急重症颅脑损伤患者抢救时紧急人工气道的建立及其管理

目的研究急重症颅脑损伤患者抢救时紧急人工气道的建立及其管理。方法 2016年7月-2017年3月,深圳市南山区人民医院急诊科收治90例急重症颅脑损伤患者。其中男性49例,女性41例;年龄20~82岁,平均51.27岁。以数字法随机划分为研究组(45例)和对照组(45例),人工气道的建立依据实际情况,选择操作便捷与迅速,且能确保最理想的气道通畅方法为主,对照组患者给予常规气管内行插管术通气方式加管理,观察组患者给予综合4类通气方式加管理。对比观察两组患者抢救中的插管时间,插管平均次数及成功率和并发症,脱离ICU时间,机械通气时间,急性呼吸窘迫综合征(ARDS),30d病死率和吸入性肺炎等。结果人工气道建立时间均存在差异;除A类气管内行插管术一次成功率相对较低,其他均一次性成功,且复苏成功率不具统计学意义;观察组通过给予综合管理治疗后其ARDS、围插管期并发症、吸入性肺炎发病率与死亡率均显著低于对照组;治疗后观察组机械通气时间(5.72±1.84)d,ICU住院时间(13.78±1.62)d,均显著低于对照组[(7.41±2.13)d,(17.58±2.67)d],差异均有统计学意义(P0.05)。结论急重症颅脑损伤患者抢救时紧急人工气道的建立及管理中,人工气道的建立需因地、因人及因时制宜选择不同的建道方法,确保患者通气顺畅,有效保持肺功能。采用综合管理能有效降低死亡率,缩短机械通气及ICU时间,能有效改善预后,值得临床参考。

Establishment and management of emergency artificial airway in patients with severe craniocerebral injury

Objective To explore the establishment and management of emergency artificial airway in patients with severe craniocerebral injury. Methods There were 90 acute severe brain injury patients diagnosed in our hospital emergency department from Jul.2016 to Mar.2017.They were divided into the study group (45 cases) and control group (45 cases), according to the emergency management of artificial airway in different ways.The artificial airway was established on the basis of the actual situation, convenient operation and quick selection, and the smooth method of the ideal airway was ensured.The control group was given routine endotracheal intubation, ventilation and management, and the observation group was given comprehensive management.The emergency intubation time, the average number and success rate of intubation, ICU stay, mechanical ventilation time, ARDS and 30d mortality with aspiration pneumonia between the two groups were compared. Results Establishment of artificial airway time was different;in addition to a relatively low success rate of tracheal intubation, all the other did successfully, and the success rate of recovery was not significantly different.The observation group received comprehensive management by ARDS after treatment, and the complications of aspiration pneumonia and mortality were significantly lower than those of the control group.After treatment the observation group's mechanical ventilation and ICU stay were significantly lower than those of the control group, and the differences were statistically significant [(5.72±1.84)d vs.(13.78±1.62)d, (7.41±2.13)d vs.(17.58±2.67)d, P<0.05]. Conclusion During the establishment of artificial airway for patients with severe craniocerebral injury, it is necessary to choose different construction methods, to ensure the smooth ventilation and to effectively maintain lung function.The comprehensive management can not only reduce the mortality effectively, shorten the mechanical ventilation time and ICU stay, but also can improve the prognosis effectively.It is worthy of clinical reference.