气管插管前预氧合对院前心搏骤停患者生存情况的影响

Effect of preoxygenation before tracheal intubation on survival of patients with prehospital cardiac arrest

目的:探讨气管插管前预氧合对院前心搏骤停患者生存情况的影响,以期为临床治疗院前心搏骤停患者提供参考。方法:前瞻性选取2018年10月至2022年5月厦门市医疗急救中心收治的63例院前心搏骤停患者为研究对象,根据通气方式的不同将其分为两组,其中A组31例(气管插管),B组32例(气囊面罩+气管插管)。两组均随访6个月。比较两组恢复自主循环、气道开放、呼吸恢复、心跳恢复及意识改善时间,入院即刻、心肺复苏1 h、6 h时左室射血分数(LVEF)、左心室舒张早期充盈峰最大充盈速度(E)/舒张晚期充盈峰最大峰值速度(A)比值,入院即刻、心肺复苏6 h的pH值、动脉氧分压(PaO2)、二氧化碳分压(PaCO_(2))、PaO_(2)/吸入气氧浓度(FiO_(2))变化,随访6个月脑复苏成功率及最终存活率。结果:B组恢复自主循环、气道开放、呼吸恢复、心律恢复、意识改善时间均短于A组(P<0.05);与入院即刻比,心肺复苏1 h、6 h时A组和B组LVEF、E/A比值均逐渐升高,且B组LVEF、E/A比值均高于A组(P<0.05);与入院即刻相比,心肺复苏6 h A组、B组PaO_(2)、PaO_(2)/FiO_(2)、pH值均升高,PaCO_(2)均降低(P<0.05);出院前,B组CPC1~2级比例高于A组(χ^(2)=4.661,P<0.05)。结论:气囊面罩联合气管插管可有效改善院前心搏骤停患者心功能和血气指标,促进其生命体征恢复,在心肺脑复苏成功率及存活率方面与气管插管效果相当。

Objective:To explore the effect of preoxygenation before tracheal intubation on the survival of patients with prehospital cardiac arrest,and to provide reference for clinical treatment of patients with prehospital cardiac arrest.Methods:A total of 63 patients with pre-hospital cardiac arrest admitted to Xiamen Medical Emergency Center from October 2018 to May 2022 were prospectively selected as the research objects.They were divided into two groups randomly,including 31 cases in group A(tra-cheal intubation)and 32 cases in group B(tracheal intubation+airbag mask).Both groups were followed up for 6 months.The time of spontaneous circulation recovery,airway opening,respiratory recovery,heartbeat recovery and consciousness improve-ment,left ventricular ejection fraction(LVEF)and the ratio of early diastolic maximum peak velocity(E)/maximum peak ve-locity of late diastolic filling peak(A)were measured immediately after admission,at 1 h and 6 h after cardiopulmonary resusci-tation.The changes of pH(potential of hydrogen,pH),partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide in artery(PaCO_(2))and PaO_(2)/fraction of inspiration O_(2)(FiO_(2))were observed immediately after admission and 6 h after CPR,suc-cess rate of cerebral resuscitation and final survival rate were followed up for 6 months.Results:The recovery time of spontaneous circulation,airway opening,respiratory recovery,cardiac rhythm recovery and consciousness improvement in group B was shorter than that in group A(P<0.05).Compared with the immediate admission,the LVEF and E/A ratio of group A and group B in-creased gradually at 1 h and 6 h after cardiopulmonary resuscitation,and the LVEF and E/A ratio of group B were higher than those of group A(P<0.05).Immediately after admission,PaO_(2),PaO_(2)/FiO_(2) and pH value of group A and group B increased at 6 h after cardiopulmonary resuscitation.PaCO2 decreased(P<0.05).Before discharge,the proportion of CPC grade 1-2 in group B was higher than that in group A(x^(2)=4.661,P<0.05).Conclusions:Airbag mask combined with tracheal intubation can effec-tively improve the cardiac function and blood gas indexes of patients with pre-hospital cardiac arrest,and promote the recovery of vital signs.The success rate and survival rate of cardiopulmonary cerebral resuscitation are comparable to those of tracheal intubation.