气-管-插-管-术

LOGO气气管管插插管管术术新疆医科大学第一附属医院麻醉科CompanyLogoContents 定定 义义 及及 概概 述述1适应症及禁忌症适应症及禁忌症2 操操 作作3 并并 发发 症症CompanyLogo定定义义Definition 气管插管术是一种将一特制的气管内气管插管术是一种将一特制的气管内导管经声门置入气管的技术，这一技导管经声门置入气管的技术，这一技术能为气道通畅、通气供氧、呼吸道术能为气道通畅、通气供氧、呼吸道吸引和防止误吸提供吸引和防止误吸提供 最佳条件。最佳条件。The insertion of a tube into the trachea to allow air to enter the CompanyLogo呼吸道解剖呼吸道解剖Anatomy 气管插管的途径是气管插管的途径是 通过鼻腔或口腔，通过鼻腔或口腔，经过咽喉、声门、经过咽喉、声门、把插管插到气管把插管插到气管 或总支气管内。或总支气管内。CompanyLCompanyLogo适适应应症症Indicationsv心跳、呼吸骤停。心跳、呼吸骤停。Cardiac or respiratory arrestv丧失气道保护功能者。丧失气道保护功能者。Failure to protect the airwayv严重呼吸衰竭不能满足机体通气和氧供需严重呼吸衰竭不能满足机体通气和氧供需要需机械通气者。要需机械通气者。Inadequate oxygenation or CompanyLogo适适应应症症Indicationsv即将发生或已发生的气道阻塞即将发生或已发生的气道阻塞 Impending or existing airway obstructionv多系统疾病或损伤的护理需要。多系统疾病或损伤的护理需要。Care of critically ill patients with multi-system disease or injuries.v外科手术麻醉需要。外科手术麻醉需要。Control of the airway in surgical procedures requiring general CompanyLogo禁忌症禁忌症Contraindications无绝对禁忌症，以下所列为相对禁忌症。无绝对禁忌症，以下所列为相对禁忌症。v由于外部原因所致上气道梗阻Obstruction of the upper airway due to foreign objects v颈椎骨折Cervical fractures v食道疾病Esophageal disease v进食腐蚀性物质Ingestion of caustic substances v下颚骨折Mandibular fractures v喉头水肿Laryngeal edema v烫伤或化学药剂灼伤Thermal or chemical burns CompanyLogo插管前准备插管前准备Equipmentpreparationv1.气管导管气管导管导管的选择导管的选择Size of endotracheal tube按导管的内径计算按导管的内径计算internal diameter(ID)男性男性Male:ID 8.0 mms 女性女性Female:ID 7.5 mms CompanyLogo插管前准备插管前准备Equipmentpreparation 儿童的导管选择儿童的导管选择Size of endotracheal tube 0-3月（月（New born-3 months）:ID 3.0 mm 3-9月月（3-9months）:ID 3.5 mm 9-18月（月（9-18 months）:ID 4.0 mms 2-6岁（岁（2-6years）:ID=(Age/3)+3.5 6岁岁（6 years）:ID=(Age/4)+CompanyLogo插管前准备插管前准备Equipmentpreparationv插插 管管 深深 度度Depth of endotracheal tube 成人成人Adult 男性男性Male=23 cms 女性女性Female=21 cmsF儿童儿童Children 经口气管插管经口气管插管=(Age/2)+12(cm)经鼻气管插管经鼻气管插管=(Age/2)+15(cm)CompanyLogo插管前准备插管前准备Equipmentpreparationv2.喉喉 镜镜Laryngoscope 气管插管使用的为直气管插管使用的为直接喉镜。直接喉镜分接喉镜。直接喉镜分直镜直镜（miller）和弯镜和弯镜（macintosh）两两种。种。CompanyLogo插管前准备插管前准备Equipmentpreparationv操作前务必检查喉镜是否明亮操作前务必检查喉镜是否明亮CompanyLogo插管前准备插管前准备Equipmentpreparationv其其 他他 Other equipments导丝导丝Stylet 手套手套Gloves吸痰器吸痰器Suction Device 5ML注射器注射器 syringe固定器固定器Endotracheal tube CompanyLogo操作步骤操作步骤PROCEDURALSTEPS 1仰卧，头垫高仰卧，头垫高10cm10cm，置入导管芯，置入导管芯,将病人头部将病人头部尽量向后伸仰，使三轴线完全重叠，让插管径路尽量向后伸仰，使三轴线完全重叠，让插管径路接近为一直线。接近为一直线。Position bed height to bring the patients head to a mid-abdominal height.Flex the cervical spine and extend the head at the atlanto-occipital joint.Long axis of the oral cavity,pharynx,and trachea lie almost in a straight CompanyLCompanyLogo 2.左手持喉镜沿左手持喉镜沿右口角右口角置入口腔，左推舌体，置入口腔，左推舌体，使喉镜移至正中位。使喉镜移至正中位。Introduce the blade into the right side of the patients mouth,move the blade posteriorly and toward the midline,sweeping the tongue to the left and keeping it away from the visual path with the flange of the blade3 3喉镜片抵达舌根与会厌交界处，上提喉喉镜片抵达舌根与会厌交界处，上提喉镜，撬起会厌镜，撬起会厌,显露声门。显露声门。advance the laryngoscope until the epiglottis is in CompanyLogo操作步骤操作步骤PROCEDURALSTEPS 4.4.右右手手以以握握笔笔式式手手势势持持气气管管导导管管，插插过过声声门门,进进入入气气管管。lift the laryngoscope upward and forward.Insert the endotracheal tube from the right with its concave curve facing downward and to the right side of the patient.Maneuver the endotracheal tube into the larynx,midway between the cricoid cartilage and the sternal angle CompanyLogo操作步骤操作步骤PROCEDURALSTEPS 5.5.放放牙牙垫垫，退退喉喉镜镜.确确定定位位置置后后，妥妥善善固固定定导导管管与与牙牙垫垫注注套套囊囊空空气气(3-5m1).(3-5m1).inflate the cuff and apply positive pressure ventilation while the assistant auscultates.Secure the endotracheal tube in position。CompanyLogo并发症并发症Complications v声音嘶哑及咽痛Postintubation hoarseness and sore throatv呕吐VomitingvAspirationv局限性肺炎Pneumonitisv肺炎Pneumoniav心动过缓BCompanyLogo并发症并发症Complicationsv喉痉挛Laryngospasmv支气管痉挛Bronchospasmv呼吸暂停Apneav牙齿、嘴唇、声带的损伤。Trauma to teeth,lips and vocal cords.v颈椎损伤加重。Exacerbation of cervical spine CompanyLogo气管内插管术（ENDOTRACHEALINTUBATION)目的：麻醉期间维持病人呼吸道通畅，防止异物进入，便于吸痰和积血。便于进行人工和机械通气，用于呼衰、复苏、中毒、新生儿窒息。便于吸入全身麻醉药气管内插管的器械与方法：CompanyLogo LCompanyLogo Tracheal CompanyLogo Anatomy of CompanyLogo Anatomy of CompanyLogo The maneuover of lifting CompanyLogo Vocal gate exposure by curved CompanyLogo Vocal gate exposure by straight CompanyLogo Blind intubation through nasal CompanyLogo经鼻盲插管图CompanyLogo气管内插管的并发症（Complications)齿、舌、咽喉部等损伤。心血管反射。呼吸道梗阻。误入一侧支气管或导管脱出。.长时间充气压迫，局部粘膜和纤毛缺血，粘膜脱落。纤毛活动停止天，局部溃疡，软骨软化，坏死。CompanyLogo确认v1.压胸有气流。v 2.人工通气：双侧胸廓对称，听双肺肺泡呼吸音。v3.吸气管壁清亮：呼气时有白雾。v4.自主呼吸时，呼吸囊随呼吸张缩v5.ETCO2：最科学CompanyLogo全身麻醉的并发症及其处理（1）返流与误吸（Regurgitation and Aspiration）原因：诱导时气道梗阻，饱胃、上消化道出血、肠梗阻表现：急性呼吸道梗阻、吸入性肺炎、肺不张 处理：预防为主，原则为减少胃内容物和提高胃液PH 值；降低胃压；保护气道；(4)麻醉方法)呼吸道梗阻（Airway Obstruction上呼吸道梗阻（upper airway obstruction)原因：舌后坠、分泌物或异物阻塞、喉痉挛、喉水肿表现：不全梗阻：呼吸困难，鼾声 完全梗阻：三凹征 LOGO3636 以上有不当之处，请大家给与批评指正，以上有不当之处，请大家给与批评指正，谢谢大家！谢谢大家！