重症颅脑损伤院前急救早期气管插管的应用分析
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摘要
目的:分析重症颅脑损伤院前急救早期气管插管的应用效果。方法:研究阶段为2012年7月1日-2018年7月1日,共纳入研究对象90例,均为重症颅脑损伤患者,根据插管时机分为对照组和观察组,对照组采用常规插管,观察组采取早期插管,比较两组上机率、上机时间和监护时间、重症肺炎发生率。结果:对照组上机率、重症肺炎发生率明显高于观察组,差异有统计学意义(P<0.05)。对照组上机时间、监护时间均长于观察组,差异有统计学意义(P<0.05)。对照组良好例数低于观察组,对照组重残、死亡例数明显高于观察组,差异有统计学意义(P<0.05),两组中残例数、植物人例数差异无统计学意义(P>0.05)。结论:对于重症颅脑损伤患者院前急救采取早期气管插管有效减少上机时间、监护时间、重症肺炎发生率,有效改善预后,值得临床应用与推广。
Objective:To analyze the the application effect of early tracheal intubation in pre-hospital emergency treatment of severe craniocerebral injury.Method:The research period was from July 1,2012 to July 1,2018.A total of 90 patients with severe head injury were included in the study.According to the timing of intubation,they were divided into the control group and the observation group.The control group was routinely intubated,and the observation group was treated with early intubation.The on-board rate,on-board time and monitoring time,and incidence of severe pneumonia were compared between the two groups.Result:The on-board rate and the incidence of severe pneumonia in the control group were significantly higher than those in the observation group,and the difference was statistically significant(P<0.05).The on-board time and monitoring time of the control group were longer than the observation group,and the difference was statistically significant(P<0.05).The number of good cases in the control group was lower than that in the observation group,the number of severe cases and deaths in the control group was significantly higher than that in the observation group,the difference was statistically significant(P<0.05).There was no significant difference in the number of moderate disability cases and the number of vegetative cases between the two groups(P>0.05).Conclusion:Early tracheal intubation for pre-hospital emergency in patients with severe craniocerebral injury can effectively reduce the time of onset,monitoring time,and incidence of severe pneumonia,and effectively improve the prognosis.It is worthy of clinical application and promotion.
Objective:To analyze the the application effect of early tracheal intubation in pre-hospital emergency treatment of severe craniocerebral injury.Method:The research period was from July 1,2012 to July 1,2018.A total of 90 patients with severe head injury were included in the study.According to the timing of intubation,they were divided into the control group and the observation group.The control group was routinely intubated,and the observation group was treated with early intubation.The on-board rate,on-board time and monitoring time,and incidence of severe pneumonia were compared between the two groups.Result:The on-board rate and the incidence of severe pneumonia in the control group were significantly higher than those in the observation group,and the difference was statistically significant(P<0.05).The on-board time and monitoring time of the control group were longer than the observation group,and the difference was statistically significant(P<0.05).The number of good cases in the control group was lower than that in the observation group,the number of severe cases and deaths in the control group was significantly higher than that in the observation group,the difference was statistically significant(P<0.05).There was no significant difference in the number of moderate disability cases and the number of vegetative cases between the two groups(P>0.05).Conclusion:Early tracheal intubation for pre-hospital emergency in patients with severe craniocerebral injury can effectively reduce the time of onset,monitoring time,and incidence of severe pneumonia,and effectively improve the prognosis.It is worthy of clinical application and promotion.
引文
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[6]吴燕生,石秀华,康德.早期纤支镜引导经鼻气管插管急诊抢救重型颅脑损伤并误吸的体会[J].中国实用医药,2015,10(31):28-30.
[7]周丹,刘伟,孙晓旭.困难气管插管中纤维支气管镜的应用价值分析[J].当代医学,2016,22(6):55-56.
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[9]丁海燕.比较普通喉罩与气管内插管全身麻醉在腹腔镜卵巢肿瘤切除术中的应用[J].中国继续医学教育,2016,8(6):49-50.
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[11]徐旭,李志伟,郭雅琼,等.肿瘤坏死因子-α、内毒素、白细胞介素-6与重症颅脑损伤急性肝损伤的相关性研究[J].医学研究杂志,2014,43(5):115-118.
[12]魏迎兵.重型颅脑伤患者持续颅内压监测数值意义分析及护理对策[J].医学信息,2014,27(6):194.
[13]张远明,柴伟,魏民,等.重症颅脑外伤急性期联合检测空腹血糖和糖化血红蛋白及乳酸脱氢酶临床价值[J].中华实用诊断与治疗杂志,2014,28(3):293-295.
[14]杨春艳.临床护理路径在重症颅脑损伤患者急救中应用的效果观察[J].临床医药实践,2014,23(2):135-137.
[15]李文彬.不同时期应用纳洛酮治疗重症颅脑损伤的效果对比[J].临床医学,2014,34(3):74-75.
[16]钟鸿波,柳德元,张开权.院前急救早期气管插管对重症颅脑损伤患者的应用效果分析[J].中国临床研究,2014,27(11):1362-1364.
[2]Karamanos E,Talving P,Skiada D,et al.Is prehospital endotracheal intubation associated with improved outcomes in isolated severe head injury:a matched cohort analysis[J].Prehosp Disaster Med,2014,29(1):32-36.
[3]吴剑锋.早期气管插管应用于重症颅脑损伤患者院前急救的疗效分析[J].现代实用医学,2016,28(10):1315-1316.
[4]Mac Donald C L,Johnson A M,Wierzechowski L,et al.Prospectively assessed clinical outcomes in concussive blast vs nonblast traumatic brain injury among evacuated US military personnel[J].JAMA Neurol,2014,71(8):994-1002.
[5]李玉萍,谢惠敏.重症颅脑损伤院前急救早期气管插管的应用[J].中国社区医师:医学专业,2011,13(34):38-39.
[6]吴燕生,石秀华,康德.早期纤支镜引导经鼻气管插管急诊抢救重型颅脑损伤并误吸的体会[J].中国实用医药,2015,10(31):28-30.
[7]周丹,刘伟,孙晓旭.困难气管插管中纤维支气管镜的应用价值分析[J].当代医学,2016,22(6):55-56.
[8]Bulger E M,Guffey D,Guyette F X,et al.Impact of prehospital mode of transport after severe injury:a multicenter evaluation from the resuscitation outcomes consortium[J].J Trauma Acute Care Surg,2012,72(3):567-573.
[9]丁海燕.比较普通喉罩与气管内插管全身麻醉在腹腔镜卵巢肿瘤切除术中的应用[J].中国继续医学教育,2016,8(6):49-50.
[10]张静.康复新液经口气管插管患者口腔护理的临床效果探讨[J].中国医药指南,2016,14(1):217.
[11]徐旭,李志伟,郭雅琼,等.肿瘤坏死因子-α、内毒素、白细胞介素-6与重症颅脑损伤急性肝损伤的相关性研究[J].医学研究杂志,2014,43(5):115-118.
[12]魏迎兵.重型颅脑伤患者持续颅内压监测数值意义分析及护理对策[J].医学信息,2014,27(6):194.
[13]张远明,柴伟,魏民,等.重症颅脑外伤急性期联合检测空腹血糖和糖化血红蛋白及乳酸脱氢酶临床价值[J].中华实用诊断与治疗杂志,2014,28(3):293-295.
[14]杨春艳.临床护理路径在重症颅脑损伤患者急救中应用的效果观察[J].临床医药实践,2014,23(2):135-137.
[15]李文彬.不同时期应用纳洛酮治疗重症颅脑损伤的效果对比[J].临床医学,2014,34(3):74-75.
[16]钟鸿波,柳德元,张开权.院前急救早期气管插管对重症颅脑损伤患者的应用效果分析[J].中国临床研究,2014,27(11):1362-1364.