ICU气管插管患者非计划性换管原因及方法探讨

目的 对ICU气管插管患者非计划换管的原因及换管方法进行分析和研究.方法 （1）对ICU行气管插管机械通气的1 062例住院患者进行回顾性分析,记录非计划换管的发生率及原因.（2）将63例非计划换管患者分为老年组和非老年组,对换管原因进行比较.（3）将换管方法分为导引式换管组和喉镜插入换管组.结果 （1）非计划换管的发生率为5.83%（63/1 062）.（2）老年患者的换管原因以痰痂阻塞多见占65.1%（28/43）,与非老年组比较,差异有显著统计学意义（P＜0.01）,而非老年组躁动、咬扁导管或自主拔管占40%（8/20）,明显高于老年组的9.3%,差异有统计学意义（P＜0.05）.导管型号过小、气囊破损两组比较差异无统计学意义（P＞0.05）.（3）导引式换管组SaO2的下降显著低于喉镜组,差异有统计学意义（P＜0.05）,出现躁动、口腔出血及血压升高也较低.换管时间、一次性插管成功率及心律失常两组差异不大.结论 （1）在气管插管非计划换管原因中,老年患者以痰液结痂堵塞常见,非老年患者以躁动、咬扁导管或自主拔管多见.（2）导引式气管插管更换方法简单易行、危险性低、并发症少,值得推广.

Study of the method and cause for unplanned replacemeut of endotracheal tube in patents of intensive care unit

Objective To observe the method and cause for unplanned replacemeut of endotracheal tube in patents of intensive care unit（ICU）. Methods （1） 1062 cases of endotracheal tube in ICU withe machine ventilates were analyzed retrospectively, were recorded incidence and cause for unplanned replacemeut of endotracheal tube.（2） 63 cases of unplanned replacemeut of endotracheal tube were divided into aged group and non- aged group, to proceed contrast cause for unplanned replacemeut of endotracheal tube.（3） Replacement method were divided into guiding catheter＇s group and laryngoscope group. Results （1） The patients of unplanned replacemeut of endotracheal tube rates were 5.83% （63/1062）.2） Aged patient＇s cause of unplanned replacemeut of endotracheal tube as sputum scab obstruct so see （ 65.1% ,28/43） were significantly higher than non- aged group （25%, P〈 0.01）; but moved restlessly, bitten flat catheter or independence pulled catheter in non-aged group （4% 8/20） were obviously higher than agedness group （9.3%, P〈 0.05）. smaller catheter and disrepairs of catheter sac were not significantly difference in two groups （P〉 0.05）.3） SaO2＇s descend, moved restlessly, mouth cavity bleeds and blood pressure raised in guiding catheter＇s group were conspicuously lower laryngoscope group （P〈 0.05）. There were not significantly difference in two groups （P〉 0.05） there were change administer＇s time, one time success rate and cardiac arrhythmia.Conclusion （1）Sputum scab obstruct in aged patients is common in cause of unplanned replacemeut of endotracheal tube;there are common that non-aged patients move restlessly, bite flat conduit or independence pull administer.（2） It is recommended that the method of Guiding catheter is easier, lesser dangerous and lesser complication.