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目的 回顾分析收治的重症严重急性呼吸综合征(SARS)患者进行首次气管插管抢救的临床过程。方法 从临床操作过程的特点系统地回顾进行首次气管插管的重症SARS患者的临床资料,试提出最佳操作方案。结果重症SARS患者无创治疗失败需气管插管人工通气共11例,55％合并有基础病(6/11),100％曾接受无创人工通气治疗失败,100％经纤维支气管镜引导经鼻气管插管;7例经治疗后成功拔除气管插管,执行严格防护措施前感染了医护人员10例,实施严格防护措施后无感染的个案。结论 有创人工通气是抢救重症SARS的最后手段之一,在单向层流设计的中心ICU里执行严格的个人防护措施建立人工气道对医护人员是安全的。
Objective To retrospectively analyze the clinical course of the first tracheal intubation rescue in patients with severe acute respiratory syndrome (SARS). Methods The clinical data of patients with severe SARS undergoing primary intubation were retrospectively reviewed from the characteristics of clinical practice. The best operation plan was proposed. Results The non-invasive treatment of severe SARS patients failed to be required artificial ventilation tracheal intubation in 11 cases, 55% with underlying disease (6/11), 100% had noninvasive artificial ventilation failed, 100% guided bronchoscopy through the nasotracheal tube Tube; 7 cases of successful removal of endotracheal intubation after treatment, the implementation of stringent protective measures before the infection of health care workers in 10 cases, the implementation of strict protective measures after no case of infection. Conclusions Invasive artificial ventilation is one of the last resorts to rescue severe SARS. It is safe for medical staff to enforce strict personal protective measures in ICU of unidirectional laminar flow design.