专家置疑：脑外伤患者是否应该在入院进行气管插管？

美迪医疗网成扬报道说，最近一项研究显示：在外伤程度相似的情况下，如果脑外伤患者在事故现场接受了紧急气管插管，他们的预后比那些在送抵医院后接受插管的患者要差。2004年11月份的《急诊医学年报》(Annals of Emergency Medicine)报道了这项研究成果。

尽管院外气管插管是一项试图挽救生命的有价值干预手段，较早期的研究提示这种快速干预造成的不利后果大于有利后果。现在，匹兹堡大学(PA, USA)的研究人员对一项回顾性分析研究做出了结论，研究资料来自2000年～2002年的宾夕法尼亚外伤预后研究项目，研究对象是严重头部外伤的成年患者。

绝大多数此类患者的基本预后是死亡，其次是不同类型的神经性和功能性损害。在4,098例插管患者中，那些在院外接受插管的患者死亡比例要高4倍多。神经性和功能性损害比例同样高出许多。

“辅助医务人员，尽管接受过良好培训，但是他们实践的机会并不多。他们必须在极其困难的环境下完成操作，并且得不到在医院里能够获得的许多帮助，”匹兹堡大学医学院急诊科副主任、教授Donald M. Yealy医学博士这样评论，他也是此文作者之一。“也许这些研究成果提示我们应该重新评介如何处理此类患者。”研究人员指出仍然需要进一步深入研究。

Value of Pre-Hospital Intubation Questioned
 
A study has shown that patients with similar traumatic brain injuries who receive an emergency breathing tube at the scene of an accident have worse outcomes than those who are intubated after arrival at the hospital. The findings were reported in the November 2004 issue of Annals of Emergency Medicine.

While out-of-hospital intubation can be a valuable interventional tool in helping to save lives, earlier studies had suggested that this rapid intervention may be more harmful than helpful. Now, researchers at the University of Pittsburgh (PA, USA) have conducted a retrospective analysis using data obtained from the Pennsylvania Trauma Outcome study between 2000 and 2002, and studied adult patients with severe head injuries.

The primary outcome for most of these patients was death, with secondary outcomes being various types of neurologic and functional impairment. Among the 4,098 patients who were intubated, the odds of death were about four times greater if they were intubated out of the hospital. Neurologic and functional impairment were also greater.

“Paramedics, while very well trained, don’t often have opportunity to perform this procedure, and must attempt it in a difficult environment and without many of the aids available in the hospital,” said Donald M. Yealy, M.D., professor and vice chairman of the department of emergency medicine at the University of Pittsburgh School of Medicine and one of the study’s authors. “Perhaps these findings indicate that we need to reassess how we manage these cases.” The researchers note that additional studies are needed.