喉罩与气管插管在肝昏迷患者院前急救中的作用对比

Comparison of role of laryngeal mask airway and endotracheal intubation in pre-hospital first aid of patients with hepatic coma

目的对比喉罩与气管插管在肝昏迷患者院前急救中的作用。方法88例肝昏迷患者,根据其实施的院前急救措施不同分为实验组和参照组,各44例。参照组患者实施气管插管治疗,实验组患者实施喉罩置管治疗。比较两组患者插管/置管情况(操作时间、操作完成后5 min心率、操作完成后5 min血氧饱和度)以及院前急救效果(首次插管/置管成功率、复苏成功率、气道损伤率、插管对抗率)。结果实验组操作时间(1.23±0.57)min短于参照组的(3.47±0.62)min,操作完成后5 min心率(91.45±3.26)次/min低于参照组的(96.81±4.53)次/min,差异均具有统计学意义(P<0.05)。两组操作完成后5 min血氧饱和度比较,差异无统计学意义(P>0.05)。实验组患者首次插管/置管成功率93.18%(41/44)、复苏成功率90.91%(40/44)均高于参照组的77.27%(34/44)、75.00%(33/44),气道损伤率4.55%(2/44)、插管对抗率2.27%(1/44)均低于参照组的18.18%(8/44)、13.64%(6/44),差异均具有统计学意义(χ^(2)=4.423、3.937、4.062、3.880,P=0.035、0.047、0.044、0.049<0.05)。结论对肝昏迷患者的院前急救实施喉罩置管方案能够有效提高急救效果,减轻对患者气道的损伤。

Objective To compare the role of laryngeal mask airway and endotracheal intubation in prehospital first aid of patients with hepatic coma.Methods A total of 88 patients with hepatic coma were divided into experimental group and reference group according to different pre-hospital first aid measures,with 44 cases in each group.Patients in the reference group were treated with endotracheal intubation,and patients in the experimental group were treated with laryngeal mask airway intubation.Both groups were compared in terms of intubation status(operation time,heart rate at 5 min after intubation,oxygen saturation at 5 min after intubation)and pre-hospital first-aid effects(intubation first-pass success rate,resuscitation success rate,airway injury rate,intubation resistance rate).Results The operation time in the experimental group was(1.23±0.57)min,which was shorter than(3.47±0.62)min in the reference group;the heart rate at 5 min after intubation in the experimental group was(91.45±3.26)beats/min,which was lower than(96.81±4.53)beats/min in the reference group;the differences were statistically significant(P<0.05).There was no statistically significant difference between the two groups in terms of oxygen saturation at 5 min after intubation(P>0.05).The experimental group had intubation first-pass success rate of 93.18%(41/44)and resuscitation success rate of 90.91%(40/44),which were higher than 77.27%(34/44)and 75.00%(33/44)in the reference group;the experimental group had airway injury rate of 4.55%(2/44)and intubation resistance rate of 2.27%(1/44),which were lower than 18.18%(8/44),13.64%(6/44)in the reference group;the differences were statistically significant(χ^(2)=4.423,3.937,4.062,3.880;P=0.035,0.047,0.044,0.049<0.05).Conclusion The implementation of laryngeal mask airway intubation for pre-hospital fist-aid of patients with hepatic coma can effectively improve the fist-aid effect and reduce the airway injury.