CAJ | 학술논문

目的探讨在清醒危重患者急救中使用Shikani喉镜引导气管插管的可行性,并评价其使用效果.方法选择2008年1月至2009年6月广州中医药大学第二附属医院收治的神志尚清楚的危重呼衰患者48例,男31例,女17例,年龄21～86岁,平均57岁,所有患者均需气管插管行机械辅助通气.采用非随机对照方法,按进入研究的日期单双数分为Shikani喉镜气管插管组(S组,n=25)和Macintosh喉镜气管插管埘照组(M组,n=23).记录每例的气管插管时间、插管次数以及包括心血管反应剧烈、呛咳、屏气、口咽腔损伤等不良反应或并发症的发生情况.统计分析采用x2检验、秩和检验等.结果 S组1次插管成功率(96.0%)较M组1次插管成功率(60.9%)高,插管时间较对照组(M组)缩短,差异均具有统计学意义(P<0.01).S组的心血管反应剧烈、呛咳、屏气的发生率均较M组少,口咽腔黏膜出血创伤的发生率也较M组小,差异均具有统计学意义(P<0.01).结论在急危重患者救治中,尤其对于神志清楚的患者,Shikani喉镜引导气管插管具有插管迅速、成功率高、心血管反应轻、损伤小、安全性高的优点,是一种安全、有效的气管插管新技术.
목적 탐토재청성위중환자급구중사용Shikani후경인도기관삽관적가행성,병평개기사용효과.방법 선택2008년1월지2009년6월엄주중의약대학제이부속의원수치적신지상청초적위중호쇠환자48례,남31례,녀17례,년령21～86세,평균57세,소유환자균수기관삽관행궤계보조통기.채용비수궤대조방법,안진입연구적일기단쌍수분위Shikani후경기관삽관조(S조,n=25)화Macintosh후경기관삽관시조조(M조,n=23).기록매례적기관삽관시간、삽관차수이급포괄심혈관반응극렬、창해、병기、구인강손상등불량반응혹병발증적발생정황.통계분석채용x2검험、질화검험등.결과 S조1차삽관성공솔(96.0%)교M조1차삽관성공솔(60.9%)고,삽관시간교대조조(M조)축단,차이균구유통계학의의(P<0.01).S조적심혈관반응극렬、창해、병기적발생솔균교M조소,구인강점막출혈창상적발생솔야교M조소,차이균구유통계학의의(P<0.01).결론 재급위중환자구치중,우기대우신지청초적환자,Shikani후경인도기관삽관구유삽관신속、성공솔고、심혈관반응경、손상소、안전성고적우점,시일충안전、유효적기관삽관신기술.
Objective To investigate the practical value of Shikani optical stylet used for orotracheal intubation in critically conscious patients and to evaluate the successful rate. Method A total of 48 conscious patients with severe respiratory failure were selected from January 2008 to June 2009. Of them, there were 31 males and 17 females,aging 21-86 years old with an average of 57 years old. All enrolled patients needed endotracheal intubation for mechanical ventilation support, and they were assigned to Shikani group (group S, n = 25) and Macintosh group (group M, n = 23) according to the odd and even number of date of admission to this study. The time consumed for intubation, the number of failure in intubation, the adverse effects or complications such as hemodynam-ic changes, injury to the pharyngo-oral cavity, choking and breath-hold were observed and recorded. The rank test and chi-square test were used for statistical analysis. Results The ratio of the successful intubation at first attempt was much higher in group S (96.0%) than that in group M (60.9%) (P <0.01). Compared with group M, the time consumed for intubation was significantly shortened, the cardiovascular reactions were much mild, and the incidence of injury to pharyngo-oral cavity, choking and breath-hold were less in the group S ( P < 0.01 all). Conclusions For the acute and critical patients, especially the conscious ones, orotracheal intubation with the Shikani optical stylet is rapid, successful, safe and less injurious, resulting in mild cardiovascular reactions.