Rhee K J, O'Malley R J, Turner J E, Ward R E
Department of Internal Medicine, University of California-Davis, Sacramento.
Am J Emerg Med. 1988 Jul;6(4):333-6. doi: 10.1016/0735-6757(88)90150-7.
There is no consensus on what constitutes appropriate field airway management in the seriously injured semiconscious patient. The respiratory complications in a selected group of patients who were transported from the scene of an accident by a helicopter service whose policy was to perform endotracheal intubation on only deeply obtunded patients and manage others with bag mask ventilation are reported. Respiratory compromise was defined as follows: partial pressure of oxygen less than 65 torr on initial hospital arterial blood gases, partial pressure of carbon dioxide greater than 45 torr on initial hospital arterial blood gases, or radiographic and clinical evidence of aspiration pneumonitis within 5 days of admission to the hospital. From a total of 116 patients transported from the scene of an accident during the period of this investigation, there were 42 patients with Trauma Scores between 4 and 14 whose records were studied in detail. Ten of these patients ha adequate perfusion and abnormal arterial blood gases after arrival at the receiving hospital. Five patients might have benefited from endotracheal intubation in the field, but there were no preventable deaths. Neurologic status of the patient appeared to be more useful than respiratory status in predicting respiratory compromise.
对于重伤半昏迷患者，何种气道管理方式才算恰当，目前尚无定论。本文报告了一组特定患者的呼吸并发症情况，这些患者由一家直升机急救服务机构从事故现场转运而来，该机构的政策是仅对深度昏迷患者进行气管插管，其他患者则采用面罩通气进行处理。呼吸功能不全的定义如下：入院时首次动脉血气分析显示氧分压低于65托，二氧化碳分压高于45托，或入院后5天内出现吸入性肺炎的影像学及临床证据。在本次调查期间从事故现场转运的116例患者中，有42例创伤评分在4至14分之间，对这些患者的记录进行了详细研究。其中10例患者在抵达接收医院后有足够的灌注，但动脉血气异常。5例患者可能在现场就会从气管插管中获益，但并无可预防的死亡病例。在预测呼吸功能不全方面，患者的神经状态似乎比呼吸状态更具参考价值。
