湖北省麻醉医师为新型冠状病毒肺炎患者实施气管插管术的现状调查

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目的:采用问卷形式调查并分析湖北省麻醉医师为新型冠状病毒肺炎患者实施气管插管术的现状。方法:采用自制电子问卷,通过微信发送至湖北省各类麻醉学专业学会会员单位主任或技术骨干的手机上,调查结果数据由网络后台生成。调查时间为2020年2月9日至23日。主要内容包括:被调查麻醉医师的一般情况,对此类患者实施气管插管术的具体操作过程和实施气管插管术中遇到的问题等。结果:回收有效问卷205份,其中140位麻醉医师亲历了疑似或确诊新型冠状病毒肺炎患者气管插管术(亲历者)。亲历者的平均工作年限为(12±8)年,多为主治医师以上级别。亲历者中67.0%采取了三级防护;95.7%考虑到了困难气道可能,53.6%准备了喉罩,95.7%实施预给氧;95.7%使用了镇静药,91.4%使用了肌松药,62.9%使用了镇痛药;82.8%使用了视频喉镜,22.9%觉得气管导管位置确认困难,判断气管导管位置主要靠直视声门和临床征象;89.3%在必要时采取吸痰操作;52.1%为单人完成气管插管操作,81.4%一次气管插管成功率达91%~100%;14.3%认为与普通患者相比气管插管时间显著延长;平均气管插管次数1(0)次;99.3%担心被感染,84.3%因眼罩起雾影响操作;76.4%存在喉镜消毒困扰,49.3%将喉镜带出污染区。与其他城市比较,武汉市亲历者工作年限缩短,气管插管工具构成比和吸痰操作时机构成比差异有统计学意义,采取三级防护比率、使用镇静药比率、使用肌松药比率、使用镇痛药比率和导管位置确认困难比率升高(n P<0.05)。n 结论:湖北省麻醉医师为新型冠状病毒肺炎患者实施气管插管术普遍担心感染风险。大多数遵照气管插管流程操作。但在三级防护下实施气管插管术面临一些问题,如眼罩起雾、气管导管位置确认困难、物资不足及人员限制等。建议加强防控物资供给,建议在三级防护措施下注重防雾处理,首选视频喉镜,以直视声门辅以临床征象确认导管位置。制定规范的操作流程,结合实际情况不断改进。“,”Objective:To investigate and analyze the current status of tracheal intubation performed by anesthesiologists in Hubei Province for the patients with coronavirus disease 2019 (COVID-19) by a questionnaire survey.Methods:Self-made electronic questionnaires were used and sent through WeChat to the mobile phones of directors or technical backbones of units of various societies of anesthesiology in Hubei Province.The surveyed data were generated by the network background.The survey was conducted from 9 to 23 February 2020.The main contents included the general information of investigated anesthesiologists and the specific operation details of tracheal intubation and problems encountered during tracheal intubation in such patients, etc.Results:A total of 205 valid questionnaires were collected, of which 140 anesthesiologists personally experienced tracheal intubation in the patients with suspected or confirmed COVID-19 (participants). The average working life of the participants was (12±8) yr, and most of them were attending physician or higher.Among the participants, 67.0% had tertiary protection; 95.7% considered the possibility of difficult airway, 53.6% prepared a laryngeal mask, and 95.7% performed preoxygenation; 95.7% administered sedatives, 91.4% administered muscle relaxants, 62.9% used analgesics, 82.8% used video laryngoscope, 22.9% found it difficult to confirm the location of the tracheal tube, and identifying the location of the tracheal tube mainly depended on visualization of glottis and clinical signs; 89.3% performed sputum aspiration when necessary; 52.1% performed tracheal intubation by a single person, 81.4% reached a success rate of 91%-100 % at first attempt; 14.3% considered that intubation time was significantly longer than that of common patients; the average number of tracheal intubations was 1 (0); 99.3% were worried about being infected, 84.3% were affected by the fogging of the eye mask; 76.4% had trouble with the disinfection of the laryngoscope, and 49.3% took the laryngoscope out of the contaminated area.Compared with other cities, the working life of participants was significantly shortened, and the composition ratio of tracheal intubation tools and the timing of sputum suction were statistically significant, the ratio of tertiary protection adopted, ratio of sedatives used, ratio of muscle relaxants used, ratio of analgesics used and ratio of difficulty in confirming the position of the catheter were increased in Wuhan (n P<0.05).n Conclusion:Anesthesiologists in Hubei Province are generally worried about the risk of infection when performing tracheal intubation for patients with COVID-19.Most follow the procedure of tracheal intubation.But there are some problems under tertiary protection, such as fogging of eye mask, difficulty in confirming the location of tracheal tube, insufficient preventive materials and personnel restrictions.It is suggested to strengthen the supply of preventive materials, to pay attention to anti-fog treatment under the tertiary protective measures, and to choose video laryngoscope first, and direct vision of the glottis with clinical signs was used to confirm the location of the tube.It is necessary to standardize the intubation process and improve continuously based on actual situation.
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