بررسی علل لوله‌گذاری مجدد داخل تراشه‌ای در بیماران با مسمومیت حاد

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 استاد، گروه سم‌شناسی بالینی، دانشکده‌ی پزشکی و مرکز تحقیقات سم‌شناسی بالینی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 دانشجوی پزشکی، کمیته‌ی تحقیقات دانشجویی، گروه سم‌شناسی بالینی، دانشکده‌ی پزشکی و مرکز تحقیقات سم‌شناسی بالینی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 استاد، گروه آمار زیستی، دانشکده‌ی بهداشت، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

4 دانشیار، گروه بیهوشی، دانشکده‌ی پزشکی و مرکز تحقیقات سم‌شناسی بالینی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

5 استاد، گروه بیهوشی، دانشکده‌ی پزشکی و مرکز تحقیقات سم‌شناسی بالینی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: لوله‌گذاری داخل تراشه، یکی از اقدامات رایج در بخش مراقبت‌های ویژه به منظور ایجاد یک راه هوایی مطمئن برای بیماران است. هدف از انجام این مطالعه، بررسی علل لوله‌گذاری مجدد داخل تراشه‌ای در بیماران بستری در واحد مراقبت‌های ویژه‌ی مسمومین بود.روش‌ها: در این مطالعه‌ی مورد- شاهدی، 43 بیمار با نیاز به لوله‌گذاری مجدد داخل تراشه (گروه مورد) و 45 بیمار گروه شاهد با تنها یک بار لوله‌گذاری داخل تراشه از نظر علایم بالینی، پیرابالینی و عاقبت درمانی مورد مقایسه قرار گرفتند.یافته‌ها: بین دو گروه اختلاف معنی‌داری بر اساس علت مصرف دارو یا سم (خودکشی، اتفاقی و یا نامشخص) وجود داشت (050/0 > P). در گروه با لوله‌گذاری مجدد، مسمومیت با مواد مخدر شایع‌تر بود. بیشتر بیماران در گروه نیاز به لوله‌گذاری مجدد داخل تراشه، دچار بهبودی با عوارض (8/55 درصد) شدند، اما بیشتر بیماران در گروه تنها یک بار لوله‌گذاری داخل تراشه بدون عارضه (4/64 درصد) بهبودی یافتند (050/0 > P) و طول مدت بستری در گروه مورد به صورت معنی‌داری بیشتر از شاهد بود (004/0 = P). در بیماران با مسمومیت اتفاقی، احتمال لوله‌گذاری مجدد کمتر بود (320/0 = Odds ratio یا OR؛ 89/0-12/0: CI 95%؛ 020/0 = P). خروج خود به خودی لوله احتمال لوله‌گذاری مجدد را افزایش داد (30/8 = OR؛ 67/39-73/1: CI 95%؛ 008/0 = P). همچنین، احتمال لوله‌گذاری مجدد در صورت خروج خودبه‌خودی بیشتر بود.نتیجه‌گیری: خروج خودبه‌خودی لوله و علت مصرف دارو یا سم، از عوامل پیش‌گویی کننده‌ی لوله‌گذاری مجدد می‌باشند. در مواردی که بیمار نیاز به لوله‌گذاری مجدد داخل تراشه پیدا می‌کند، طول مدت بستری و عوارض بیشتر است.

کلیدواژه‌ها


عنوان مقاله [English]

Reintubation in Patients with Acute Poisoning: Risk Factor Analysis

نویسندگان [English]

  • Nastaran Eizadi-Mood 1
  • Parisa Jafari-Khouzani 2
  • Marjan Mansourian 3
  • Gholamreza Massoumi 4
  • Ahmad Yaraghi 5
1 Professor, Department of Clinical Toxicology, School of Medicine AND Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Student of Medicine, Student Research Committee, Department of Clinical Toxicology, School of Medicine AND Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Professor, Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
4 Associate Professor, Department of Anesthesiology, School of Medicine AND Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
5 Professor, Department of Anesthesiology, School of Medicine AND Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Endotracheal intubation is one of the most common interventions in the intensive care unit to provide a reliable airway for patients. We investigated the causes of endotracheal reintubation in cases with poisoning admitted to the intensive care unit.Methods: In this case-control study, 43 patients required endotracheal reintubation (case group) and 45 patients in the control group with only one time endotracheal intubation were compared according to clinical, paraclinical, and post-treatment sign and symptoms.Findings: There was a significant difference between the two groups based on the cause of consumption of drug or poison (suicide, accidental, or unspecified) (P < 0.050). In the group with reintubation, opioid poisoning was more common. Most of the patients in the reintubation group (55.8%) were recovered with complications. However, most patients in the control group (64.4%) were recovered without complications (P < 0.050). The duration of hospitalization in case group was significantly higher than control group (P = 0.004). Patients with accidental poisoning had less chance of reintubation [Odds ratio (OR) = 0.32; 95% of confidence interval (95%CI) = 0.12-0.89; P= 0.020]. Whereas, spontaneous extubation increased the risk of reintubation (OR = 8.30; 95%CI = 1.73-39.67; P = 0.008). Moreover, the possibility of reintubation was higher in spontaneous extubation.Conclusion: Spontaneous extubation and the cause of poisoning are predictive factors for reintubation. In cases where the patient needs endotracheal reintubation, the duration of hospitalization and complications are higher.

کلیدواژه‌ها [English]

  • Endotracheal intubation
  • Poisoning
  • Suicide
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