手术室外抢救性气管插管的常见问题分析

目的分析手术室外抢救性气管插管存在的问题,总结相应的预防和处理经验。方法回顾分析我院2年来853例手术室外抢救性气管插管的经过,总结相应的成功经验或有关教训。结果能经口明视插入气管导管者791例,48例经口插管失败后改经鼻盲探成功,9例需用镇静、肌松剂后才成功插入,5例借助纤维支气管镜引导插入。插管时常见问题依次为患者牙关紧闭开口困难、吸引设备未到位或无功能,开口后直接喉镜难于显露声门、插管器械准备不足、患者家属干涉、求救电话表述不清或讹传。结论手术室外抢救性气管插管经口明视困难时应改经鼻盲探法,有条件时可辅用肌松剂或纤支镜。插管器具及吸引设施应随时处于备用状态。

Difficulties in emergent intubation outside of operation room

Objective To prevent from and deal with difficulties during intubation in emergent patients outside of operation room.Methods Reviewed 853 cases of out-operation-room emergency intubation in the recent 2 years.Emergency intubation cases were analyzed.Results Direct vision trans-oral intubation could be routinely accomplished in 791 cases,but failed in 48 cases which were finally succeeded by trans-nasal intubation.Other 9 cases needed sedation and paralysis and 5 cases needed fibro-bronchoscope induction.Common affected factor to intubation included mouth stiffness,suction apparatus failure,laryngeal visualization difficulties,insufficient preparation,interferer of patients' relatives.Conclusion Difficult oral intubation in emergency out-operation-room patients may be resolved by nasal intubation,in some cases needing muscle relaxation drug and fibro-bronchoscope affiliation.Sufficient preparation are necessary.