储氧面罩在院前低张性低氧血症救治中的应用价值

目的研究储氧面罩吸氧在院前低张性低氧血症救治中的临床价值。方法将82例院前低张性低氧血症患者（轻度52例,中度22例,重度8例）按随机数字表法分为对照组和观察组,每组41例。所有病例均在院前进行救治,常规给予心电、血压、呼吸、动脉血氧饱和度（SaO2）监测,同时快速建立静脉通道。对照组和观察组患者分别佩带普通面罩和储氧面罩,均给予8-10L·min^-1高流量氧气吸入,常规湿化。观察2组患者在吸氧15、30min时SaO2变化及加用便携式呼吸机正压通气的例数。结果 2组患者随吸氧时间的增加SaO2均有不同程度的提升。观察组轻、中度患者吸氧15、30min时SaO2均明显高于对照组（均P〈0.01）;2组重度低张性低氧血症患者给予高流量氧气吸入15min时SaO2比较差异无统计学意义（t=-1.414,P〉0.05）;高流量氧气吸入30min时,观察组SaO2明显高于对照组（t=-9.000,P〈0.01）。对照组中加用便携式呼吸机正压通气患者6例（重度4例,中度2例）,观察组仅1例（重度）加用便携式呼吸机正压通气,2组比较差异有统计学意义（χ^2=3.905,P〈0.05）。结论对于轻、中度低张性低氧血症患者,单一使用储氧面罩吸氧能较快提升SaO2,迅速纠正机体缺氧状态,在院前急救中具有极高的临床价值。对于重度低张性低氧血症患者,在增加吸氧时间的同时,应充分评估机体缺氧严重程度和院前转运路程的远近,在此基础上,可酌情使用便携式呼吸机正压通气,以降低院前急救风险。

Application of Oxygen Mask in Prehospital Treatment of Hypotonic Hypoxemia

Objective To study the clinical value of oxygen inhalation via face mask in the treatment of prehospital hypotonic hypoxemia.Methods Eighty-two patients with prehospital hypotonic hypoxemia（mild in 52,moderate in 22 and severe in 8）were randomly divided into two groups,with 41 patients in each group.All patients received prehospital treatment.Furthermore, electrocardiography,blood pressure,respiration rate and arterial oxygen saturation（SaO2 ）were monitored and intravenous access was quickly established.The control group and observation group were given high flow oxygen（8-10 L＆#183;min-1 ）through ordinary face mask and oxygen stor-age mask,respectively.Changes in SaO2 were observed after oxygen inhalation for 15 and 30 mi-nutes,respectively.In addition,the number of patients who used portable ventilator for positive pressure ventilation was recorded.Results SaO2 increased with oxygen inhalation time in both groups.Compared with control group,SaO2 significantly increased after oxygen inhalation for 1 5 and 30 minutes in mild or moderate hypotonic hypoxemia group（P〈0.01）.No significant differ-ences in SaO2 in patiens with severe hypotonic hypoxemia were found between control group and＆amp;nbsp;observation group after oxygen inhalation for 15 minutes（t=-1.414,P＆gt;0.05）.However,SaO2 in severe hypotonic hypoxemia group was significantly higher than that in control group after ox-ygen inhalation for 30 minutes（t=-9.000,P〈0.01）.The number of patients who used portable ventilator for positive pressure ventilation in control group（6 patients,moderate in 2 and severe in 4）was significantly higher than that in observation group（1 severe patients）（χ^2=3.905,P〈0.05）.Conclusion For patients with mild or moderate hypotonic hypoxemia,the use of oxygen storage mask alone can quickly increase SaO2 and correct hypoxia status,with a high clinical value in the prehospital treatment.For patients with severe hypotonic hypoxemia,the duration of oxy-gen inhalation should be increased.At the same time,the severity of hypoxia and distance of pre-hospital transport should be fully assessed.On this basis,the portable ventilator may be appropri-ately used for positive pressure ventilation to reduce the risk of pre-hospital first aid.