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目的观察不同预氧合方式在重症监护病房(ICU)危重患者急救插管中的效果。方法 2013年6月-2014年1月,按随机化原则将入住综合ICU需紧急行气管插管的患者40例分为4组,每组10例,分别为较普通吸氧组(A组)、面罩-球囊预氧合组(B组)、无创呼吸机预氧合组(C组)、麻醉充气面罩-有创呼吸机预氧合组(D组)。A组入ICU后立即进行快速气管插管;B组中当面罩-球囊预氧合后脉搏血氧饱和度(Sp O2)达90%行气管插管;C组中当无创呼吸机预氧合后Sp O2达90%行气管插管;D组中当麻醉充气面罩-有创呼吸机预氧合Sp O2达90%行气管插管。记录B、C、D组患者达到目标预氧合(Sp O2≥90%)所需要的时间,预氧合前及插管成功后即刻动脉血气分析,插管成功后即刻Sp O2,插管后并发症发生情况。结果 1预氧合前,4组患者各项基本指标比较差异无统计学意义(P>0.05),C组和D组患者达到目标预氧合所需要的时间明显低于B组(P<0.05)。2预氧合后,B、C、D组的Sp O2明显高于A组(P<0.05),C、D组的动脉血氧分压(Pa O2)和动脉血氧饱和度(Sa O2)均高于B组(P<0.05)。3插管后即刻,B、C、D组的Sp O2、Pa O2和Sa O2高于A组(P<0.05),C、D组Sp O2、Pa O2和Sa O2高于B组(P<0.05),D组Pa O2高于C组(P<0.05)。4 D组的腹胀发生率明显低于B、C组(P<0.05)。结论在急救插管前进行预氧合较直接气管插管可以提高患者的血氧水平;在预氧合的方式中,麻醉充气面罩-有创呼吸机预氧合方式的疗效和安全性较好。
Objective To observe the effect of different preoxygenation methods in the first aid catheterization of critically ill patients in intensive care unit (ICU). Methods From June 2013 to January 2014, 40 patients who needed urgent endotracheal intubation admitted to ICU were randomly divided into 4 groups (n = 10 in each group) , Mask - balloon preoxygenation group (group B), noninvasive ventilator preoxygenation group (group C), anesthetic gas mask - invasive ventilator preoxygenation group (group D). A group immediately into the ICU after rapid tracheal intubation; B group when the mask - balloon preoxygenation SpO2 90% endotracheal intubation; C group when non-invasive ventilator preoxygenation SpO2 reached 90% of tracheal intubation after co-occlusion. In group D, intratracheal intubation was performed with 90% of pre-oxygenated Sp O2 of invasive ventilator when anesthetized inflatable mask was used. The time required for patients to reach the target preoxygenation (Sp O2≥90%) in group B, C and D was recorded. Before preoxygenation and immediately after intubation, arterial blood gas analysis was performed. After the intubation was successful, Complications of the situation. Results 1 Pre-oxygenation, the basic indicators of the four groups of patients with no significant difference (P> 0.05), C and D patients to reach the goal of preoxygenation time is significantly lower than the B group (P <0.05 ). SpO2 in groups B, C and D were significantly higher than those in group A (P <0.05) after preoxygenation, and Pa O2 and Sa O2 in groups C and D Were higher than the B group (P <0.05). SpO2, Pa O2 and Sa O2 were significantly higher in group B, C and D than those in group A immediately after intubation (P <0.05), while Sp O2, Pa O2 and Sa O2 in group C and D were higher than those in group B (P < 0.05). Pa O2 in group D was higher than that in group C (P <0.05). The incidence of abdominal distension in group D was significantly lower than that in group B and C (P <0.05). CONCLUSION: Pre-oxygenation combined with direct tracheal intubation can improve the blood oxygenation level of the patients before the first-aid intubation. In the pre-oxygenation mode, the effect and safety of the pre-oxygenated mask-invasive ventilator preoxygenation are better .