多功能气管导管给氧连接装置制作与应用

目的：解决气管切开和气管插管病人给氧管、湿化液滴管占用气管导管腔,致气道阻力增加问题;同时解决呼吸监测探头固定问题.方法：用输液器的莫菲氏管制成＂多功能气管导管给氧连接装置＂.结果：经气管切开和气管插管病人应用,给氧、气道湿化、呼吸监测探头固定效果满意.结论：该装置解决了给氧管、湿化液管占用气管导管腔和呼吸监测探头固定问题,是气管切开导管和气管插管病人给氧不可缺少的装置.     

可测温气管导管的设计制作与临床应用研究

目的介绍一种用于气管插管患者的气道测温装置。方法在传统气管导管的套囊内装配温度传感探头,制作成可测温的气管导管,即使在套囊破裂的情况下温度传感探头也不会脱落至气道成为异物。在保证通气功能不受影响的同时,可以使用此装置连续监测气道温度。结果经过临床初步应用证实,可测温气管导管可以便捷、准确及稳定地监测气道温度。气道温度与食道温度呈高度正相关,可准确显示人体体温变化。结论该装置可用于临床科室需气管插管（如全身麻醉）患者的体温监测,提高了临床诊治的安全性,减轻了医护人员的劳动负担。     

PVC气管导管和加强型气管导管经鼻气管插管引起鼻出血的比较研究

目的 比较PVC气管导管和加强型气管导管这两种导管在室温下和60 ℃温箱热软化后经鼻插管时鼻出血机率的差别.方法 100例病人随机分为4组,每组25例:分别为室温PVC导管组和室温加强型导管组,60 ℃热软化PVC导管组和60 ℃热软化加强型导管组;经标准的麻醉诱导,充分的润滑后进行气管插管,插管时观察病人鼻出血的情况.结果 4个组的鼻出血几率依次为18/25、14/25、4/25和5/25.经60 ℃温箱热软化后的两种气管导管均比室温下的同种导管引起鼻出血的机率明显降低(P＜0.05),而两种导管无论是在室温下还是60 ℃温箱热软化后经鼻气管插管时鼻出血的几率其差别均无统计学意义(P＞0.05).结论 60 ℃温箱对气管导管进行热软化能显著降低经鼻气管插管时的鼻出血,而这两种气管导管无论在室温下或者60 ℃温箱热软化后,经鼻插管时鼻出血的几率相当.     

急诊室及ICU患者人工气道情况分析

目的 比较PVC气管导管和加强型气管导管这两种导管在室温下和60 ℃温箱热软化后经鼻插管时鼻出血机率的差别.方法 100例病人随机分为4组,每组25例：分别为室温PVC导管组和室温加强型导管组,60 ℃热软化PVC导管组和60 ℃热软化加强型导管组;经标准的麻醉诱导,充分的润滑后进行气管插管,插管时观察病人鼻出血的情况.结果 4个组的鼻出血几率依次为18/25、14/25、4/25和5/25.经60 ℃温箱热软化后的两种气管导管均比室温下的同种导管引起鼻出血的机率明显降低（P＜0.05）,而两种导管无论是在室温下还是60 ℃温箱热软化后经鼻气管插管时鼻出血的几率其差别均无统计学意义（P＞0.05）.结论 60 ℃温箱对气管导管进行热软化能显著降低经鼻气管插管时的鼻出血,而这两种气管导管无论在室温下或者60 ℃温箱热软化后,经鼻插管时鼻出血的几率相当.     

纤维支气管镜结构及临床应用中的几个问题

目的:通过介绍纤维支气管镜应用时需注意的事项,提高麻醉医疗安全.方法:纤维支气管镜辅助气管插管时,气管导管内径与纤维支气管镜插入轴光缆外径之比不宜过大,纤维支气管镜光缆插入患者气道后,用优势手稳定并不断调整其位置,气管导管进入气管内并确保位置正确后退出纤维支气管镜纤维支气管镜用于DLT对位,应以可视支气管端套囊上部边缘位于隆突之下为准.结果:正确掌握纤维支气管镜的使用方法,可以提高应用水平结论:知晓纤维支气管镜的结构、精细的操作调控、反复实践的经验总结是临床麻醉医师掌握纤维支气管镜的技巧所在.     

中心静脉导管导丝支撑引导钢丝螺纹管插管在困难气管插管中的应用

目的 探讨中心静脉导管导丝支撑引导行钢丝螺纹管气管内插管在困难气管插管时应用的有效性和安全性.方法 将80例估计气管插管有困难的患者(舌咽关系Ⅲ～Ⅳ级)随机分为导丝支撑引导插管组(A组)和常规导管芯引导插管组(B组).进行插管对比研究.结果 两组一次插管成功率分别是90.0%和67.5%,两组比较差异有统计学意义(P＜0.05),并且A组对咽喉部组织损伤小.结论 中心静脉导管导丝支撑引导钢丝螺纹管插管在困难气管插管时应用有效、安全可行.     

可调灯光的气管导管管芯

长期以来,麻醉医生在气管插管中,因光源不足,喉头难以暴露等原因,造成插管困难或延长插管时间,增加了气管插管并发症。若术前估计不到,无思想准备往往措手不及。为此我们对气管导管管芯进行了改制,设计出这种灯光可调的给氧气管导管管芯。经临床选用各类不同手术全麻插管44例病人(男28例,女     

指控弯度可调气管导管

临床中所用的国产或进口的一次性气管导管，虽有一个自然的弯曲度，但仅适应部分声门位置正常的气管插管病人。通常情况下，我们都在气管导管中预先置入一导线（铜或铝质），根据预估情况调整导管的弯曲度后进行插管操作。即使如此，也常常会因为预估不准确（如病人声门较高或会厌较大或下颌小）而需重新拔出气管导管、改变导线乃至导管弯曲度，这样就延长了为病人建立机械通气前的插管时间和氧耗时间，增加了气管插管的风险度。本技术在原有气管导管的基础上加以改进，在导管壁与其弯折角对面的导管壁之间增设细螺纹管，螺纹管内套设闸线，…     

自带光源光导气管导管的研制及院前急救应用效果观察

目的:研制一种主要应用于院前急救气管插管的自身携带光源的光导气管导管并探讨其临床应用价值。方法:采用镶嵌技术将光导纤维植入导管管壁内,在管体连接头下侧设置光浦,光浦、分光器、光导纤维、聚光器相邻依次连接并与管体固为一体,使光浦发出的光能传递照明前方气道。将该导管随机应用于院前急救气管插管63例,与应用普通气管导管插管87例对照,观察2组的一次插管成功率、平均插管时间。结果:实验组的一次插管成功59例,成功率为93.65%,平均插管时间(11.53±0.62)s;对照组一次插管成功62例,成功率为71.26%,平均插管时间(13.72±0.55)s。分别比较2组同性指标,差异均有统计学意义(P<0.01)。结论:该新型气管导管性能优于普通气管导管,适合在院前急救中推广应用。     

150例高血压脑出血气管插管全麻术后气管拔管并发症的预防和处理

目的探讨150例高血压脑出血气管插管全麻术后气管拔管并发症的预防和处理.方法高血压脑出血全麻术后达到气管拔管指征的全部拔出气管导管,密切观察患者的临床生命体征,待安稳后送返病房.结果本组2例出现气管插管后舌后坠;2例出现气管插管后呕吐;1例出现气管插管后呼吸骤停.结论高血压脑出血的患者术后气管拔管时必须严格遵守气管拔管指征,尤其是接近中度昏迷、深度昏迷的高龄患者,防止气管拔管并发症的发生.     

Clinical audit: optimal positioning of endotracheal tubes in neonates

BACKGROUND: The malposition of endotracheal tubes (ETTs) can be associated with endo-bronchial intubation or accidental extubation. A variety of methods have been reported for predicting insertional length (IL) including weight, nasal-tragus length (NTL) and sternal length (STL) measurements. In our unit no consistent predictor method was being used. AIM: To audit the proportion of endotracheal tubes that required a significant position change after oral intubation. Our standard set was that the endotracheal tube should be in a satisfactory position in > 80% of cases. If not met, practice would then be re-audited after a consistent predictor method had been implemented. METHODS: Data regarding changes in endotracheal tube position were collected. Significant position changes were defined as adjustments > 0.5 cm. RESULTS: Twenty two babies were included in the initial audit, and only 73% of endotracheal tubes had a satisfactory position. Thirty six babies were included in the re-audit and when the nasal-tragus length predictor was used, 94% of endotracheal tubes had a satisfactory position, meeting the standard. CONCLUSION: The nasal-tragus length predictor improved the accuracy of endotracheal tube positioning after oral intubation. It is a simple, fast, reproducible method and can be used in everyday practice to help avoid significant endotracheal tube malposition.     

Noninvasive verification of nasogastric tube placement using a magnet-tracking system: a pilot study in healthy subjects

BACKGROUND: Fluoroscopic verification of nasogastric (NG) feeding tube placement is inconvenient and involves radiation exposure. We tested whether the position of an NG tube can be assessed reliably by a recently introduced magnet-tracking system. METHODS: A small permanent magnet was attached at the end of an NG tube and its position was monitored using an external sensor array connected to a computer. NG tube trajectory, spontaneous movements of the magnet, and its position relative to the lower esophageal sphincter (LES) and xiphisternum were assessed in 22 healthy subjects and compared with esophageal manometry. In 12 subjects, localization of the magnet was also compared with fluoroscopy. RESULTS: Magnet-tracking displayed NG tube tip movement reproducibly as it moved vertically in the esophagus and then laterally into the stomach. Compared with manometry, the accuracy and sensitivity of magnet tracking for localization of the NG tube tip, above or below the diaphragm, were 100%. Compared with fluoroscopy, the accuracy of NG tube localization by magnet tracking was 100%. With the magnet in the stomach, but not in the esophagus or LES, low amplitude displacements at a frequency of 3 per minute, consistent with gastric slow wave activity, were observed. CONCLUSIONS: Magnet tracking allows accurate, real-time, 3-dimensional localization of an NG tube with respect to anatomic landmarks. Recorded motor patterns are indicative of the position of the NG tube. Magnet tracking may be a useful tool for bedside placement of nasogastric and enteral feeding tubes.     

超滑涂层气管导管用于全麻下非困难气道气管插管的临床效果

目的:与普通气管导管相比,观察超滑涂层气管导管是否减轻全麻插管刺激及改善操作效果。方法:选取2016年7月~2017年1月全麻插管的患者60例,ASA分级Ⅰ~Ⅱ级,患者随机分为超滑气管导管组(观察组)和普通气管导管组(对照组)。记录插管时间和插管阻力评价;记录诱导前(T0)、插管前(T1)、插管即刻(T2)、插管后1min(T3)、3min(T4)、5min(T5)、术毕自主呼吸恢复(T6)SBP、DBP、MAP和HR;记录拔管后和术后24h出现咽痛的情况。结果:两组患者T2、T3、T6时对照组SBP、DBP和MAP明显高于观察组(P<0.01),T2、T3、T4时对照组HR明显高于观察组(P<0.01),观察组插管时间短于对照组(P<0.05),对照组术后咽痛发生高于观察组(P<0.05)。结论:超滑气管导管在非困难气道使用时有益于患者血流动力学平稳,缩短插管时间,有效降低术后咽痛的发生率,是一种安全有效的气管插管工具。     

Endotracheal intubation skills of medical students.

The ability and confidence of clinical medical students to insert endotracheal tubes correctly and quickly and to recognize oesophageal misplacement was evaluated. Ten (33%) of the medical students intubated the trachea correctly at their first attempt but 14 (47%) incorrectly identified the position of the endotracheal tube. However, recognition improved by their second and third attempts (70% and 80% respectively). Ninety-three percent of students intubated correctly on their third attempt. Although medical students can obtain better results at correct tube placement with repeated attempts under optimum conditions--a practice effect--and do better at recognizing correct tube placement there is still a persistent failure to recognize endotracheal tube misplacement, ie oesophageal intubation. It is the ability to recognize oesophageal intubation promptly that is a life-saving skill. This essential skill should be taught during the introductory anaesthesia programme through the use of clinical patients.     

Pneumothorax following attempted nasogastric intubation for nutritional support

Nasogastric intubation is a routine procedure, performed daily by both medical and nursing staff. It is a simple procedure, but not without complications which can be life threatening. We present an unusual, life threatening complication which occurred when nasogastric intubation using a no. 8 polyurethane tube with its metal stilet resulted in a pneumothorax after intubation of the endotracheal tree in the presence of a cuffed endotracheal tube. We emphasize that the presence of a cuffed endotracheal tube should not be considered a safeguard against pulmonary intubation during nasogastric placement of a feeding catheter.     

Lung perforation by nasogastric feeding tubes

Endotracheal misdirection of narrow bore nasogastric feeding tubes resulted in perforation of the lung, pneumothorax and hydrothorax in two intensive care patients. Both were intubated with cuffed endotracheal low pressure tubes, one patient was on respirator therapy with neuromuscular relaxation. Feeding tubes were inserted by experienced personnel with the assistance of a steel stylet without difficulties. Aspiration of fluid was misinterpreted as proof of correct positioning, the liquid being however pleural effusion and not gastric juice. Similarly auscultation of gurgling sounds in the upper epigastrium was not a reliable sign of intragastric position. Insertion of nasoenteric feeding tubes may be complicated by perforation of the upper gastrointestinal tract and lung in poorly responsive patients with cuffed endotracheal devices during neuromuscular blockage. In these patients a laryngoscope and forceps should be used to ensure free passage of the tube into the oesophagus. R?ntgenographic confirmation of correct positioning of the tube immediately after insertion is mandatory.     

Improved design of nasogastric feeding tubes

Disappointed with the overall performance of weighted and unweighted nasogastric feeding tubes, a design programme was initiated which resulted in the development of two new nasogastric tubes, one weighted and one unweighted. The tubes were manufactured with polyurethane rather than polyvinylchloride (PVC) which permitted an increase in diameter of the internal lumen which in turn was coated with water activated lubricant to ease removal of the introducer wire. A specially modelled outflow port was incorporated into the tips of both tubes. The performance of the two new polyurethane nasogastric feeding tubes was assessed under controlled trial condition using as a reference a widely used PVC unweighted open ended tube. While intubation times were similar in patients without concurrent endotracheal intubation, it took a significantly shorter time to intubate patients with concurrent endotracheal intubation with the new weighted tube. Following tube intubation, it was possible to aspirate gastric contents significantly more often through the new polyurethane tubes (p < 0.001) than through the PVC tube, and the unweighted polyurethane tube stayed in situ longer (p < 0.05) than the PVC tube. The newly designed polyurethane nasogastric feeding tubes are the first tubes that have been shown to have advantages over the simpler type of open ended, unweighted PVC nasogastric feeding tubes.     

A multicenter, prospective study of the placement of transpyloric feeding tubes with assistance of a magnetic device. The Magnet-Guided Enteral Feeding Tube Study Group

BACKGROUND: Placement of feeding tubes in the transpyloric position can be helpful in the management of enterally fed patients with pancreatitis, gastric atony, enterocutaneous fistulae, or pulmonary aspiration risk. The attainment of transpyloric position is difficult, and numerous techniques have been proposed to help in achieving this location. Recently, the use of a magnet-tipped feeding tube, dragged into proper position with an external magnet, has been described with an excellent success rate. METHODS: At 10 participating institutions, practitioners were trained in the use of the device. Successful tube placement was determined by abdominal radiograph. RESULTS: One hundred fifty-six tube placements were attempted. Transpyloric position was obtained in 60%. Placement into the third portion of the duodenum or distal was obtained in only 32%. Analysis of the data did not reveal a learning curve at the institutions, and 7 of 10 had a 50% or lower success rate. CONCLUSIONS: Placement of feeding tubes with the assistance of a magnetic device was infrequently successful at the majority of institutions where it was attempted. We report a lower success rate than the original article, which described an 88% success rate of transpyloric intubation. Although this technique has a high failure rate, some individuals seem to be very successful using it, which could reduce the need for endoscopy or transport for the placement of feeding tubes.