儿童气管插管前后留置胃管的研究

目的 探讨儿童气管插管中留置胃管更为有效的方法.方法 将163例病例随机分为2组,实验组93例采用气管插管前插胃管,对照组70例气管插管后插胃管,并经统计学分析.结果 实验组首次成功率为97.8%,对照组首次成功率60%(P＜0.05);2组患儿鼻胃管平均留置时间均有显著性意义(P ＜ 0.05).结论 气管插管前插胃...     

经口气管插管病人快速留置胃管方法的对照研究

目的探讨经口气管插管病人应用鼻空肠管导丝快速留置胃管的临床效果。方法收集ICU需在气管插管状态下留置胃管病人66例随机分为试验组(鼻空肠管导丝引导下经鼻留置胃管法)与对照组(常规留置胃管法),记录留置胃管一次成功例数,置管过程中心率、MAP、SpO2变化差值,置管中恶心、呕吐、呛咳及置管后鼻黏膜出血例数,进行统计学处理。结果2组各项观察指标的差异均有统计学意义(P<0.05)。结论应用鼻空肠管导丝对经口气管插管病人留置胃管快速、安全、有效。     

经口气管插管病人快速留置胃管方法的对照研究

目的 探讨经口气管插管病人应用鼻空肠管导丝快速留置胃管的临床效果.方法 收集ICU需在气管插管状态下留置胃管病人66例随机分为试验组(鼻空肠管导丝引导下经鼻留置胃管法)与对照组(常规留置胃管法),记录留置胃管一次成功例数,置管过程中心率、MAP、SpO2变化差值,置管中恶心、呕吐、呛咳及置管后鼻黏膜出血例数,进行统计学处理.结果 2组各项观察指标的差异均有统计学意义(P＜0.05).结论 应用鼻空肠管导丝对经口气管插管病人留置胃管快速、安全、有效.     

经口气管插管患者两种留置胃管方法的比较

目的探讨经口气管插管患者应用经鼻、经口留置胃管的优缺点。方法将84例患者插胃管时间分成两组,经口留置胃管为观察组（42例）,经鼻留置胃管为对照组（42例）,观察两组的一次置管成功率、呼吸机相关性肺炎发生率。结果观察组一次置管成功率高于对照组;呼吸机相关性肺炎发生率低于对照组,P〈0．05,差异有统计学意义。结论经口气管插管患者一次置管成功率高,并发症少。     

气管插管患者胃管留置困难原因分析及对策

气管插管患者常需留置胃管观察胃液颜色、性质，或经胃管灌注食物、药物。常规经鼻插胃管法，由于刺激大，加上在气管插管状态下患者失去吞咽功能不能主动配合，给插管工作带来一定难度。在临床实践中。我们摸索了在镇静状态下牵拉气管同时置入胃管，具有成功率高不良反应少的优点。我科利用本方法对2000～2003年间48例气管插管患者进行胃管留置，一次置管成功率达95％，现就插管困难原因及对策进行讨论。     

气管插管病人胃管置入方法的临床研究

目的：探讨气管插管病人不同胃管置入方法一次插管成功率及对病人的影响。方法：将308例气管插管病人随机分为卡弗放气组（A组）、卡弗不放气组（B组）、头部前倾组（C组）和牵拉气管组（D组）各77例。观察并比较四组一次插管成功率、插管所需时间、插管前后HR、SpO2及插管过程中呛咳、鼻咽黏膜出血等不良反应发生率。结果：（1）一次插管成功率比较,A组与B组无显著差异（P〉0.05）,C组显著低于A、B组（均P〈0.01）,D组显著高于其他各组（均P〈0.01）。（2）置管时间,A组与B组无显著性意义（P〉0.05）;C组与A、B组相比,置管时间明显延长（均P〈0.01）;D组与其他各组相比,置管时间明显缩短（P〈0.05和P〈0.01）。（3）置管后HR、SpO2与各自置管前相比,B、D组差异无显著性（均P〉0.05）,A、C组HR明显加快（P〈0.05和P〈0.01）、SpO2显著降低（均P〈0.01）。（4）D组与A、B、C三组相比,恶心、呛咳发生率均显著降低（均P〈0.01）;D组与A、C两组相比,黏膜出血发生率均显著降低（均P〈0.01）;D组与B组相比,黏膜出血发生率无显著差异（P〉0.05）。结论：对气管插管病人在镇静状态下牵拉气管的同时置入胃管,准确性高、不良反应少。     

经口气管插管导引留置胃管的插入与护理配合1例

2005年2月，我科成功为1例全身大面积烧伤伴吸人性损伤行气管切开术，术后并发气管食管瘘的患插胃管。现将插管方法及护理体会报告如下。     

气管插管时不同胃管置入方法效果比较

2000年12月~2006年12月,我们共收治378例气管插管并需留置胃管患者,分别给予不同的胃管置入法,并比较其效果。现报告如下。1资料与方法1.1临床资料本组378例,男214例,12~87岁,平均47·8岁;女164例,14~84岁,平均44.6岁。所有患者中能配合插管者76例,不能配合插管但有咽反射者173     

应用牵拉气管法为气管插管病人留置胃管的临床观察

人工气道是将导管经口或鼻腔插入气管或气管切开置入套管所建立的气体交换通道。急危重病人建立人工气道后，一般都需留置胃管进行消化道监测或肠内营养支持。由于气管导管及气囊的压迫间接引起食管狭窄甚至使入口闭塞，并且病人处于镇静或昏迷状态，无自主吞咽动作，采用气囊放气和前倾头部置胃管一次成功率较低。为减少反复插胃管给病人带来的痛苦及不良反应，仔细分析气管与食管的解剖特点，总结出一种简易可行的留置胃管方法，即当胃管置入14cm～16cm（咽喉部）时，一手轻轻向上牵拉气管，另一手迅速将胃管置入10cm，使其通过食管的狭窄处后，再按常规置胃管到预定长度。经临床使用，此方法均能一次成功。现报道如下。     

气管插管状态下置胃管方法的对比研究

目的比较经口气管插管状态下口插胃管与鼻插胃管的临床效果,方法将190例气管插管患者的随机分为A,B两组,两种插胃管方法从平均置管时间,恶心发生率及一次置管成功率三方面进行比较。结果,口插胃管法优于鼻插胃管法,两组间差异有显著意义。结论在经口气管插管状态下口插胃管法优于鼻插胃管法。     

昏迷患者留置胃管的方法选择与效果评价

目的提高昏迷患者留置胃管的一次性成功率。方法随机选取1990年6月至2005年6月昏迷患者189例,患者选择不同方法留置胃管并进行效果评价,所得有效计数资料数据用SPSS10．0软件进行统计处理,通过χ^2检验进行统计学分析。结果对单纯昏迷患者采取左侧卧位法（χ^2=17．43,P〈0．01）;对昏迷伴气管切开患者采取左侧卧位伴拔出部分气管套管法（χ^2=15．92,P〈0．01）;对昏迷伴舌后坠的患者采取左侧卧位拉舌法（χ^2=19．71,P〈0．01）;对昏迷伴咽喉部水肿的患者采取左侧卧位不锈钢螺纹法（χ^2=4．84,P〈0．05）,疗效明显优于常规的插胃管操作方法。结论改良留置胃管左侧卧位优于常规留置胃管法,提高了插胃管的一次性成功率,减轻了对患者的刺激和减少了并发症的发生,为患者的后期治疗奠定了营养基础。     

不同胃管留置方法在脑卒中患者中的应用效果

目的探讨不同胃管留置方法在脑卒中患者中的应用效果。方法便利抽样法选择2009年1月至2012年1月在广西医科大学第七附属医院治疗的需要留置胃管的脑卒中患者81例为研究对象,按随机数字表法将其分为观察组与对照组。对照组40例患者采用常规胃管留置法,观察组41例患者采用改良胃管留置法,比较两种置管方法的效果。结果观察组患者在置管过程中出现不良反应较少,与对照组比较差异有统计学意义（P〈0．05或P〈0．01）。观察组患者置管成功率及患者满意率明显高于对照组,置管平均用时少于对照组,差异均有统计学意义（P〈0．05或P％0．01）。观察组患者留置胃管前后心率、血压、血氧饱和度的差异无统计学意义（P〉0．05）。结论改良胃管留置法能有效地减少置管过程中不适与不良反应发生率,减轻患者痛苦,提高置管成功率,是一种简便、安全、有效的胃管留置方法。     

A New Maneuver for Endotracheal Tube Insertion During Difficult Glidescope Intubation

Background: The GlideScope® Video Laryngoscope (Verathon, Bothell, WA) is a video laryngoscopy system that can be used for routine intubation, but is also commonly used as an alternative for difficult or failed airways. Previous reports have identified a very high incidence of grade 1 and grade 2 Cormack-Lehane glottic views, but despite these high-grade views, intubation is sometimes difficult due to the angle of insertion and shape of the endotracheal tube. Several maneuvers have been reported to increase the likelihood of successful endotracheal tube placement in these uncommon cases of failure. Case Report: We report the case of a patient who could not be intubated with the GlideScope® despite an easily obtained grade 1 laryngoscopic view. The impediment to intubation was identified as a sharp angulation of the trachea with respect to the larynx, such that the trachea formed a steep posterior angle with the laryngeal/glottic axis. Intubation was achieved using a previously unreported maneuver, in which the endotracheal tube with a sharply curved malleable stylet was inserted through the glottis, and then rotated 180° to permit passage down the trachea. Discussion and Conclusion: We believe that this maneuver may be useful in other cases of failed GlideScope® intubation, when a high-grade laryngeal view is obtained but tube passage is not possible due to a sharp posterior angulation of the trachea.     

Assessment of a New Method to Distinguish Esophageal from Tracheal Intubation by Measuring the Endotracheal Cuff Pressure in a Porcine Model

Objectives: With the knowledge of differences in anatomic structures between the trachea and the esophagus, the authors conducted an animal study to evaluate the usefulness of endotracheal cuff pressure in distinguishing endotracheal and esophageal intubations. Methods: Six swine were anesthetized and endotracheally intubated with 7.5-mm cuffed endotracheal tubes. The intubations were confirmed by fiber-optic bronchoscopy. Each pilot balloon was connected to a 10-mL syringe and a manometer via a three-way stopcock. The cuff pressures were measured for each 1-mL incremental filling of air (1–10 mL). After removal of the endotracheal tubes, each swine was then intubated with the same endotracheal tubes into its esophagus. The cuff pressures of the esophageal intubation were measured with the same procedure. The cuff pressures and the pressure–volume relationships in both intubations were compared. Results: The cuff pressure increased significantly in the esophageal intubation in comparison with the endotracheal intubation in all the comparisons from 1 mL to 10 mL (p = 0.028 for all Wilcoxon signed-rank tests). The slope of the pressure–volume curve of the cuff pressure was also significantly higher in the esophageal intubation during the inflation of the cuff on average (0.047 vs. 0.032 cm H₂O/mL; p = 0.001), particularly in the first 5 mL of air inflation. Conclusions: The cuff pressure in the esophageal intubation was significantly higher than that in the endotracheal intubation under the same inflated volume from 1 to 10 mL. This may provide the basis for an adjunctive, simple, rapid, and reliable method to verify endotracheal intubation.     

Paramedic King Laryngeal Tube Airway Insertion versus Endotracheal Intubation in Simulated Pediatric Respiratory Arrest

Abstract

Introduction: Pediatric endotracheal intubation (ETI) is difficult and can have serious adverse events when performed by paramedics in the prehospital setting. Paramedics may use the King Laryngeal Tube airway (KLT) in difficult adult airways, but only limited data describe their application in pediatric patients. Objective: To compare paramedic airway insertion speed and complications between KLT and ETI in a simulated model of pediatric respiratory arrest. Methods: This prospective, randomized trial included paramedics and senior paramedic students with limited prior KLT experience. We provided brief training on pediatric KLT insertion. Using a random allocation protocol, participants performed both ETI and KLT on a pediatric mannequin (6-month old size) in simulated respiratory arrest. The primary outcomes were 1) elapsed time to successful airway placement (seconds), and 2) proper airway positioning. We compared airway insertion performance between KLT and ETI using the Wilcoxon signed-ranks test. Subjects also indicated their preferred airway device. Results: The 25 subjects included 19 paramedics and 6 senior paramedic students. Two subjects had prior adult KLT experience. Airway insertion time was not statistically different between the KLT (median 27 secs) and ETI (median 31 secs) (p = 0.08). Esophageal intubation occurred in 2 of 25 (8%) ETI. Airway leak occurred in 3 of 25 (12%) KLT, but ventilation remained satisfactory. Eighty-four percent of the subjects preferred the KLT over ETI. Conclusions: Paramedics and paramedic students demonstrated similar airway insertion performance between KLT and ETI in simulated, pediatric respiratory arrest. Most subjects preferred KLT. KLT may provide a viable alternative to ETI in prehospital pediatric airway management.     

Effect of Airway-Securing Method on Prehospital Endotracheal Tube Dislodgment

Abstract

Objective. We compared the effectiveness of common airway-securing techniques in preventing endotracheal tube (ETT) dislodgment in the prehospital setting. Methods. This was a prospective, observational, multicenter study conducted at 42 emergency medical services (EMS) agencies. EMS providers completed structured, closed-response data forms for all endotracheal intubation (ETI) attempts during an 18-month period. We included all successful intubations as well as failed ETIs in which ETT securing was performed. EMS providers indicated methods used to secure the ETT, including the use of adhesive tape to the face (face tape), tape wrapped around the neck (neck tape), woven twill or umbilical tape (twill tape), intravenous or oxygen tubing (tubing), commercial tube holders, and manual stabilization/none. Providers also indicated the concurrent use of a cervical collar and/or cervical immobilization device (CID) with backboard. ETT dislodgment was reported by providers. We evaluated the rates and odds of ETT dislodgment for each tube-securing technique using multivariate logistic regression. Results. Of 1,732 patients undergoing tube-securing efforts, ETT dislodgment occurred in 51 (2.9%). ETT dislodgment rates were as follows: tube held manually, four of 32 (12.5%); face tape, 13 of 292 (4.5%); neck tape, nine of 205 (4.4%); twill tape, zero of 67 (0%); tubing, one of 30 (3.3%); commercial tube holders, 25 of 1,111 (2.3%); cervical collar, two of 121 (1.7%); and CID, 12 of 377 (3.2 %). On multivariate regression, when compared with securing the tube with face tape, only manually holding the tube in place showed a significant difference in the odds of dislodgment (odds ratio [OR] 5.0, 95% confidence interval [CI] 1.2–15.2). Whereas cardiac arrest and trauma did not increase the odds of ETT dislodgment (OR 1.3, 95% CI 0.7–2.6; and OR 0.3, 95% CI 0.1–1.4, respectively), patient age less than 5 years was associated with ETT dislodgment (OR 6.6, 95% CI 2.2–19.7). Conclusion. In this multicenter observational series, the odds of ETT dislodgment were similar for face tape, neck tape, twill tape, plastic tubing, and commercial tube holders. ETT dislodgment did not occur with woven twill tape. Patients under 5 years of age are at heightened risk for ETT dislodgment.     

低体重早产儿2种留置胃管方法的对比观察

目的比较2种低体重早产儿不同留置胃管方法的效果。方法把需要留置胃管的低体重早产儿随机分为2组，经口留置胃管组33例，经鼻留置胃管组30例，比较2组患儿的一次插管成功率、平均操作时间、相关并发症。结果2组一次插管成功率、平均操作时间、插管相关并发症的发生率比较，差异均有统计学意义。结论低体重早产儿经口留置胃管比经鼻留置胃管一次插管成功率高，操作时问短，并发症少。     

老年尿毒症吞咽障碍患者改良插胃管法的效果观察

目的探讨并评价改良插胃管法在老年尿毒症吞咽障碍患者中应用的效果。方法将41例肾内科老年尿毒症吞咽障碍需要鼻饲患者作为研究对象,按照入院的先后顺序分为对照组20例和改良组21例。对照组采用传统插胃管法,改良组采用改良插胃管法。观察比较两组患者置管成功率、置管时间、恶心呕吐和呛咳发生率。结果改良组1次置管成功率、2次置管成功率明显高于对照组,差异有统计学意义(χ2=4.111,χ2=4.221,均P<0.05);改良组置管时间明显少于对照组(t=2.271,P<0.05),置管时呛咳发生率低于对照组(χ2=4.667,P<0.05),差异有统计学意义。而两组患者恶心呕吐发生率比较差异无统计学意义(χ2=0.006,P>0.05),置管费用无差异。结论改良插胃管法能显著提高置管成功率,缩短置管时间,减轻患者痛苦。     

视频喉镜辅助胃癌患者术中置入鼻肠管的效果观察

目的 探讨视频喉镜辅助胃癌患者术中置入鼻肠管的应用效果。方法 选取2017年3-9月在我院行根治性全胃切除术的80例患者,按随机数字表将入选患者分为对照组和观察组,每组各40例。对照组采用传统的经鼻盲探下置入鼻肠管,观察组采用视频喉镜辅助鼻肠管置入方法。比较2组患者置管时间、一次置管成功率、鼻腔出血发生率及术后当天咽喉疼痛程度。结果 2组患者鼻肠管的置管时间比较差异无统计学意义（P>0.05）;观察组患者鼻肠管的一次置管成功率高于对照组,鼻腔出血发生率、术后当天咽喉疼痛程度低于对照组（均P<0.05）。结论 胃癌患者术中置入鼻肠管采用视频喉镜辅助,可提高一次置管成功率,降低鼻腔出血发生,减轻咽喉疼痛程度。     

气管插管患者拔管后二次插管常见原因与对策分析

气管插管机械通气是生命支持的重要手段,也是急诊和危重患者呼吸道开放的基本方法之一,但随着气管插管的留置时间延长,给患者带来的呼吸道压伤、感染、不舒适及管道的阻塞、扭曲、脱落机会等也随之增加。因此,及早撤机、拔管是减轻患者痛苦、减少并发症的重要途径;顺利脱机拔管更是机械通气治疗成功的标志。大多数患者在拔管后能顺利康复,而部分患者因各种原因需再次行气管插管。