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急診科醫師於急診處進行快速麻醉誘導插管之可行性

Feasibility of Rapid Sequence Intubation by Emergency Physicians in the Emergency Department

摘要


目的:由急診科醫師進行快速麻醉誘導插管(rapid sequence intubation, RSI)已是急診處之標準處置流程之一。在臺灣,卻仍有許多急診室之非麻醉科醫師對RSI感到陌生。此研究之目的在於評估急診科醫師在急診處進行快速麻醉誘導插管是否可行。 方法:利用回溯性研究收集了兩個不同時期需要緊急呼吸道處置之單純頭部外傷病患。A組包含從1996-1997年期間不符合RSI插管之病患。B組包含了從2000-2001年期間符合RSI插管之病患。B組包含了從200至2001年期間曾接受適當的RSI之插管病患。針對這兩組病患,我們記錄了病患之基本資料(年齡、性別)、起始之GCS分數、是否接受開顱手術、是否接受緊急氣管切開術、住院中是否發生肺炎、住院中是否死亡以及出院時之GCS分數。 結果:此研究總共包含了48個病患:A組22位,B組26位。兩組之年齡、性別比率、起始GCS分數以及開顱手術比率並無顯著差異。兩組在緊急氣管切開術之比率、肺炎之比率以及死亡率變無顯著差異。但是,RSI組(B組)之出院GCS分數卻明顯優於非RSI組(A組)。 結論:在一個標準化的呼吸道處置流程引導下由受訓過的急診科醫師進行急診處之快速麻醉誘導插管是可行的。在預後方面,在需要緊急呼吸道處置之單純頭部外傷病患中,有使用RSI方式插管者出院時有較佳的GCS分數。

並列摘要


Background: The use of rapid sequence intubation (RSI) by emergency physicians (EPs) has been a standard of care in our emergency departments (EDs). However, there are still many non-anesthesiology physicians in Taiwan who are unfamiliar with the procedure. This study attempted to justify the feasibility of using RSI by EPs in EDs. Methods: Data on patients with isolated head trauma requiring emergency airway control were retrospectively collected over 2 study periods: from 1996 to 1997 (group A) and from 2000 to 2001 (group B). Group A included all patients that were intubated without RSI, and group B included all patients that were intubated with appropriate RSI. Data collected included patient demographics (age and gender), initial Glasgow Coma Scale (GCS) scores, need for cranial surgery, need for a surgical airway, pneumonia, in-hospital death, and discharge GCS scores. Results: In total, 48 patients, 22 from group A and 26 from group B, were included in the study. Both groups were similar in age, gender distribution, initial GCS scores, and rate of cranial surgery. The rates of surgical airway, pneumonia, and in-hospital mortality were also similar in the 2 groups. However, the discharge GCS scores were significantly higher in the RSI group (group B) then in the non-RSI group (group A). Conclusions: Trained EPs are prepared to perform RSI in the ED under guidance of a standard airway protocol. Isolated head trauma patients who were intubated using an RSI protocol seemed to have better outcomes in terms of GCS scores.

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