导引式气管插管更换方法的研究

介绍和评价了一种人工气道管理中的实用临床技术。对６例因各种原因需更换气管插管的患者采用预置导引管后拔除原气管插管，沿导引管置入新的气管插管的方法来完成换管操作。操作中监测患者的心率、脉搏容积血氧饱和度（ＳａＯ２）及其它临床情况，并与采用以往换管方法的１０例患者进行了对比分析。研究发现：采用导引式换管方法的操作时间（平均约３０ｓ）远远短于对照组（平均约２０ｍｉｎ），心率、ＳａＯ２均无临床意义的变化，无合并症发生，全部病例一次换管成功；采用以往方法的病例则在换管中心率升高约２７次／ｍｉｎ，ＳａＯ２下降近１０％，多例发生躁动、鼻出血和插管误入食道的情况，发生窒息１例，一次换管成功率仅为６７％（６／９）。研究说明导引式气管插管更换方法较之以往的换管方法简便易行，危险性小，患者痛苦少，换管成功率高，有助于提高人工气道管理水平。

Study of Using Guide to Change Endotracheal Tube

A new way to manage artificial airway was introduced and estimated in this research. Six patients,who needed replacements of endotracheal tubes by varies reasons,were studied by using a guide wire through the existing endotracheal tube then removing the tube, and a new one was threaded over the wire into the trachea. During the procedure,the patient's HR, SaO2 and other clinical symptoms were monitored. It was compared with the control group of ten patients in which the old changing method was used. The result showed that average replacing time of study group, which was 30 sec ,was much shorter than that of the control group, which was 20 min. there were no significant changes of HR and SaO2,no complications happened ,and all the tubes were changed successfully with one time in study group. For the control group ,the HR increased about 27 beats/min,SaO2 decreased about 10 /00,some patients were restlessness ,had nose bleeding ,or intubated into the esophagus and one patient had apnea. The success rate was only 67%. It is recommended that the new method is easier,less dangerous, less painful ,and more successful.