Achibudirira ekuzvinyudza muitiro neSuccinylcholine Versus Rocuronium
In Emergency Departments kumativi ose enyika, intubation inoitwa uye iyo yakaoma nzira nekuda kwemamiriro ayo uye ehe, nekuda kwesimba remurwere.
Ed intubations kazhinji inosanganisira kukurumidza kuteedzerana kupinza, pamwe nekubatanidzwa kweanomirira inomiririra uye anorwara nemishonga, asi zvakadaro zvakare kune nzira yechipiri yekumbira, kureva nekushandiswa succinylcholine versus rocuronium.
Kufambisa nekukurumidza kubudirira-kwekutanga kubudirira uye kuderedza zviitiko zvinopesana, kuwana nekukurumidza kwemamiriro ekunze kwakanaka kwakakosha. Kuoma mitezo kunogona kukanganisa chiyero chekubudirira kana pane kushandiswa ancinylcholine uye rocuronium. Kunyangwe anesthesia mabhuku anoratidza zviri nani mamiriro e kukurumidza kutevedzana yemaitiro ane ancinylcholine pane rocuronium, yakanakisa mitezo yeEE nekukurumidza kutevedzera inoramba isingazivikanwe.
Chidzidzo chekudzidza
Kunyangwe zvese zviri zviviri ancinylcholine uye rocuronium zvinoshandiswa kufambisa dhipatimendi rekukurumidzira (ED) nekukurumidza kutevedzana kupinza, mutsauko intubation kubudirira mwero pakati pavo hazvizivikanwe. Isu tinofananidza kubudirira kwekutanga-kupinda mukati mekubudirira pakati peD nekukurumidza kutevedzera intubation kunofambiswa ne ancinylcholine versus rocuronium.
nzira
Takaongorora tarisiro yekuunganidza data kubva kuNational Emergency Airway Registry, iyo multicenter registry inounganidza data pane zvese intubations zvakaitwa mu22 ED.
Isu takasanganisira varwere vakadarika makore gumi nemana avo vakagamuchira succinylcholine kana rocuronium panguva ya 14. Isu takafananidza kubudirira kwekutanga-pass intubation pakati pevarwere vanogamuchira ancinylcholine nevaya vanogamuchira rocuronium.
Isu takafananidzawo chiitiko chezviitiko zvakashata (kusungwa kwemwoyo, kukuvadzwa kwemazino, kukuvadzwa kwemhepo yakananga, dysrhythmias, epistaxis, esophageal intubation, hypotension, hypoxia, iatrogenic kubuda ropa, kutadza kwelaryngoscope, laryngospasm, lip laceration, main-stem bronchus intubation, malignant hyperthermia. kukanganisa kwemishonga, pharyngeal laceration, pneumothorax, endotracheal tube cuff kukundikana, uye kurutsa).
Takaitisa subgroup inoongorora stratified neparalytic-based dosi.
Results
Paive 2,275 kukurumidza kutevedza intubations inofambisirwa ne succinylcholine uye 1,800 ne rocuronium. Varwere vanogashira ancinylcholine vaive vadiki uye vachiwanzoita maitiro evhidhiyo laryngoscopy uye nevanoziva vatapi
Yekutanga-yekubudirira budiriro yaive 87.0% ine ancinylcholine inopesana ne87.5% ine rocuronium (yakagadziridzwa odds ratio 0.9; 95% kuvimba kupindirana 0.6 kusvika 1.3). Chiitiko chechero chiitiko chakashata chaive chakafananiswawo pakati pevamiririri ava: 14.7% yeanpinylcholine inopesana 14.8% yeiyo rocuronium (yakagadziridzwa odds ratio 1.1; 95% kuvimba kupindirana 0.9 kusvika 1.3). Isu takawona mhedzisiro yakafanana pavakadzvanywa neyakaremara-yakavakirwa piritsi.
mhedziso
Munhepfenyuro yakakura iyi yekutarisa, hatina kuona hukama pakati pesarudzo yekumanikidza uye yekutanga-pfuura nekukurumidza kutevedzana kwekubudirira kana peri-intubation zvinopesana zviitiko.
intubation pdf
Authors
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- Michael D. April, MD, DPhil
- Allyson Arana, PhD
