拔管后喘鸣的预防和治疗

背景喉水肿所致的拔管后喘鸣（post-extubation stridor，PES）是气管内插管的严重并发症，影响患者预后。目的临床医师有必要掌握恰当的拔管时机，及早发现PES高危患者并采取预防措施，从而避免PES及再插管的发生。内容临床医师可在拔管前通过纤维支气管镜检查、超声检查和气囊漏气试验（cuff leakage test，GET）来筛选出PES的高危人群，通过规范手术、麻醉操作和预防性应用糖皮质激素来预防PES。对PES高危患者，拔管时可使用气管交换导管。PES的治疗策略包括进行再插管、全身注射糖皮质激素、局部喷洒肾上腺素、吸入氦气，氧气混合气和气管切开术。趋向通过规范操作、筛选高危人群和采取预防措施降低PES的发生率。

Prevention and treatment of post extubation stridor

Background Post extubation stridor （PES） resulting from laryngeal edema is a severe complication of endotracheal intubation, which exerts negative influences on patients＂ prognosis. Objective In order to avoid PES and reintubation, clinicians should extubate at an appropriate time, find high risk patients of PES and take preventive measures. Content Clinicians can distinguish high risk PES patients by using fiberoptic bronchoscopy, uhrasonography and cuff leakage test （CLT）. The operative and anesthesia procedures should be standardized and corticosteroids can be used to prevent patients from developing PES. For those at high risk of PES, airway exchange catheter can be used at the time of extubation. Therapeutical measures include corticosteroids, nebulized epinephrine, helium administration and tracheostomy. Trend Clinicians should standardized procedures, detect high-risk patients and take preventive procedures to lower of PES.