徒手急诊动脉测压管引导经鼻气管导管置换

目的观察应用动脉测压管做引导,置换经鼻气管导管的临床效果。方法经鼻气管内插管的病人由于呼吸机报警提示气管导管漏气、或气管导管内痰痂阻塞等原因经常规处理无效,需要再次气管插管。实验组12例患者不使用先拔管再插管的老办法,而是徒手(不借助其他如纤支镜等器械)将引导管插入气管导管内至隆突水平,并拔出原气管导管;将欲更换的气管导管套在引导管外,在引导管引导下将新的气管导管插入气管内,完成换置;对照组为20例患者通过常规先拔管再在纤支镜引导下经鼻气管插管,完成更换。结果实验组及对照组全部32例病例均顺利完成更换经鼻气管导管,术后均未发生与更换导管相关重大并发症,但实验组较对照组在换管过程中病人氧合更加稳定,心率血压变化小,鼻出血、心律失常发生率低,耗时短。结论应用气管导管置换,方法安全、简便易行,可替代传统的先拔管再借助纤支镜引导经鼻气管导管换管的方法。

Barehanded Emergency of Arterial Pressure Measured Ducts Aiming AGT Tracheal Tube Replacement

Objective To observe and apply clinical effects of arterial pressure measured ducts aiming and replacing AGT tracheal tubes.Method AGT trachea cannulas patients should be inserted with trachea cannulas again as a result of infeasibihty of conventional measures like breathing machine warning tracheal tubes of air leaking or sputum clog inside tubes.12 patients in the empirical group were barehanded(by no means of any apparatuses like the fibreoptic bronchoscope(FOB))to insert aiming ducts into tracheal tubes as eminence to extubate former tra- cheal tubes,instead of the way of extubation before inserting cannulas;Aiming ducts were sheathed with well-to-be replaced tracheal tubes and new tracheal tubes were inserted into trachea aimed by aiming tubes,replacement over;20 patients in the control group were operated in the con- ventional way of extubation before ACT trachea cannula aimed by the FOB,replacement over.Results 32 total patients in the empirical group and the control group were replaced successfully by ACT trachea cannula,after which severe complication did not occur.Compared with the control group,patients in the empirical group showed that oxygenation were more stable,heart rate blood pressure changed little,and hemorrhinia and ar- rhythmogenesis happened with low rate,or with short periods.Conclusion It was safe and easy to apply tracheal tube replacement and such re- placement can be applied to clinics instead of conventional way of extubating before replacing ACT trachea cannula aimed by the FOB.