Syverud S A, Borron S W, Storer D L, Hedges J R, Dronen S C, Braunstein L T, Hubbard B J
Department of Emergency Medicine, University of Cincinnati College of Medicine, Ohio 45267-0769.
Ann Emerg Med. 1988 Mar;17(3):236-42. doi: 10.1016/s0196-0644(88)80114-8.
We prospectively studied the use of succinylcholine chloride and pancuronium bromide by the physician/nurse flight team of our hospital-based helicopter ambulance service. Patients who received these agents at the scene of an accident (prehospital group, n = 39) were compared with patients who were paralyzed by the flight team in the emergency department of transferring hospitals (control group, n = 35). By protocol, succinylcholine was used primarily for endotracheal intubation and pancuronium for prolonged paralysis after endotracheal intubation. Seventy-four patients received one or both agents. Overall, 61 of 74 patients had intracranial pathology as their primary diagnosis (82%). Endotracheal intubation was the primary indication for paralysis in the majority of patients (67 of 74), although intracranial pressure control, ventilation, agitation control, and seizure control were frequent secondary indications. Prior intubation attempts had failed in 40 of 74 patients (54%). After paralysis, intubation was successful in 68 of 71 patients (96%). Serious complications (ie, dysrhythmia requiring drug therapy) occurred in three patients but resolved with appropriate therapy in each case. Minor complications (ie, dysrhythmia not requiring drug therapy, histamine flush, infiltrated IV line) occurred in 18 patients. There was no significant difference in successful intubation or complication rate between the prehospital and control group. Paralysis allowed airway stabilization in a significant number of critically ill patients who could not otherwise be endotracheally intubated, with a lower incidence of complications than has been previously reported for ED patients. These results suggest that neuromuscular blocking agents can be used safely and effectively at accident scenes by a physician/nurse team.
我们对我院直升机救护服务的医生/护士飞行团队使用氯化琥珀胆碱和溴化潘库溴铵的情况进行了前瞻性研究。将在事故现场接受这些药物的患者（院前组，n = 39）与在转诊医院急诊科由飞行团队实施麻痹的患者（对照组，n = 35）进行比较。根据方案，琥珀胆碱主要用于气管插管，潘库溴铵用于气管插管后的长时间麻痹。74例患者接受了一种或两种药物。总体而言，74例患者中有61例以颅内病变作为主要诊断（82%）。气管插管是大多数患者（74例中的67例）麻痹的主要指征，尽管控制颅内压、通气、控制躁动和控制癫痫发作也是常见的次要指征。74例患者中有40例（54%）先前的插管尝试失败。麻痹后，71例患者中有68例（96%）插管成功。3例患者出现严重并发症（即需要药物治疗的心律失常），但每例均经适当治疗后缓解。18例患者出现轻微并发症（即不需要药物治疗的心律失常、组胺潮红、静脉输液渗漏）。院前组和对照组在插管成功率或并发症发生率方面无显著差异。麻痹使大量病情危重、否则无法进行气管插管的患者气道得以稳定，并发症发生率低于先前报道的急诊科患者。这些结果表明，医生/护士团队可在事故现场安全有效地使用神经肌肉阻滞剂。
