Koetter K P, Hilker T, Genzwuerker H V, Lenz M, Maleck W H, Petroianu G A, Fisher J A
Department of Neurology, Juliusspital, Wuerzburg, Germany.
Prehosp Emerg Care. 1997 Apr-Jun;1(2):96-9. doi: 10.1080/10903129708958796.
To examine the ease of endotracheal intubation on the ground for various rescuer positions.
Six female and 18 male emergency medical technicians were asked to intubate a Laerdal Megacode Trainer placed on the ground. Rescuers assumed the following positions in random order: prone, sitting, kneeling at the mannequin's head, and straddling the chest. The authors measured times 1) for changing from mask ventilation to assuming intubation position and 2) from touching the laryngoscope to putting it down. Incidences of esophageal tube placement and clicks (possible tooth damage) were noted. The rescuers rated their satisfaction with each position on a six-point scale (1 = very good, 6 = insufficient). Total intubation times of the other three positions were compared with that for prone by rank order test for paired observations. Handling, esophageal positions, and clicks of the other three positions were compared with those for prone by sign test for paired observations. A Bonferroni correction (factor 12) was applied.
Mean total intubation times (in seconds) were 11.8 +/- 3.3 for prone, 13.9 +/- 4.7 for sitting, 11.4 +/- 4.5 for kneeling, and 16.2 +/- 5.8 for straddling. The difference between straddling and prone was statistically significant (p < 0.005). For handling, the results were for prone 3.0 +/- 1.4, for sitting 3.1 +/- 1.1, for kneeling 2.2 +/- 0.6, and for straddling 2.8 +/- 1.4. Esophageal positions occurred for prone 1, for sitting 1, for kneeling 2, and for straddling 3. Clicks were counted for prone 2, for sitting 1, for kneeling 1, and for straddling 0.
All tested positions provide satisfactory conditions for intubation on the ground. The straddling position requires statistically, but not clinically, significantly more time for intubation than does prone and may be an important backup position if access from behind the patient's head is impossible.
研究在地面上不同救援人员体位下进行气管插管的难易程度。
邀请6名女性和18名男性急救医疗技术人员对放置在地面上的Laerdal综合模拟人进行插管操作。救援人员按随机顺序采取以下体位：俯卧位、坐位、跪在模拟人头侧以及跨骑在模拟人胸部。作者测量了以下时间：1）从面罩通气转换到插管体位的时间；2）从接触喉镜到放下喉镜的时间。记录食管插管的发生率和咔哒声（可能导致牙齿损伤）。救援人员根据六点量表（1 = 非常好，6 = 不足）对每个体位的满意度进行评分。通过配对观察的秩和检验比较其他三个体位与俯卧位的总插管时间。通过配对观察的符号检验比较其他三个体位与俯卧位在操作、食管位置及咔哒声方面的情况。应用Bonferroni校正（系数12）。
俯卧位的平均总插管时间（秒）为11.8±3.3，坐位为13.9±4.7，跪位为11.4±4.5，跨骑位为16.2±5.8。跨骑位与俯卧位之间的差异具有统计学意义（p < 0.005）。在操作方面，俯卧位为3.0±1.4，坐位为3.1±1.1，跪位为2.2±0.6，跨骑位为2.8±1.4。食管插管情况：俯卧位1次，坐位1次，跪位2次，跨骑位3次。咔哒声情况：俯卧位2次，坐位1次，跪位1次，跨骑位0次。
所有测试体位均能为地面插管提供满意条件。跨骑位在统计学上比俯卧位插管所需时间显著更长，但在临床上并非如此。如果无法从患者头部后方进行操作，跨骑位可能是一个重要的备用体位。
