呼气末二氧化碳在急诊科机械通气患者的应用

目的探讨呼气末二氧化碳(ETCO2)监测在急诊科机械通气患者中的应用价值。方法回顾性分析2012年1月—2013年1月该院急诊抢救室应用有创机械通气患者58例,分为ETCO2监测组(A组)27例及非ETCO2监测组(B组)31例,统计发生错误插管、呼吸机工作故障及其所致的不良事件发生频次、从不良事件发生到医护人员响应时间,并对医务人员反应时间进行比较。结果医务人员对A、B两组患者错误插管反应时间为[(0.59±0.21)min vs(2.12±0.48)min,P=0],呼吸机管路脱落反应时间为[(0.27±0.15)min vs(0.87±0.16)min,P=0],呼吸机管路扭曲、打折反应时间为[(1.17±0.24)min vs(1.93±0.18)min,P=0],通气不足反应时间为[(4.27±1.44)min vs(8.08±1.81)min,P=0]。两组患者严重不良反应事件之间相比差异无统计学意义(P=0.087)。结论急诊科各种接受有创机械通气患者,通过监测ETCO2可以尽早发现不良事件并及时处理,从而避免造成不必要的医源性事故发生。

Application of end-tidal carbon dioxide in patients with invasive mechanical ventilation at emergency department

Objective To explore the value of end-tidal carbon dioxide monitoring for patients undergoing invasive mechanical ventilation at emergency department.Methods From January 2012 to January 2013,58 patients with mechanical ventilation in the emergency department were assigned into two groups： ETCO2monitoring（group A,n = 27） and non-ETCO2（group B,n =31）.We recorded the cacoethic incident frequency due to wrong intratracheal intubation and working trouble of ventilator and different response time to what happened of two groups,and compared the response time.Results The response time for medical staff to wrong intratracheal intubation was 0.59 ± 0.21 vs 2.12 ± 0.48 min（P = 0）,to twist and / or fold of circuit 1.17 ± 0.24 vs 1.93 ± 0.18 min（P = 0）,to separation of circuit 0.27 ± 0.15 vs 0.87 ± 0.16 min（P = 0）,to low ventilation 4.27 ± 1.44 vs 8.08 ± 1.81 min（P = 0）.There was no significant difference in cacoethic incident between the two groups（P = 0.087）.Conclusion Patients undergoing invasive mechanical ventilation in emergency department can be prevented from developing cacoethic iatrogenic incident by ETCO2monitoring which is helpful to detect and treat the incident in time.