Helm M, Breschinski W, Lampl L, Frey W, Bock K H
Abteilung für Anästhesiologie und Intensivmedizin, Bundeswehrkrankenhaus Ulm.
Anaesthesist. 1996 Dec;45(12):1196-202. doi: 10.1007/s001010050358.
In prehospital emergency treatment, the timely establishment of a secure vascular access, especially in infants and small children, can be difficult or even impossible. An alternative to the puncture of peripheral or central veins is intraosseous (IO) puncture However, experience with this method in prehospital emergency medicine within the Federal Republic of Germany is extremely limited at present. After intensive theoretical and practical training of our trauma anaesthesiologists, IO puncture was introduced in our rescue helicopter program "Christoph 22" as an alternative to peripheral or central venous puncture in the prehospital treatment of patients up to 6 years of age. IO puncture is indicated after a maximum of three failed peripheral venous puncture attempts. The purpose of this study was to collect data and summarise first-hand experience on the prehospital use of the IO method as well as the practicability of our prescribed IO puncture algorithm in order to subject them to critical review and evaluation.
A restrospective study by the rescue helicopter service "Christoph 22" was carried out for the period 1 June 1993-31 August 1995.
In a total of 1,455 primary rescue missions flown, the proportion of patients < and = 6 years of age, was 6.2% (n = 90). Ten patients in this partial collective (11.1%) were subjected to IO puncture (Fig. 3). In all of these cases (10/10), the first IO puncture attempt was successful. A standardized puncture technique was performed using the proximal tibia. The time required to successful placement of the IO infusion line was < and = 60 s in all cases. Complications, especially incorrect needle position, did not occur during the study period. Materials infused by IO infusion before hospitalisation included crystalloids (Lactated Ringer's, Päd OP) as well as colloids (hydroxyethylstarch, human albumin), adrenaline, atropine, ketamine, thiopentone, diazepam, fentanyl, succinylcholine, and vecuronium (Table 3). Prehospital induction of general anaesthesia using the IO infusion line was required by 2/10 children; dosage and onset of administered drugs was described by the trauma anaesthesiologists as being similar to that using an i.v. infusion line. Seven of the patients had been treated prior to the arrival of the rescue helicopter team by other emergency medical personnel; in all of these cases multiple peripheral and in 3 additional central venous puncture attempts had failed (duration of attempts: 10-50 min). Upon arrival of the rescue helicopter, 5 of these patients had been pulseless and non-breathing (Table 2).
The IO infusion technique has proven to be a simple, fast, and safe alternative method of emergent access to the vascular system.
在院前急救治疗中，尤其是对于婴幼儿，及时建立安全的血管通路可能困难甚至无法实现。外周或中心静脉穿刺的替代方法是骨内（IO）穿刺。然而，目前在德意志联邦共和国的院前急救医学中，这种方法的经验极其有限。经过我们创伤麻醉医生的强化理论和实践培训后，IO穿刺被引入我们的救援直升机项目“克里斯托夫22”，作为6岁以下患者院前治疗中外周或中心静脉穿刺的替代方法。在最多三次外周静脉穿刺尝试失败后，才进行IO穿刺。本研究的目的是收集数据并总结IO方法院前使用的第一手经验以及我们规定的IO穿刺算法的实用性，以便对其进行严格审查和评估。
救援直升机服务“克里斯托夫22”进行了一项回顾性研究，研究时间为1993年6月1日至1995年8月31日。
在总共执行的1455次初级救援任务中，年龄≤6岁的患者比例为6.2%（n = 90）。这部分人群中有10名患者（11.1%）接受了IO穿刺（图3）。在所有这些病例（10/10）中，首次IO穿刺尝试均成功。使用胫骨近端进行标准化穿刺技术。在所有病例中，成功放置IO输液管所需时间≤60秒。在研究期间未发生并发症，尤其是针位置不正确的情况。住院前通过IO输液注入的物质包括晶体液（乳酸林格氏液、儿童手术用液）以及胶体液（羟乙基淀粉、人白蛋白）、肾上腺素、阿托品、氯胺酮、硫喷妥钠、地西泮、芬太尼、琥珀酰胆碱和维库溴铵（表3）。10名儿童中有2名需要通过IO输液管进行院前全身麻醉诱导；创伤麻醉医生描述所给药的剂量和起效情况与使用静脉输液管时相似。其中7名患者在救援直升机团队到达之前已由其他急救人员进行了治疗；在所有这些病例中，多次外周静脉穿刺以及另外3次中心静脉穿刺尝试均失败（尝试持续时间：10 - 50分钟）。救援直升机到达时，这些患者中有5名已无脉搏且无呼吸（表2）。
IO输液技术已被证明是一种简单、快速且安全的紧急进入血管系统的替代方法。
