Brownstein D, Shugerman R, Cummings P, Rivara F, Copass M
Department of Pediatrics, University of Washington, Seattle, USA.
Ann Emerg Med. 1996 Jul;28(1):34-9. doi: 10.1016/s0196-0644(96)70136-1.
To describe the experience of an emergency medical services system with the use of liberal indications for prehospital pediatric endotracheal intubation.
We performed a retrospective review of prehospital and hospital patient records in an urban and suburban prehospital care system. The study included all children aged 15 years or younger who were intubated in the prehospital setting by King County paramedics from January 1, 1984, to December 31, 1990.
During the 7-year study period, 654 children were intubated, of which 355 (54%) were study patients. The median age of the patients was 3 years; 60% had an injury diagnosis. On arrival of the paramedics, 60% of the patients were in sinus rhythm, 62% had a systolic blood pressure of 70 mm Hg or greater, and 56% had a respiratory rate of 10 breaths per minute or greater. The Glasgow Coma Scale score was 8 or lower in 83% of the patients. Succinylcholine was used to facilitate intubation in 47% of patients. On arrival at the emergency department, 79% of the patients were in sinus rhythm; 75% had an adequate blood pressure (70 mm Hg or greater); 86% had a PaO2 value of 100 mm Hg or greater; and 74% had a PaCO2 value of 45 mm Hg or lower. Complications of intubation, more than half of which were classified as minor, were noted in 22.6% of patients. We were unable to determine the number of failed intubation attempts. Most of the patients (58%) survived to hospital discharge. Among cardiac arrest victims, only 12% survived.
In a setting where paramedics practice with close medical direction, applying liberal indications for pediatric intubation and permitting the use of succinylcholine allowed paramedics to intubate children of different ages and diagnoses.
描述一个紧急医疗服务系统在院前小儿气管插管时采用宽松指征的经验。
我们对一个城市和郊区院前护理系统中的院前及医院患者记录进行了回顾性研究。该研究纳入了1984年1月1日至1990年12月31日期间由金县护理人员在院前环境中进行气管插管的所有15岁及以下儿童。
在7年的研究期间，654名儿童接受了气管插管，其中355名（54%）为研究患者。患者的中位年龄为3岁；60%有损伤诊断。护理人员到达时，60%的患者为窦性心律，62%的患者收缩压≥70 mmHg，56%的患者呼吸频率≥10次/分钟。83%的患者格拉斯哥昏迷量表评分≤8分。47%的患者使用琥珀酰胆碱辅助插管。到达急诊科时，79%的患者为窦性心律；75%血压正常（≥70 mmHg）；86%的患者动脉血氧分压≥100 mmHg；74%的患者动脉血二氧化碳分压≤45 mmHg。22.6%的患者出现插管并发症，其中一半以上为轻微并发症。我们无法确定插管失败的次数。大多数患者（58%）存活至出院。在心脏骤停患者中，只有12%存活。
在护理人员在密切医疗指导下开展工作的环境中，采用宽松的小儿插管指征并允许使用琥珀酰胆碱，使护理人员能够为不同年龄和诊断的儿童进行气管插管。
