气管插管在院前急救中的应用研究进展

Research progress on the application of tracheal intubation in pre-hospital first aid

院前急救是指对各种患者(创伤、中毒、危急生命的急症、灾难性事故等)进行的医院前紧急治疗,包括在发病现场以及转运入院的途中对患者开展有效、安全的医疗救治以及护理,尽最大可能地稳定患者生命体征,为患者院内救治争取时间,降低患者伤残率及死亡率。院前急救是急诊医学的重要组成部分,院前对患者病情做出初步的判断及处置,能为院内进一步治疗打下基础,对挽救患者生命具有重要意义。需要接受院前急救的患者多为危急重症患者,面临生命危险,现场需通过多种治疗手段对此类患者进行生命支持,以维持其生命体征,争取院内治疗时机。气管插管是高级生命支持中气道管理最为常用的治疗措施。该措施不仅能为患者提供足够氧气,保证患者呼吸畅通,也可避免治疗过程中误吸的发生。但是,并非所有需要建立高级气道的患者均适用气管插管,部分患者存在气管插管禁忌证,故而在进行气管插管前需了解患者的基本情况,方可确定是否使用此种气道管理方式对患者进行救治。气管插管越来越多的被用于院前气道管理中,其应用效果较好。本文对气管插管在院前急救中的应用适应证、置入方法及效果研究进展进行综述,以期指导临床应用。

Pre-hospital first aid refers to the pre-hospital emergency treatment of various patients(trauma,poisoning,life-threatening emergencies,catastrophic accidents,etc.),including effective and safe medical treatment and nursing of patients at the scene of the onset of the disease and on the way to the hospital,so as to stabilize the vital signs of patients as much as possible,gain time for hospital treatment of patients,and reduce the disability rate and mortality rate of patients.Pre-hospital first aid is an important part of emergency medicine.The preliminary judgment and treatment of the patient's condition before the hospital can lay a foundation for further treatment in the hospital and is of great significance for saving the patient's life.Most of the patients who need to receive pre-hospital first aid are critically ill patients,facing life danger,and such patients need to be supported by various treatment means at the scene to maintain their vital signs,and strive for the opportunity of hospital treatment.Tracheal intubation is the most commonly used treatment measure for airway management in advanced life support.This measure can not only provide enough oxygen for patients to ensure that patients breathe smoothly,but also avoid the occurrence of aspiration during treatment.However,not all patients who need to establish an advanced airway are suitable for tracheal intubation,and some patients have contraindications for tracheal intubation.Therefore,before performing tracheal intubation,it is necessary to understand the basic situation of patients,in order to determine whether to use this airway management method for patient treatment.Tracheal intubation is more and more used for pre-hospital airway management,its application effect is better.This article reviews the research progress on application indications,implantation methods and effects of tracheal intubation in pre-hospital first aid,in order to guide clinical application.