纤维支气管镜在ICU的临床应用71例分析

目的：探讨纤维支气管镜（纤支镜）在ICU危重患者的应用价值。方法：回顾总结我院ICU71例患者行纤支镜检查及治疗的病历资料。结果：本组共行109次纤支镜检查及镜下治疗，包括纤支镜引导下气管内吸痰、支气管灌洗、经鼻气管插管、置入胃管及气管支架等，效果满意，无严重并发症。结论：纤支镜在ICU患者的临床应用中可以发挥重要作用，是安全有效的。     

抢救COPD合并呼吸衰竭中纤维支气管镜引导经鼻气管插管的应用

目的：探讨纤维支气管镜引导经鼻气管插管在抢救COPD合并呼吸衰竭中的作用和意义，建立一种有效的人工气道技术。方法：对52例COPD合并呼吸衰竭重症患者采用在纤维支气管镜引导下经鼻气管插管并进行人工机械通气。结果：在纤维支气管引导下经鼻气管插管56次例均一次成功，插管时间为30s～2min，无喉痉挛、心跳、呼吸骤停等严重并发症发生。结论：在纤维支气管镜引导下经鼻气管插管术是一种安全、准确、有效、迅速建立人工气道的技术。     

经鼻气管插管应用中导管内痰痂形成的原因分析及预防

经鼻气管插管操作方法分为经鼻明视插管术,经鼻盲探气管插管术,纤维支气管引导插管,主要应用于脸部整形、口腔科、耳鼻喉科的手术,使术中术野扩大,便于手术。大部分病人术后需要带管回病房,其护理也是非常重要的,如果护理不当则会在导管内形成痰痂,从而危及病人的生命。我科2007年4月—2010年4月64例病人中,部分或全部堵管4例,由于及时发现,及时抢救均获成功,现就经鼻气管插管应用中导管内痰痂形成的原因分析及预防报告如下。     

纤维支气管镜引导经鼻气管插管抢救急性呼吸衰竭的护理

笔报告纤维支气管镜引导经鼻气管插管抢救急性呼吸衰竭的护理。阐述插管前做好术前用药及局部麻醉的护理;插管过程密切配合术将导管沿纤维支气管管镜插入气管内,退出管内,退出镜子,因定导管,接呼吸机通气,及监测生命体征、血氧饱和度和并发症的护理;插管后7卤出血、鼻溃疡、做好人工气道维护措施及纤维支气管镜清洁消毒。     

纤维支气管镜引导改口气管插管为鼻气管插管机械通气成功6例

纤维支气管镜引导改口气管插管为鼻气管插管机械通气成功６例龙发李振罗文熙采用低压硅胶导管通过纤维支气管镜（纤支镜）引导，改经口气管插管机械通气为经鼻气管插管机械通气抢救呼吸衰竭患者６例均获成功。报告如下。１病例与方法１．１病例：６例呼吸衰竭患者中男３例...     

机械通气无创气道护理研究进展

机械通气用于危重患者呼吸支持有显著改善气体交换功能犤1犦。气道护理是机械通气治疗极其关键的环节,现对无创人工气道护理进展综述如下。1气管插管护理1.1无创气道的建立无创气道插管是指将气管导管经口或鼻插入气道而建立的气体通道。经口气管内插管:气管插管开口应在气管隆突上1～2cm,成人插管深度为22～23cm,过浅易脱出,过深则易顶在气管隆突或插入一侧支气管,特别是右支气管犤2犦。经鼻气管内插管:将导管从鼻孔插至口咽部,根据外口径处呼气气流的强度或声音调整导管头端方向,接近声门时呼吸音响,气流强,于吸气时将导管插入气管犤3犦。经鼻气管插管时,须将导管与面部做垂直方向插入,忌将导管向头顶方向推进,以免引起严重出血犤4犦。气管插管病人头部应稍后仰,减轻插管对咽后壁的刺激和压迫,并1～2h转动头部1次,以变换导管压迫点。1.2气管插管固定避免气管导管随呼吸运动上下滑动损伤气管粘膜或脱出,或在搬动病人与呼吸机时导管脱出或滑入一侧支气管。气管插管成功后,选用适当的牙垫,将气管插管用胶布固定。测量气管插管刻度并标记,经口气管插管者测量应从气管插管外口到门齿距离。经鼻气管插管者测量应从外鼻孔至门齿距离。记录气管插管的刻度,并班...     

床边纤维支气管镜引导下经鼻气管插管的护理

[目的]总结急慢性呼吸衰竭病人行床边纤维支气管镜引导下经鼻气管插管的护理。[方法]对23例急慢性呼吸衰竭病人行床边纤维支气管镜引导下经鼻气管插管,同时加强术前准备、术中配合及术后护理。[结果]本组病人本组23例病人经鼻气管插管均一次成功,插管时间为30s至5min,未发生喉痉挛、严重心律失常、心搏骤停等严重并发症。[结论]加强围术期的护理及配合是纤维支气管镜引导下经鼻气管插管成功的保证。     

逆行气管插管在麻醉诱导时肿物阻塞喉咽腔部的应用9例分析

目的：探讨在麻醉诱导时肿物阻塞喉咽腔，经喉气管内插管失败紧急情况下行逆行气管插管。方法：9例病例在环甲膜处以硬膜外穿刺针行气管内穿刺，置入带金属管芯的硬膜外导管，经口腔将其拉出，以此作引导，将气管导管顺沿而置入气管内。结果：本组插管均1次成功。结论：逆行气管插管成功率高，但操作费时，创伤较大，只能作为最后一种插管方法。     

床边纤维支气管镜引导下经鼻气管插管的护理

[目的]总结急慢性呼吸衰竭病人行床边纤维支气管镜引导下经鼻气管插管的护理.[方法]对23例急慢性呼吸衰竭病人行床边纤维支气管镜引导下经鼻气管插管,同时加强术前准备、术中配合及术后护理.[结果]本组病人本组23例病人经鼻气管插管均一次成功,插管时间为30 s至5 min,未发生喉痉挛、严重心律失常、心搏骤停等严重并发症.[结论]加强围术期的护理及配合是纤维支气管镜引导下经鼻气管插管成功的保证.     

纤维插管镜引导困难气管插管1 245例临床分析

目的分析纤维支气管插管镜引导困难气管插管在临床麻醉中的应用。方法回顾分析1245例纤维支气管插管镜引导困难气管插管的临床资料。结果1245例均成功完成纤维插管镜引导下气管插管。97%的病例在3min内插入气管导管,5min内完成麻醉的诱导,插管过程中未见严重的血流动力学波动,血氧饱和度监测平均92.4%。结论纤维支气管镜在临床麻醉中的应用应取决于术前对困难气管插管的正确评估,是一安全、可靠、有效且并发症少的插管方法。     

纤维支气管镜引导下经鼻气管插管机械通气在COPD并呼吸衰竭中应用

目的探讨纤维支气管镜引导下经鼻气管插管机械通气在COPD并呼吸衰竭中应用。方法2008年1月至2009年10月收治的慢性阻塞性肺疾病（COPD）并发Ⅱ型呼吸衰竭120例分为纤维支气管镜插管组60例采用纤维支气管镜引导下经鼻气管插管,经口气管插管组60例采用经口气管插管,进行观察。结果纤维支气管镜插管组纤维支气管镜引导下经鼻气管插管全部病例均一次插管成功,一次性插管成功率100％,插管时间1—2min,无一例插管时发生心跳、呼吸骤停,血压下降,气管破裂,气管损伤,咯血等并发症。经口气管插管组由于患者气道分泌物过多、肥胖等原因咽喉暴露不充分出现插管困难7例;插管时发生发生心跳、呼吸骤停3例。结论纤维支气管镜引导下经鼻气管插管明显优于经口管插管具有操作简单,创伤小,并发症发生少,同时可以清理呼吸道,以迅速纠正阻塞、改善通气。     

双镜联合用于阻塞性睡眠呼吸暂停综合征患者经鼻气管插管的观察*

目的观察纤维支气管镜(FOB)联合Glidescope视频喉镜(GVL)用于阻塞性睡眠呼吸暂停综合征(OSAS)患者经鼻气管插管的效果。方法拟行腭咽成型术的OSAS患者90例,随机分为M、G和F3组,每组30例,M组使用普通喉镜、G组使用GVL、F组使用FOB联合GVL经鼻气管插管,记录麻醉开始前(T_0)、气管插管即刻(T_1)、插管后1 min(T_2)和5 min(T_3)的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)和气管插管时间,观察喉镜显露Cormack-Lehane(C-L)分级情况及一次插管成功率、按压喉外部和使用气管插管钳的发生率以及鼻腔出血和低氧血症的发生率。结果 C-L分级G和F组优于M组(P 0.05),一次插管成功率M组低于G和F组(P 0.05),需按压喉外部F组低于M和G组(P 0.05),G组低于M组(P 0.05),使用气管插管钳次数和鼻腔出血的发生率F组低于M和G组(P 0.05)。结论 FOB联合GVL用于OSAS患者经鼻气管插管,可提高气管插管成功率,减少鼻腔出血。     

盲探插管新技术与纤支镜插管技术在颈椎骨折患者中的应用效果比较

[摘要] 目的:比较盲探插管新技术与纤支镜插管技术在颈椎骨折病人中插管的效果。方法: 40例行颈椎骨折手术患者随机分成盲探插管新技术组和经纤维支气管镜引导插管组，每组20例。观察两组插管效果、插管时间、对循环和呼吸的影响以及并发症情况。 结果:两组插管成功率均为100%（20/20）； 插管时间分别为4.1±1.6min和4.4±2.2min；插管过程中两组患者的循环和呼吸功能均无明显变化；所有病例未见严重并发症。 结论：在颈椎骨折病人手术中盲探插管新技术和纤支镜插管技术取得的效果无显著差异。     

Management of tracheal intubation in the respiratory intensive care unit by pulmonary physicians

BACKGROUND: Expert management of tracheal intubation has become fundamental to the routine practice of pulmonary physicians who work in respiratory intensive care units (ICUs). In Italy, tracheal intubation is not included as part of the training in respiratory medicine, and pulmonary physicians are usually dissuaded from managing intubations. METHODS: We prospectively studied the intubation success rate in 46 consecutive respiratory ICU patients who required either emergency or urgent intubation, conducted by 3 intubation-trained pulmonary physicians in our respiratory ICU. Intubation success was defined as successful tracheal intubation without any of 7 pre-defined complications. RESULTS: There were 17 emergency intubations and 29 urgent intubations. Intubation was successful in 43 of the 46 intubation attempts. Complications occurred in 3 cases: 2 patients needed to be intubated by an anesthesiologist, and 1 patient received fiberoptic intubation. CONCLUSIONS: Pulmonary physicians trained in tracheal intubation can have a high success rate in performing intubation in the respiratory ICU. Collaborative efforts between anesthesiologists and pulmonary physicians are necessary to optimize the training, skill-retention, and back-up for advanced airway management in the respiratory ICU.     

Initial Experience of Emergency Physicians Using the Intubating Laryngeal Mask Airway: A Case Series

OBJECTIVE: Although the intubating laryngeal mask airway (ILMA) is widely available, its use by emergency physicians (EPs) has not been reported. The authors report the initial experience of EPs using the ILMA. A review of their experience and the relevant anesthesia literature provides a basis for EPs to use the ILMA more confidently and effectively. METHODS: Between January 2000 and January 2001, the ILMA was used on a convenience sample of emergency department (ED) patients undergoing "routine" intubations, and "rescue" situations, after failed rapid-sequence intubation (RSI). Patients were identified from the ED resuscitation case database. Chart review and intubating physician interviews focused on success of the device, complications encountered, and "pearls" of the device's use as perceived by the intubating physician. RESULTS: Ventilation with the appropriate-size ILMA occurred in less than 15 seconds in all "routine" intubations; tracheal intubation was subsequently accomplished in less than 1 minute. Eight of nine "routine" patients had blind tracheal intubation through the ILMA. One patient required fiberoptic bronchoscopy to guide the endotracheal tube into the trachea. Of the "rescue" intubations, all patients (n = 7) were successfully ventilated and five were successfully intubated using the ILMA. CONCLUSIONS: In this case series, the ILMA was easy to use in acute resuscitations, and proved to be invaluable in cases of failed RSI.     

A secure ��double-check�� technique of bedside post pyloric feeding tube placement using transnasal endoscopy

Enteral feeding has become an important means of providing nutritional support to seriously ill patients. Placement of the feeding tube through the pyloric ring and past the ligament of Treitz into the proximal jejunum is critical to reduce the risk of gastroesophageal regurgitation and microaspiration. We started utilizing transnasal endoscopy for intestinal feeding tube placement, placing enteral tubes for 40 patients between March 2008 and February 2009. Although we achieved a high success rate comparable to previous reports, we experienced several cases of failure, which was corrected with repeated endoscopy. Based on these experiences, we modified our method by adding a ”double-check” transnasal endoscopy through the other nasal passage. After April 2010, we have placed the feeding tube by ”double-check” method for all patients (more than 40 patients) who required transnasal endoscopic feeding tube placement. We have not experienced any misplacement in all these patients after 24 h later with 100% successful rate since the introduction of ”double-check” procedure. We describe our experience with ”double-check” transnasal endoscopic feeding tube placement, which we found to be a helpful adjunct, for patients in intensive care unit.     

Fiberoptic-Guided and Blind Tracheal Intubation Through iLTS-D,Ambu® Auragain™, and I-Gel® Supraglottic Airway Devices: A Randomized Crossover Manikin Trial

BackgroundThe use of supraglottic airway devices (SADs) is becoming more widespread. However, there is little evidence to show which device is best in an emergent clinical scenario.ObjectiveWe compared both fiberoptic-guided and blind tracheal intubation through the Intubating Laryngeal Tube Suction-Disposal (iLTS-D), the AuraGain™, and the i-gel® in an airway manikin.MethodsThirty residents were included in a randomized trial to perform both fiberoptic-guided and blind tracheal intubation using the iLTS-D, the AuraGain, and the i-gel. The main endpoint was the total time taken to achieve successful fiberoptic intubation through the SAD. Additional endpoints included total time for blind intubation, SAD insertion time, tracheal tube insertion time, intubation success rate, fiberoptic view, and maneuvers performed to achieve tracheal intubation.ResultsAll participants performed fiberoptic intubation using all three SADs on the first attempt. The total time to fiberoptic tracheal intubation using the i-gel, AuraGain, and iLTS-D was 42 s, 56 s, and 56 s, respectively. The blind tracheal intubation success rate was 80% with the iLTS-D, 43% with the i-gel, and 0% with the AuraGain. The total time for blind tracheal intubation through the i-gel and the iLTS-D was 29 s and 40 s, respectively. Laryngeal view grades were significantly poorer with the iLTS-D compared to the other devices. The iLTS-D required significantly more maneuvers to achieve successful tracheal intubation.ConclusionsIn an airway manikin, the iLTS-D, AuraGain, and i-gel appear to be reliable devices for airway rescue and fiberoptic-guided tracheal intubation. The iLTS-D is recommended for blind tracheal intubation.     

导管加温后纤维支气管镜引导经鼻建立人工气道的临床应用

目的 探讨气管插管导管加温软化后再经纤维支气管镜(纤支镜)引导经鼻建立人工气道行机械通气支持的优越性和安全性.方法 209例接受纤支镜引导经鼻置管行机械通气支持治疗的患者被随机分为加温组(105例,置管前先将导管加温到52 ℃)和常规组(104例,置管前导管温度23～26 ℃),导管由纤支镜引导经鼻建立人工气道.加温组置管前不应用麻黄素喷鼻.结果 ①导管加温组首次置管成功者所需时间[(14.48±8.31)s,99例]明显短于常规组[(23.85±11.97)s,96例,P＜0.01).②加温组清醒状态下患者的首次置管成功率为100.0%(28/28例),显著高于常规组(87.5%,21/24例,P＜0.05).③加温组首次置管成功者30 s内置管成功率为93.9%(93/99例),明显高于常规组(68.6%,66/96例,P＜0.01).④加温组首次置管成功者中导管向气管内推送困难的发生率为5.05%(5/99例),常规组为32.29%(31/96例),两者比较差异有显著性(P＜0.01).⑤加温组首次置管成功者中鼻出血发生率为4.0%(4/99例),明显低于常规组(15.6%,15/96例),差异有显著性(P＜0.01).⑥加温组清醒状态下首次置管成功者的鼻出血发生率为3.6%(1/28例),常规组为28.6%(6/21例),两者比较差异有显著性(P＜0.05).结论 导管加温后纤支镜引导经鼻建立人工气道,在置管前鼻腔黏膜表面无需使用缩血管药物,插管前准备时间缩短,避免了药物引发的心血管反应;提高了清醒状态下患者对插管操作的依从性和置管成功率.     

球囊扩张术治疗结核性支气管狭窄的疗效分析

目的 观察和分析经纤维支气管镜(纤支镜)球囊扩张术治疗结核性支气管狭窄的的疗效.方法 将2002年至2004年间我院收治的76例结核性支气管狭窄的患者分为两组:对照组41例,给予抗结核方案治疗和纤支镜镜检;治疗组35例,除给予对照组相同的治疗外,另给予1-4次球囊扩张术治疗.结果 对照组显著好转5例(12%),好转10例(24%),好转率36%;治疗组显著好转30例(86%),好转5例(14%),好转率100%,差异有统计学意义(P<0.01).结论 球囊扩张术是治疗结核性支气管狭窄的一种简便、有效的治疗手段,值得临床推广.     

纤支镜引导双腔支气管插管

目的：研究纤支镜引导下双腔支气管导管插管的一次成功率和定位情况。方法：选择ASAⅠ-Ⅱ级的胸科手术患者320例,随机分成试验组（160例）和对照组（160例）。试验组在纤支镜引导下插入双腔支气管导管并确定管端位置后固定,对照组在普通喉镜显露下插入双腔支气管导管,再用纤支镜判断管端所在位置。结果：试验组双腔支气管导管插入一次成功率为99．98％,管端定位准确率达99．99％,对照组双腔支气管导管插入过深发生率24．35％,插入过浅发生率为15．23％,总错位率达39．58％,定位率仅占61．56％。结论：纤支镜引导双腔支气管导管插管均一次成功,管端定位准确,是目前双腔支气管导管插管及定位的最佳方法。