预见性气管插管抢救重度有机磷农药中毒合并呼吸不全研究

目的：探讨在重度有机磷农药中毒合并呼吸不全患者中实施预见性气管插管的方法及效果。方法：对2011年10月-2013年10月本院抢救的70例重度有机磷农药中毒合并呼吸不全患者进行随机数字表法分组,每组35例,两组均给予常规基础治疗,在此基础上,对照组（非气管插管组）实施血液灌流,观察组实施血液灌流及预见性气管插管,分析并评估两组病例的临床抢救情况。结果：观察组抢救成功率与病死率分别为94.29%、5.71%,明显优于对照组的74.29%、25.71%,两组比较差异有统计学意义（P〈0.05）;观察组在复能剂用量、昏迷时间及住院时间等方面要更具优越性,差异均有统计学意义（P〈0.05）。另外,两组治疗期间均有严重不适症状发生,两组比较差异无统计学意义（P〉0.05）。结论：在重度有机磷农药中毒合并呼吸不全患者中实施预见性气管插管进行抢救有确切效果,适合在今后的临床上普及应用。     

Comparison of fluid leakage from four different cuffed pediatric endotracheal tubes using a pediatric airway simulation model

This study used an airway model to compare the ability of a pediatric endotracheal tube with a taper‐shaped cuff to prevent microaspiration relative to endotracheal tubes with conventional cuffs. Four different types of 5.0‐mm inner diameter cuffed pediatric endotracheal tubes (taper‐shaped cuff [Taper], high‐volume low‐pressure [Hi‐Lo], middle‐volume low‐pressure [Intermediate], and low‐volume low‐profile [Lo‐Pro]) were fixed within vertically placed acrylic tubes. The cuffs were maintained at 10, 20, or 30 cmH₂O pressure and 3 mL of simulated stomach contents was added to the top of the cuffs. The volume of leakage around the cuffs after 5 min and 4 h was measured. After 5 min, the volume of leakage was significantly lower with the Taper than with the Hi‐Lo, Intermediate, or Lo‐Pro at all pressure settings. After 4 h, leakage was significantly lower with the Taper than with the other three tubes regardless of initial cuff pressure (P < 0.05).     

帝视内镜与Macintosh喉镜在小儿气管插管中应用效果的比较

目的 探讨帝视内镜在小儿扁桃体切除术中气管插管的应用效果,并与Macintosh喉镜作比较。方法 选择该院择期行扁桃体切除术的患儿60例,年龄6～9岁,美国麻醉医师协会（ASA）分级Ⅰ至Ⅱ级,Mallampati气道分级Ⅰ至Ⅱ级,扁桃体肿大Ⅰ至Ⅱ度,随机分为帝视内镜组（DE组）和Macintosh喉镜组（MA组）。全麻诱导后,分别使用帝视内镜和Macintosh喉镜行气管插管。记录两组的声门暴露时间、气管插管总时间、声门暴露分级、气管插管次数、插管并发症发生例数、各麻醉诱导时相的心率（HR）、平均动脉压（MAP）和患儿与麻醉医师口对鼻距离（MN间距）。结果 DE组声门暴露时间、气管插管总时间短于MA组（P = 0.000）;DE组声门暴露分级优于MA组（P < 0.01）;DE组均一次插管成功,MA组有3例需二次插管;DE组插管并发症发生率低于MA组（P < 0.05）;DE组MN间距明显大于MA组（P = 0.000）;两组患儿麻醉诱导前（T₀,记为基础值）、麻醉诱导后插管前即刻（T₁）和气管插管后3 min（T₄）的HR和MAP比较,差异均无统计学意义（P > 0.05）;DE组患儿气管插管后即刻（T₂）和气管插管后1 min（T₃）的HR和MAP均低于MA组（P < 0.01）。结论 相比Macintosh喉镜,在小儿扁桃体切除术气管插管时使用帝视内镜,能明显改善声门显露效果、缩短气管插管操作时间、减少插管并发症和减轻血流动力学波动,并增大MN间距。     

Effect of leak around the endotracheal tube on measurements of pulmonary compliance and resistance during mechanical ventilation: A lung model study

We studied the effect of leaks around the endotracheal tube (ETT) on the measurement of pulmonary mechanics during mechanical ventilation. We also evaluated the influence of different ventilator settings on the magnitude of leak. An adjustable leak was created at the end of the ETT in a lung model with constant compliance. Flow, tidal volume, and pressure changes were measured above and below the leak. Compliance (C_i) and resistance (R_i) during inspiration were determined by linear regression analysis (LRA) using the equation of motion and the Mead and Wittenberger method (MWM). The ventilatory change that influenced the degree of leak most was prolongation of inspiratory time (T_i). The presence of a leak around the ETT resulted in an overestimation of the C_i and R_i values, which was proportional to the size of the leak. This overestimation was also influenced by the method used to determine C_i and R_i. Because the contribution of the leak to the tidal volume progressively increased as inspiration continued, methods of analysis that depended mainly on measurement points at the end of inspiration showed a larger deviation from the true C_i and R_i values than methods mainly influenced by measurement points at the beginning of inspiration. Because of this, shortening of inspiration, or analysis of points at the beginning of inspiration reduces the error in the measurements of C_i and R_i when a leak is present. Breaths with a large leak should be excluded from any analysis of pulmonary mechanics. Pediatr Pulmonol. 1996; 22:35–43. © 1996 Wiley-Liss, Inc.     

心脏手术术后气管插管带管时间对声音嘶哑的影响

目的 分析在气管插管全身麻醉下接受心脏手术的患者术后发生声音嘶哑的情况及其影响因素.方法 回顾性分析2014年1月至2014年12月间在北京协和医院接受心脏手术患者的围术期资料,按照是否出现术后声音嘶哑分为声嘶组与对照组,分别统计两组患者的一般情况、手术麻醉信息、术后带管时间并作统计学分析;根据患者的带管时间分组,分别统计其声音嘶哑发病率并进行相关性分析.结果 在218例纳入研究的患者中,共有12例出现声音嘶哑,其平均术后带管时间显著长于对照组(P＜0.01);且声音嘶哑的发生率随术后带管时间延长而增加(P＜0.05).结论 在行心脏手术的患者中,发生声音嘶哑患者的术后带管时间较长,且声音嘶哑发生率随带管时间延长而升高.     

纤维支气管镜引导下经鼻气管插管救治慢性阻塞性肺病并Ⅱ型呼吸衰竭的临床价值

目的:探讨纤维支气管镜引导下经鼻气管插管救治慢性阻塞性肺病(COPD)Ⅱ型呼吸衰竭的临床价值。方法:对32例COPDⅡ型呼吸衰竭的患者,通过纤维支气管镜引导下经鼻气管插管连接呼吸机辅助呼吸,辅予纤支镜下吸痰及灌洗,比较治疗前后血气分析的结果,统计其抢救成功率、并发症发生率及机械通气时间来评价疗效。结果:纤维支气管镜引导下经鼻气管插管抢救COPDⅡ型呼吸衰竭成功率为84.38%,平均机械通气时间为8.35±2.15天,并发症少。结论:纤维支气管镜引导下经鼻气管插管救治COPDⅡ型呼吸衰竭疗效好,并发症少,值得推广。     

“挑厌式”盲探气管内插管术应用于头后仰度差患者的临床观察

目的观察经口“挑厌式”盲探气管内插管术应用于头后仰度差患者全身麻醉气管内插管的可行性。方法30例气管内麻醉患者随机分为盲、明两组各15例,盲组应用经口“挑厌式”盲探气管内插管,明组应用普通喉镜（弯喉镜片）气管内插管。结果盲组一次成功12例,1次插管成功率高（80％）,平均用时（31±15）s,较明组用时显著缩短（P〈0.01）。结论经口“挑厌式”盲探气管内插管术对头后仰度要求低,应用在“头后仰度Ⅲ～Ⅳ级”患者全身麻醉快速诱导插管可行,简便快捷,成功率高,可操作性强。     

全麻气管插管的教学观察

目的:观察气管插管教学中伴随的问题及术后喉痛及声音嘶哑的发生情况,以期提高气管插管教学的质量。方法:100例全麻手术患者随机分为教学组和医师组,每组50例。记录2组的插管时间、脱氧合发生率和尝试插管次数,并在患者离开麻醉后恢复室时和术后24 h评估患者喉痛和声音嘶哑情况。结果:插管时间、脱氧合发生率和插管次数在教学组均显著高于医师组(P<0.01)。医师组的喉痛视觉模拟评分显著低于教学组(P<0.01),而2组声音嘶哑发生率差异无统计学意义(P>0.05)。结论:气管插管教学会延长插管时间并增加插管次数,同时增加气道损伤的概率。     

胸腔手术时肺循环的右向左分流

目的探讨胸腔手术时肺循环的右向左分流 (right to lefttranspulmonaryshuntfraction ,Qs/Qt)。 方法直接测定肺泡气氧分压和动脉血氧分压 ,计算肺泡 动脉氧分压差 (alveolar arterialoxygentensiondifference ,A aDO2 )和Qs/Qt,观察 2 6例胸腔手术对Qs/Qt的影响。结果由平卧位到侧卧位A aDO2 和Qs/Qt无明显变化 ,开胸后A aDO2 和Qs/Qt增加 ,开胸 1hQs/Qt达 (12 .16± 5 .5 7) % ,动脉血气分析未发现缺氧情况。结论胸腔手术开胸后肺循环的右向左分流增加 ,并随手术时间延长有加重趋势