以气道保护为目的的气管插管在ICU危重患者中的应用

Application of endotracheal intubation for airway protection in critically ill patients in ICU

目的:总结以气道保护为目的的气管插管在ICU危重患者中的应用。方法:回顾总结2010年1月至2019年12月ICU的269例以气道保护为目的的气管插管危重患者的临床资料,其中经口气管插管243例,纤支镜引导下经鼻气管插管23例,紧急床边气管切开3例;建立人工气道后有192例患者出现呼吸不规则、呼吸抑制、血氧饱和度下降等而进行机械通气,77例自主呼吸平顺者予经导管吸氧;共进行275人次院内影像学检查、介入治疗等,其中210人次院内转运过程中使用简易呼吸机,43人次在机械通气下进行洗胃、胃镜检查、治疗等。结果:经导管吸氧的77例患者在转运过程中有16例分别出现血氧饱和度下降、呼吸不规则等情况,及时给予人工气囊通气、机械通气;有6例患者在气管插管后的治疗、转运过程中出现心跳呼吸骤停,5例心肺复苏成功。在抢救、治疗期间未发生呼吸道阻塞、窒息、严重缺氧等呼吸道原因导致患者直接死亡。结论:早期实施积极有效的气道保护措施,可避免误吸、窒息、缺氧等危险情况的发生,同时预防性气管插管为实施心肺复苏提供很大的方便,可提高复苏成功率。

Objective:To summarize the experience of endotracheal intubation(ETI)for airway protection in critically ill patients in ICU.Methods:The clinical data of critically ill patients with ETI for airway protection in the ICU of our hospital from January 2010 to December 2019 were reviewed.In 269 patients,243 cases were orotracheal intubation;23 cases were nasotracheal intubation via fibrobronchoscopy,and 3 cases were emergency tracheotomy.After the establishment of the artificial airway,192 patients suffered from irregular breathing,respiratory depression,hypoxemia,etc.,and were subjected to mechanical ventilation.Seventy-seven patients with spontaneous breathing smoothly received oxygen therapy via a tracheal tube.A total of 275 case-times in-hospital imaging examinations,interventional therapy,of which 210 case-times use portable ventilator during in-hospital transportation;43 case-times undergo gastric lavage,gastroscopy examination and treatment under mechanical ventilation.Results:Of the 77 patients who received oxygen therapy through a endotracheal tube,16 of them had progressed to hypoxemia and irregular breathing during the transfer process and were given simple breathing balloon ventilation and mechanical ventilation in time.Six patients suffered cardiac arrest after ETI,and 5 patients had successful cardiopulmonary resuscitation.During the rescue and follow-up treatment,there was no airway obstruction,asphyxia,severe hypoxemia,and other respiratory causes that led to the direct death of the patient.Conclusion:Early implementation of active and effective airway protection measures can avoid dangerous situations such as aspiration,asphyxia,and fatal hypoxemia.At the same time,preventive ETI provides great convenience for the implementation of cardiopulmonary resuscitation and can improve the success rate of resuscitation.