肌松监测下罗库溴铵气管插管时机的临床研究

目的 比较肌松监测下静脉注射罗库溴铵0.9mg/kg后60秒和4个成串刺激(train-of-four,TOF)的T1达到最大抑制程度时的气管插管条件,探讨该药理想的气管插管时机.方法 120例行择期腹腔镜胆囊切除术患者,年龄18岁～60岁,ASA Ⅰ-Ⅱ级,随机均分为两组.分别于静脉注射罗库溴铵0.9 mg/kg后60秒(A组)或T1达到最大抑制程度时(B组)行气管插管.观察并记录两组罗库溴铵起效时间(TOF的T1达到最大抑制程度的时间)、气管插管条件(Cooper's评分)、声门暴露程度(Cormack-Lehane分级)、诱导过程中的心率(heart rate,HR)和收缩压(systolic blood pressuref,SBP)变化以及术后24 h咽喉并发症(喉痛、声嘶等不适).结果 静注罗库溴铵0.9 mg/kg后66.0秒±18.1秒(95%可信区间30.2秒一101.8秒)达到T1最大抑制.B组Cooper's评分和Cormack-Lehane分级均优于A组(P相似文献   

院前气管插管联合简易呼吸机对院前颅脑外伤影响的护理研究

目的探讨使用院前气管插管联合简易呼吸机对院前颅脑外伤的影响。方法对我院2009年2月至2010年12月收治的51例颅脑外伤的患者,在院前急救中采用气管插管和简易呼吸机联合使用,观察患者使用后的情况。结果 51例患者经过气管插管和简易呼吸机使用,患者均抢救成功,抢救成功率达100%。患者呼吸恢复平稳,血氧饱和度增加。结论院前气管插管联合简易呼吸机使用方便,在院前急救颅脑损伤,可提高患者治愈率,减少并发症,效果明显。     

老年气管插管患者舒适护理的管理

目的：探讨舒适护理在老年气管插管患者的应用及管理。方法：对46例老年气管插管患者，在整体护理中运用舒适护理，并评价其效果。结果：老年气管插管患者实施舒适护理，患者能适应非语言沟通方式，90％患者感觉身体舒适，能配合治疗；部分患者恐惧焦虑情绪逐渐好转，病人及家属满意度为96％。结论：舒适护理在老年气管插管患者中的应用，体现了以人为本的护理理念，提高了患者及家属的满意度，提高了护理服务质量。     

危重肥胖患者气管切开术的效果及并发症

目的探讨危重肥胖患者实施气管切开术行机械通气的临床效果及并发症。方法根据40例肥胖患者的主观意愿及病情,采取常规局麻下气管切开术13例,全麻插管下气管切开术27例。结果皮下气肿15例,术中出血6例,气胸2例,手术并发症率为55.0%,死亡5例,病死率12.5%。死因为术中呼吸窒息2例,心搏骤停2例,麻醉插管意外1例。术后随访资料完整者33例,综合判断,手术效果良好。结论对危重肥胖患者,早期行气管切开术是安全之策,麻醉插管下行气管切开术是较好的方法。     

口服有机磷中毒昏迷患者胃管插入方法探讨

目的 探讨口服有机磷中毒昏迷患者的胃管插入方法。方法 32例口服有机磷中毒并昏迷患者均用直接喉镜打开口咽部，盲插或直视下插入7—8mm内径气管导管20—25cm，观察导管外口是否有气流吹出，如有气流则表示气管导管已入气管内，此时在气管导管旁插入胃管；如导管外口无气流则表示导管已入食管内，此时将胃管从气管导管内插入即可。结果 32例患者中有28例1次插胃管成功，4例因食管痉挛难以插入，后用硬质导丝导引插管成功。结论 直接喉镜经口插胃管法能对中毒昏迷患者快速进行插管抢救。     

Tracheal ruptures in endotracheal intubation. Diagnosis and therapy

Background. Tracheal ruptures are most frequently the result of a blunt trauma to the thorax or of forced intubation. They represent a rare, but life-threatening complication that requires immediate help. Methods. The resulting pneumothorax and the skin/mediastinal emphysema are the most prominent clinical signs. Injuries of the tracheobronchial tract should be diagnosed endoscopically and treated surgically immediately after the trauma. Results. The present paper reports on three cases of tracheal ruptures after forced intubation which could be successfully managed by tracheostomy and subsequent reconstruction of the defects. The postoperative care of the patients is critically discussed.     

Prähospitale Intubation und Verifizierung der endotrachealen Tubuslage

Study objective. The purpose of the study was to evaluate the quality of prehospital intubations regarding the special difficulties encountered during emergency medical care. Diagnostic accuracy of confirming correct tube placement using clinical parameters was evaluated and compared with the verification of endotracheal tube position using end-tidal carbon dioxide detection devices as a possible improvement of diagnostic accuracy in this setting. Methods. Prospective multicenter study with online data collection by an additional study assistant using three different capnometry systems on four different German physician-based EMS systems: two primary rescue helicopters, one ground-based ALS unit, and one ALS squad vehicle. Results. A total of 204 patients were enrolled in the study. A difficult intubation was documented in 57% of all attempts. Vocal ligaments could be completely seen in 61% of all cases; in 10% of all intubation attempts they could not be identified at all. Tube position could not be verified with certainty by clinical methods in every ninth intubation attempt. The portable CO₂ detection devices used in this study demonstrated reliable performance in the prehospital setting. Positive end-tidal CO₂ detection improved the quality of tube placement verification while a lack of CO₂ detection caused confusion in some cases. Taking physiological conditions into consideration, capnometry is a useful adjunct to verify endotracheal tube placement also in the prehospital setting. Capnometry should become a standard device in all ALS providing EMS systems.     

PTCA导丝逆行引导小鼠气管插管术

目的探索改进小动物气管插管的方法。方法40只C57BL／6小鼠，PTCA导丝经气管逆行至口腔．引导气管插管。结果40只小鼠成功行气管插管，未出现严重并发症。结论PTCA导丝逆行引导气管插管简单，有效，创伤小。     

Nicardipine versus lidocaine for attenuating the cardiovascular response to endotracheal intubation

Purpose. The aim of this study was to compare the efficacy of nicardipine and lidocaine in attenuation of cardiovascular responses to endotracheal intubation. Methods. In a randomized, double-blind, controlled trial, 60 unpremedicated (ASA I) patients undergoing elective sur-gery were given either 30 μg·kg⁻¹ nicardipine or 1.5 mg·kg⁻¹ lidocaine intravenously 2 min before intubation. Laryngoscopy and tracheal intubation were performed 1 min after induction of anesthesia with 5 mg·kg⁻¹ thiopentone, followed by administration of 1.5 mg·kg⁻¹ succinylcholine intravenously. Blood pressure and heart rate were monitored at baseline and every minute until 4 min after intubation. Repeated-measures ANOVA, Student's t test, the chi-square test, and 95% confidence intervals were used as appropriate. P < 0.05 was considered statistically significant. Results. Baseline hemodynamic variables were not different between the groups. After administration of either agents, diastolic blood pressure and mean blood pressure were significantly lower in the nicardipine group. The heart rate in the nicardipine group was significantly higher. The mean between-group differences in diastolic blood pressure, mean blood pressure, heart rate, and rate-pressure product at baseline and 1 min after starting laryngoscopy were statistically significant. Conclusion. Nicardipine can be used as an alternative to lidocaine in attenuation of cardiovasculars response to tracheal intubation in patients without ischemic heart disease. Received for publication on August 3, 1999; accepted on December 25, 1999