及血儿茶酚胺浓度的变化情况。结果:A组患者插管成功率为100.0%,B组患者插管成功率为76.9%,两组患者的插管成功率比较,差异有统计学意义(χ^ 2=12.15, P<0.05);A组患者成功插管所需要的时间为(5.2±0.8)s,B组患者成功插管所需要的时间为(8.5±2.5)s,成功插管时间差异有统计学意义( t=6.41, P<0.05);A组患者在插管后,指脉氧浓度较插管前明显升高,差异有统计学意义( t=-7.99, P<0.05);患者在插管后,患者的心率、平均动脉压、血清去甲肾上腺素、多巴胺水平均较插管前降低,但差异均无统计学意义(均 P>0.05);患者的血清肾上腺素水平较插管前升高,但差异无统计学意义( t=-1.03, P>0.05);B组患者在插管前后,指脉氧浓度较插管前明显升高,差异有统计学意义( t=5.74, P<0.05),但B组患者的心率、平均动脉压、血儿茶酚胺浓度水平较插管前的变化,差异均有统计学意义(均 P>0.05)。 结论:在急诊科危重症患者气道管理中,应用镇静联合顺式阿曲库铵快速诱导插管的方法可更加迅速改善患者缺氧症状,并且能够保持患者血流动力学、儿茶酚胺浓度相对稳定,具有安全高效的特点。

Objective To study the effect of sedative combined with cis-atracurium in rapid induction intubation in emergency department.Methods From October 15,2017 to April 15,2019,52 critically ill patients who needed tracheal intubation in emergency department of the People's Hospital of Changzhi were selected.And the patients were numbered according to the time sequence of enrollment,and then randomly divided into group A and group B according to the random number table,with 26 cases in each group.Group A was given sedatives combined with cis-atracurium to induce rapid intubation.Group B only received sedatives to induce intubation.The success rate of intubation,successful intubation time were compared between the two groups.Before and after endotracheal intubation,the heart rate,mean arterial blood pressure,pulse oxygen concentration and the change of catecholamine concentration were compared.Results The success rate of intubation in group A was 100.0%,which in group B was 76.9%,the difference between the two groups was statistically significant(χ2=12.15,P<0.05).The time required for successful intubation in group A was(5.2±0.8)s,which in group B was(8.5±2.5)s,the difference was statistically significant(χ2=6.41,P<0.05).After intubation,the pulse oxygen concentration in group A was significantly increased compared with before intubation(t=-7.99,P<0.05).After intubation,the heart rate,mean arterial pressure,and serum norepinephrine,dopamine levels in group A were reduced compared with before intubation,but there were no statistically significant differences(all P>0.05).The serum adrenaline level was higher compared with before intubation,but there was no statistically significant difference(t=-1.03,P>0.05).In group B,the pulse oxygen concentration was significantly increased after intubation compared with before intubation(t=5.74,P<0.05),but the heart rate,mean arterial pressure,and the change of blood catecholamine concentration levels in group B had no statistically significant differences(P>0.05).Conclusion In the airway management of critically ill patients in emergency department,the application of sedatives combined with cis-atracurium to rapidly induce intubation can improve the hypoxia symptoms of patients more rapidly and can keep patients'hemodynamics,catecholamine concentration is relatively stable,it has the characteristics of safety and efficiency.