郑敏伟

[摘要]目的 探討急诊内科危重昏迷患者气管插管的时机与方法。方法 选取2017年1月～2018年1月我院急诊内科接受气管插管的危重昏迷患者76例作为研究对象，根据插管时机分为即刻组（n=39）和延时组（n=37）。即刻组为急诊内科医护人员即刻行气管插管，延时组则等麻醉科医师到达急诊内科后行气管插管，比较两组患者从准备到插管时间、插管所需时间及患者气管插管成功率、抢救成功率、1个月内存活率。结果 两组患者插管方法的比较，差异无统计学意义（P>0.05）。即刻组患者的准备至插管时间短于延时组，差异有统计学意义 （P<0.05）。两组患者插管所用时间的比较，差异无统计学意义（P>0.05）。两组患者气管插管成功率的比较，差异无统计学意义（P>0.05），即刻组患者的抢救成功率、1个月内存活率均明显高于延时组，差异均有统计学意义 （P<0.05）。结论 针对急诊内科危重患者，在结合患者具体情况的基础上尽早进行气管插管，能够提高抢救成功率，降低死亡率发生。

[关键词]急诊内科；危重昏迷；气管插管；时机；方法

[中图分类号] R459 [文献标识码] A [文章编号] 1674-4721（2018）8（b）-0053-03

Timing and method of endotracheal intubation for critically ill comatose patients in emergency department of internal medicine

ZHENG Min-wei

Department of Emergency， People′s Hospital of Yingtan City in Jiangxi Province， Yingtan 3350003， China

[Abstract] Objective To explore the timing and method of endotracheal intubation for critically ill comatose patients in emergency department. Methods Seventy-six critically ill comatose patients who received endotracheal intubation in our emergency department from January 2017 to January 2018 were selected as the research objects， and divided into immediate group （n=39） and delayed group （n=37） according to the intubation timing. In the immediate group， the emergency medical staff immediately underwent endotracheal intubation， while in the delayed group， after the anesthesiologists arrived in the emergency medical department， they underwent endotracheal intubation. The time from preparation to intubation， the time required for intubation， the success rate of endotracheal intubation， the success rate of rescue and the survival rate within one month were compared between the two groups. Results There was no statistical difference between the two groups （P>0.05）. The time from preparation to intubation in the immediate group was shorter than that in the delayed group， the difference was statistically significant （P<0.05）. There was no statistical difference between the two groups （P>0.05）. There was no statistically significant difference in the success rate of tracheal intubation between the two groups（P>0.05）. The success rate of rescue and survival rate within one month in the immediate group were significantly higher than those in the delayed group， and the difference was statistically significant （P<0.05）. Conclusion For critically ill patients in emergency department， endotracheal intubation as soon as possible based on the specific conditions of the patients can improve the success rate of rescue and reduce the occurrence of death rate.

[Key words] Emergency internal medicine； Severe coma； Tracheal intubation； Timing； Methods

对于进入到急诊内科危重昏迷患者而言，由于生命体征不平稳，情况危急，实现紧急抢救，最大限度降低死亡率十分关键[1-2]。气管插管在急诊科的应用十分广泛，主要应用于危重患者以及需要吸氧的患者中。作为呼吸道管理中的一种有效手段，能够确保患者呼吸通畅，维持危重昏迷患者的供氧[3]。气管插管也是急诊内科医护人员必须掌握的一项基本技能[4]。对于气管插管的时机与方法，很大程度上关系到后续的抢救工作。针对急诊内科危重昏迷患者气管插管时机的选择，考虑到患者病情发展迅速，随时都有可能出现呼吸停止、心脏骤停等情况，如果在这种情况下进行气管插管可能会降低抢救成功率。本研……