重症加强治疗病房内气管插管分析

目的分析ICU内重症患者床旁气管插管的特点及并发症发生率,探讨适宜的插管时机和策略。方法收集四川大学华西医院ICU内2008年9月至2009年3月共105例床旁气管插管中资料完整的42例患者,总结插管成功次数、时间及插管并发症。医师预先评估有插管指征并作插管准备者24例为计划插管组,因病情突变或意外拔管作紧急气管插管者18例为紧急插管组。结果 42例患者中1次插管成功率较低,仅为57.1%;插管并发症多,药物诱导致低血压19例(45.2%),低氧21例(50.0%)。计划插管组平均插管次数(1.71±1.12比2.67±1.75)、2次以内插管成功率(87.5%比61.1%)、低氧并发症发生率(29.1%比77.8%)均优于紧急插管组(P均0.05)。结论 ICU内气管插管难度大,并发症显著。预先评估病情进展趋势主动插管可提高紧急插管成功率,减少插管时间及并发症。

Analysis of Tracheal Intubation in Intensive Care Unit

Objective To evaluate the clinical features and complications of bedside tracheal intubation in intensive care unit （ICU）,and explore the suitable strategy of intubation.Methods In this retrospective study,42 patients who underwent bedside tracheal intubation in ICU during September 2008 and March 2009 were divided into a schedule group （n=24） and an emergency group （n=18）.The time to successful intubation,number of intubation attempts,and complications were recorded.The schedule group was defined as those with indications for intubation and fully prepared,while the emergency group was defined as those undergoing emergency intubations without full preparation due to rapid progression of disease and accidental extubation.Results The success rate for all patients was only 57.1% on the first attempt of intubation.The main complications during and after induction were hypotension （45.2%） and hypoxemia （50.0%）.Compared with the emergency group,the schedule group had fewer attempts to successful intubation （1.71±1.12 vs.2.67±1.75）,higher success rate on the second attempt （87.5% vs.61.1%）,and lower hypoxemia incidence （29.1% vs.77.8%,P0.05）.Conclusions The tracheal intubation in ICU is a difficult and high risk procedure with obvious complications.Early recognition of patients with indications and well preparation are critical to successful bedside intubation.