急诊气管插管术在抢救中的应用时间

急诊室是病人就诊的第一站，医护人员正确掌握气管插管的指征，及时施行急诊气管插管术，能有效提高抢救成功率，为挽救病人生命赢得宝贵时间。     

一种用于心肺复苏时快速检测导管位置的装置:气管插管鉴定囊

气管内插管是心肺脑复苏(CPCR)和麻醉时的重要抢救技术.抢救插管时要求中断心脏按压的时间越短越好,美国心脏病学会和国际复苏联盟在2005国际心肺复苏(CPR)和心血管急救指南中提出:"作为一个目标,要将气管内插管的时间控制在10 s以内","仅能在暴露声门和置入导管的这段时间内停止胸外按压[1]".为了达到这一目标,我们利用气管插管鉴定囊来检测气管导管的位置,并对气管内插管的时间进行了测定,介绍如下.     

逆行气管插管在急诊抢救中的价值

紧急气管插管是可快速简便建立人工气道的有效手段。作者在近3年尝试了8例逆行气管插管,效果满意,现报告如下。     

气管插管在急诊抢救中的应用体会

气管插管术是临床急诊抢救过程中心肺复苏的关键，是心脏停搏后抢救成功的关键。尽早为气道梗阻患者实施气管插管，建立有效的呼吸通道，明显降低了患者的死亡率。     

带套囊气管导管在急救性气管插管术中的应用

在2003年抗击严重急性呼吸综合征(SARS)过程中,一些医务人员给患者行急救气管插管时,被从导管中喷出的传染性分泌物直接污染而感染了SARS,有的医生还因此而失去了宝贵的生命。本研究试图找出一种能避免插管操作者被从导管中直接喷出的分泌物直接污染的简单易行的防护方法。1资料与方法1.1末端带套囊气管导管的备制按预定长度将铜导管芯插入气管导管,将导管外口铜线弯曲倒U型,铜线尽可能贴近导管,通过铜线弯曲端在导管外口套上从7.5号手套剪下的第1或第2指指套,尽是缩小导管、铜芯和套囊间的缝隙,套上套囊后套囊末端无明显张力,以用嘴向…     

“气管插管鉴定囊”检测技术的应用总结

气管内捕管是临床麻醉和抢救患者时的重要技术,是保障患者呼吸道通畅的重要措施。气管内插管时有误入食管的潜在危险,如不及时发现并纠正,可导致缺氧性损害,甚至患者死亡。1998年10月至2010年1月,东南大学附属中大医院应用“气管插管鉴定囊”检测技术对气管插管时导管的位置做检测,总计已有7326例,其中对全身麻醉时的插管检测6955例,对急诊抢救时的捅管检测371例,男3846例,女3480例,年龄3～9l岁,平均（46．7±7．2）岁,取得了理想的妁果,．卿介绍加下。     

急诊直视气管插管抢救危重症临床分析

将我院2012年5～10月,ICU收入的出现呼吸困难的需要进行插管处理的急诊重症患者39例,在喉镜的可视监测下对患者进行可视插管。结果 39例患者当中,进行成功插管的患者有38例,患者成功率为97.4%,其中一次性成功的患者27例,平均插管时间5min,患者未出现明显的不适和并发症。结论对危急重症患者进行直视气管插管具有成功率高,患者痛苦少,可以有效节约患者抢救时间,提高患者抢救的成功率,同时费用不是太高,容易被普遍基层患者接受,值得临床推广运用。     

气管导管套囊充气法用于经鼻盲探气管插管初步体会

口腔颌面手术常因出血多,存在误吸与窒息的危险性,原则上应在气管插管全麻下进行,以利于供O_2,保持气道通畅,避免血性分泌物流入气道而窒息。由于经口气管插管与术者占用同一通道,有碍术野暴露,不利于手术操作。故经鼻气管插管现已成为此类手术常     

气管插管鉴定囊对气管内插管时呼出气体和飞沫的阻断效果

目的 观察一种新研制的气管插管鉴定囊在急诊气管内插管时对患者呼出气体或飞沫的阻断效果.方法 选择急诊抢救中需气管内插管的62例患者进行观察试验,性别不限,年龄21～73岁,所选患者均有不同程度的意识和自主呼吸;按随机数字表法分为两组,每组31例患者.对照组(C组)用普通气管导管;气管插管鉴定囊组(T组)在气管内插管时用接有气管插管鉴定囊的气管导管.观察并记录两组插管过程中有无呛咳发生、操作者面颈部有无感受到在气管导管口处有呼出气流、操作者面颈部有无受到血液或分泌物的沾染.结果 T组全部患者在插管时气管插管鉴定囊均出现了胀缩,但操作者没有感觉到在气管导管口处有呼出气流;插管期间有9例患者发生了呛咳,其中2例使操作者面颈部受到了沾染.C组中有16例插管使操作者感受到在气管导管口处有呼出气流,其中7例出现了呛咳,11例使操作者面颈部受到了沾染.与C组比较,T组的操作者感受到有呼出气流和受到血液、分泌物沾染的发生率低(0比16,2比11,均P＜0.05),插管过程中患者呛咳的发生率差异无统计学意义(9比7,P＞0.05).结论 气管插管鉴定囊用于气管内插管时能够起到阻断呼出气体泄漏或飞沫播散的作用,有助于防控插管时血液或分泌物的喷溅.     

Preoxygenation in critically ill patients requiring emergency tracheal intubation

OBJECTIVE: To determine the effectiveness of preoxygenation with 100% oxygen in the critically ill patient in preparation for emergency tracheal intubation. DESIGN: Nonrandomized, controlled trial. SETTING: Large, level 1 trauma center, tertiary care intensive care unit. PATIENTS: Critically ill patients failing noninvasive respiratory support techniques who require tracheal intubation followed by mechanical ventilation. INTERVENTIONS: A baseline arterial blood gas was obtained on noninvasive therapy and 4 mins post-100% oxygen therapy with a bag-mask assembly. Best effort to achieve a tight-fitting mask seal was pursued coupled with other mask ventilation maneuvers to optimize noninvasive oxygenation and ventilation. MEASUREMENTS AND MAIN RESULTS: A total of 42 patients consecutively intubated during the 15-month study period were studied. The baseline Pao2 (mean +/- sd) with concurrent noninvasive support was 67 +/- 19.6 mm Hg (range, 43-88 mm Hg) and increased a mean of 37 mm Hg to 103.8 +/- 63.2 mm Hg after 4 mins of preoxygenation with 100% oxygen. A total of 36% of patients had minimal changes (+/-5%) in their baseline Pao2, and only 19% increased their baseline Pao2 by at least 50 mm Hg after preoxygenation maneuvers. CONCLUSIONS: The critically ill patient has little reserve to tolerate interruption of oxygen delivery and, thus, is at risk for hypoxemia during emergency airway management. Preoxygenation efforts as described in this clinical trial appear to be marginally effective in regard to providing a reasonable safeguard against hypoxemia during laryngoscopy and endotracheal intubation.     

一次性气管套管在置管期间的护理问题及对策

目的分析一次性气管套管置管期间的护理问题,探讨更好的有效的处理方法。方法对15例气管套管出现的护理问题进行观察、分析。结果发现气管置管期间出现的护理问题主要是痰液黏稠结痂粘附阻塞气管套管,其中气管套管阻塞13例,气管套管脱落1例,1例未形成窦道拔管重插。结论护士正确掌握痰液黏稠度和气道湿化标准,是防止气管套管阻塞,维持呼吸道正常生理功能,确保和提高置管病人护理质量的关键。     

Severe low-pressure cuff tracheal injury in burn patients

Two cases are presented of severe tracheal damage secondary to low-pressure high-volume endotracheal tube cuffs monitored carefully against over-inflation. Our patients' findings suggest that in the presence of tracheal inhalation injury or severe tracheal infection strict monitoring of pressures, though essential, does not preclude tracheal trauma from a low-pressure cuff, trauma to a degree generally ascribed only to high-pressure stiff cuffs. There is probably no arbitrarily safe level of cuff pressure in these patients; any amount of pressure is likely to further harm the tracheal wall and must be weighed into the risk-benefit equation for prolonged intubation.Partly supported by National Institutes of Health Grant GM 21700     

新型专利气管导管在困难气管插管中的临床应用

目的评价本新型专利气管导管在困难气管插管中的临床应用价值。方法随机对73例困难或异常的气道患者分为两组,I组（1／,=73）：在麻醉诱导下,首先采用目前临床上使用的塑料气管导管（传统气管导管）插管,在不用管芯情况下,分析其插管成功率;Ⅱ组（n=63）：在I组2次插管不成功者归为Ⅱ组,并换用新型气管导管插管,在不用管芯情况下分析其插管成功率。结果I组首次插管成功率为2．7％（2／73）,插管总成功率为13．7％（10／73）;11组首次插管成功率为73．02％（46／63）,插管总成功率为98．41％（62／63）,两组首次插管成功率和插管总成功率相比较,差异均有统计学意义（x。值分别为36．01、31．08,P均〈0．01）。结论本新型专利气管导管比传统气管导管有三大优点：具有良好的可塑性,无需辅用气管管芯插管,能充分发挥软导引管的引插管导作用。新型专利气管导管比传统气管导管更加实用。     

Comparison of three types of laryngoscope for tracheal intubation during rhythmic chest compressions: A manikin study

Background

If tracheal intubation can be performed during uninterrupted chest compressions, this will sustain circulation during the procedure of intubation and may lead to successful resuscitation. We compared three types of laryngoscope on a manikin as to whether they enabled tracheal intubation while the manikin's chest was rhythmically compressed.

Methods

A total of 35 persons who had little or no experience in intubation served as examinees. The laryngoscopes employed were a conventional Macintosh laryngoscope (MAC), a new video laryngoscope, Pentax-AWS (AWS) and an optic laryngoscope Airtraq (ATQ). During chest compression on the manikin by an assistant, the examinee attempted to perform intubation. The success rate and the time for successful intubation were measured.

Results

During rhythmic chest compressions, nine examinees failed in tracheal intubation with the MAC, seven failed with the ATQ, and no one failed with the AWS. The success rates with the AWS were significantly higher than those with the MAC (P < 0.01) or ATQ (P < 0.05). The time needed for intubation was significantly shorter with the Pentax-AWS than with the others.

Conclusions

These results suggest that the use of the Pentax-AWS enables tracheal intubation while the patient's chest is rhythmically compressed, and would more often lead to successful intubation, which in turn may lead to more successful resuscitation.     

国产UE可视喉镜与普通喉镜用于小儿气管插管比较

目的评价国产UE可视喉镜在小儿气管插管中的应用价值。方法择期全身麻醉下气管插管行手术治疗患儿200例,随机分为可视喉镜组和普通喉镜组各100例,分别应用UE可视喉镜和普通喉镜行气管插管,记录2组声门暴露程度（Cormark—Lehane分级）、气管插管时间、插管成功率并进行比较。结果可视喉镜组声门暴露程度优于普通喉镜组,插管成功率高于普通喉镜组（P〈0．05）;2组气管插管时间比较差异无统计学意义（尸〉O．05）。结论国产UE可视喉镜用于小儿气管插管明显优于普通喉镜。     

Antibacterial-coated tracheal tubes cleaned with the Mucus Shaver

OBJECTIVE: To assess the long-term benefit from antibacterial coatings of the tracheal tube (ETT), and to keep clean the lumen of the ETT. DESIGN: Experimental animal study. SETTING: USA National Institutes of Health. SUBJECTS: Twelve sheep. INTERVENTIONS: Twelve ETTs were internally dip-coated with a silver-sulfadiazine in polyurethane. We developed a concentric inflatable silicone rubber "razor", the Mucus Shaver (MS), to shave the ETT lumen free of mucus. In a single pass, we cleaned all mucus from the internal surface of the ETT. Control group: Five intubated sheep were mechanically ventilated for 72 h. The ETT was suctioned every 6 h. Study group: Six sheep were intubated and mechanically ventilated for 72 h. The ETT was suctioned and cleaned with the MS every 6 h. An additional sheep was intubated and mechanically ventilated for 168 h. Bacteriologic studies and scanning electron microscopy were performed to assess bacterial colonization and thickness of secretions on the internal surface of the ETT. MEASUREMENTS AND MAIN RESULTS: In the control group, the ETT was always heavily colonized: median debris thickness was 380 microm, range 270-550 microm. In the study group, there was no colonization and no secretions in the ETT, except for three ETT that were colonized solely at the very tip. CONCLUSIONS: Silver-based coating of ETT cleaned with the MS every 6 h significantly reduces accumulation of mucus/secretion and bacterial growth within the ETT following 72 h of mechanical ventilation.     

Pre-hospital tracheal intubation versus esophageal gastric tube airway use: a prospective study

A prospective study compared the respiratory effectiveness of the endotracheal tube (ET) with that of the esophageal gastric tube airway (EGTA) for victims of nontraumatic cardiac arrest in the pre-hospital setting. Arterial blood gases were obtained within 3 minutes of hospital arrival, and survival (defined as discharge from the hospital) was determined. During EGTA ventilation, mean pH was 7.12 +/- 0.2, mean P02 was 77 +/- 92 mm Hg, and mean PC02 was 78.2 +/- 42.9 mm Hg; the survival rate was 4.5%. During ET ventilation, mean pH was 7.34 +/- 0.2, mean P02 was 265 +/- 151 mm Hg, mean PC02 was 35 +/- 20.5 mm Hg; the survival rate was 7%. The authors conclude that endotracheal intubation remains the procedure of choice for airway management in the victim of cardiopulmonary arrest.