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华西医学  2015 

重症监护病房危重患者急救插管前预氧合方式的比较研究

DOI: 10.7507/1002-0179.20150583, PP. 2054-2058

Keywords: 急救插管,预氧合,重症监护

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Abstract:

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(SpO2)达90%行气管插管;C组中当无创呼吸机预氧合后SpO2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SpO2达90%行气管插管。记录B、C、D组患者达到目标预氧合(SpO2≥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SpO2,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SpO2明显高于A组(P<0.05),C、D组的动脉血氧分压(PaO2)和动脉血氧饱和度(SaO2)均高于B组(P<0.05)。③插管后即刻,B、C、D组的SpO2、PaO2和SaO2高于A组(P<0.05),C、D组SpO2、PaO2和SaO2高于B组(P<0.05),D组PaO2高于C组(P<0.05)。④D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。

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