超声在气道管理中的应用

1、.上上 海海 交交 通通 大大 学学 附附 属属 第第 六六 人人 民民 医医 院院 麻麻 醉醉 科科赵达强赵达强 超声在气道管理中的应用2016-5-27上海市第六人民医院Shanghai Sixth Peoples Hospital颈部气道解剖颈部气道解剖上海市第六人民医院Shanghai Sixth Peoples Hospital定位喉上神经定位喉上神经The thyrohyoid membrane as a target for block of the internal branch of the superior laryngeal nerveStopar-Pintaric T,

2、 Vlassakov K, Azman J.J Clin Anesth.2015 Nov ; 27(7): 548-52.In conclusion, we are proposing an anatomical concept for a US-guided iSLN block technique using the thyrohyoid membrane to define the target plane for low-volume local anesthetic injection.上海市第六人民医院Shanghai Sixth Peoples Hospital外侧外侧舌骨舌骨外

3、侧外侧舌骨舌骨超声影像超声影像舌骨、喉上神经舌骨、喉上神经外侧外侧过拱桥，甲舌膜里寻过拱桥，甲舌膜里寻喉上喉上上海市第六人民医院Shanghai Sixth Peoples Hospital定位环甲膜定位环甲膜The conventional method, inspection and palpation, has a low success rate, especially in women (2435%).Elliott DS, Baker PA, Scott MR, et al. Accuracy of surface landmark identification for cannu

4、la Elliott DS, Baker PA, Scott MR, et al. Accuracy of surface landmark identification for cannula cricothyroidotomy.Anaesthesia 2010; 65: 88994cricothyroidotomy.Anaesthesia 2010; 65: 88994 Lamb A, Zhang J, Hung O, et al. Accuracy of identifying the cricothyroid membrane by Lamb A, Zhang J, Hung O, e

5、t al. Accuracy of identifying the cricothyroid membrane by anesthesia trainees and staff in a Canadian institution. Can J Anaesth 2015; 62: 495503anesthesia trainees and staff in a Canadian institution. Can J Anaesth 2015; 62: 495503上海市第六人民医院Shanghai Sixth Peoples Hospital上海市第六人民医院Shanghai Sixth Peo

6、ples Hospital上海市第六人民医院Shanghai Sixth Peoples HospitalSiddiqui N, Arzola C, Friedman Z, et al.Anesthesiology.2015 Nov;123(5):1033-41. 定位环甲膜定位环甲膜 Improves Cricothyrotomy Success inCadavers with Poorly Defined Neck AnatomyUltrasound guidance significantly decreased the incidence of injuries to the lary

7、nx and trachea Increased the probability of correct insertion by 5.6 times in cadavers with difficult and impossible landmark palpation.上海市第六人民医院Shanghai Sixth Peoples Hospital外侧外侧甲状软骨甲状软骨声带声带声带声带环甲膜环甲膜外侧外侧超声影像超声影像甲状软骨、环甲膜甲状软骨、环甲膜外侧外侧越尖峰，缺口越尖峰，缺口伪影伪影环甲膜环甲膜甲状软骨甲状软骨声带声带声带声带伪影伪影上海市第六人民医院Shanghai Sixth

8、Peoples Hospital超声影像超声影像环状软骨环状软骨外侧外侧气管软骨气管软骨甲状腺峡部甲状腺峡部外侧外侧气管软骨气管软骨外侧外侧上海市第六人民医院Shanghai Sixth Peoples HospitalUltrasound-guided superior laryngeal nerve block and translaryngeal block for awake tracheal intubation in a patient with laryngeal abscessIida T,Suzuki A, Kunisawa T,et al. J Anesth (2013)

9、27:309310临床应用临床应用1清醒插管清醒插管上海市第六人民医院Shanghai Sixth Peoples HospitalGuided Superior Laryngeal Nerve Block During Awake Fiberoptic IntubationSawka A, Tang R, Vaghadia H.A A Case Rep.2015 Apr 15; 4(8): 107-10.Sonographically guided superior laryngeal nerve block may be in patients where identification o

10、f landmarks in the neck is as a result of patient anatomy临床应用临床应用1清醒插管清醒插管上海市第六人民医院Shanghai Sixth Peoples Hospital临床应用临床应用1清醒插管清醒插管Ultrasound-guided Cannula CricothyroidotomySuzuki A,Iida T, kunisawa T,et al.Anesthesiology 2012 Nov;117(5):1128Ultrasound-assisted translaryngeal block for awake fibreo

11、ptic intubationDe Oliveira GSJr, Fitzgerald P, Kendall M.Can J Anesth. 2011 58:664665上海市第六人民医院Shanghai Sixth Peoples Hospital临床应用临床应用1清醒插管清醒插管病态肥胖 BMI 60上海市第六人民医院Shanghai Sixth Peoples Hospital临床应用临床应用1清醒插管清醒插管上海市第六人民医院Shanghai Sixth Peoples Hospital临床应用临床应用1清醒插管清醒插管上海市第六人民医院Shanghai Sixth Peoples H

12、ospital临床应用临床应用2判断喉镜显露困难判断喉镜显露困难气管软骨气管软骨外侧外侧食管食管甲状腺甲状腺Wu J,Dong J, Ding Y, et al.Med Sci Monit, 2014; 20: 2343-2350Role of anterior neck soft tissue quantifications by ultrasound in predicting difficult laryngoscopyAnterior neck soft tissue thicknesses measured by US at hyoid bone, thyrohyoid membra

13、ne, and anterior commissure levels are independent predictors of difficult laryngoscopy.Combinations of those screening tests or risk factors with US measurements might increase the ability to predict difficult laryngoscopy.上海市第六人民医院Shanghai Sixth Peoples Hospital临床应用临床应用2判断喉镜显露困难判断喉镜显露困难气管软骨气管软骨外侧外

14、侧食管食管甲状腺甲状腺上海市第六人民医院Shanghai Sixth Peoples HospitalUltrasonographic measurement of the minimal transverse diameter of the subglottic airway in the transverse plane, typically at the caudal outlet of the cricoid ring临床应用临床应用3选择适合气管导管选择适合气管导管上海市第六人民医院Shanghai Sixth Peoples Hospital临床应用临床应用4判断气管导管位置判断气

15、管导管位置气管软骨气管软骨外侧外侧食管食管甲状腺甲状腺上海市第六人民医院Shanghai Sixth Peoples Hospital临床应用临床应用4判断气管导管位置判断气管导管位置THE SENSITIVITY AND SPECIFICITY OF TRANSCRICOTHYROID ULTRASONOGRAPHY TO CONFIRM ENDOTRACHEAL TUBE PLACEMENT IN A CADAVER MODELDynamic assessment resulted in sensitivity and specificity for detecting esophagea

16、l ET placement. Static assessment resulted in only sensitivity and specificity.Ma G,Davis DP, Schmitt J, et al.J Emerg Med.2007 May;32(4):405-7. 上海市第六人民医院Shanghai Sixth Peoples Hospital气管插管过程中环甲膜改变气管插管过程中环甲膜改变上海市第六人民医院Shanghai Sixth Peoples Hospital气管导管气囊充气表现气管导管气囊充气表现上海市第六人民医院Shanghai Sixth Peoples

17、 Hospital临床应用临床应用5判断喉罩位置判断喉罩位置Laryngo-tracheal ultrasonography to confirm correct endotracheal tube and laryngeal mask airway placementSonographic upper airway assessment emerges as a to predict difficult intubation, to assess the laryngeal and hypopharyngeal size and visualize the position of the l

18、aryngeal mask airway in situ.Wojtczak JA,Cattano D.Journal of Ultrasonography 2014; 14: 362366上海市第六人民医院Shanghai Sixth Peoples Hospital临床应用临床应用5判断喉罩位置判断喉罩位置Unique喉罩的位置ESupreme喉罩的位置E上海市第六人民医院Shanghai Sixth Peoples Hospital临床应用临床应用6定位气管切开定位气管切开Real-time ultrasound-guided percutaneousdilatational trache

19、ostomy: a feasibility studyPercutaneous tracheostomy performed under real-time ultrasound guidance is feasible and appears , including in patients with . Venkatakrishna Rajajee, Jeffrey J Fletcher, Lauryn R Rochlen, et al.Critical Care 2011, 15:R67上海市第六人民医院Shanghai Sixth Peoples Hospital临床应用临床应用6定位气

20、管切开定位气管切开Traditional landmark versus ultrasound guided tracheal puncture during percutaneous dilatational tracheostomy in adult intensive care patients: a randomised controlled trialUltrasound guidance significantly improved the rate of first-pass puncture and puncture accuracy. Fewer procedural com

21、plications were observed; however, this did not reach statistical significance. These results support wider general use of real-time ultrasound guidance as an additional tool to improve PDT.Mt Rudas, Ian Seppelt, Robert Herkes,et al.Critical Care 2014, 18:514上海市第六人民医院Shanghai Sixth Peoples Hospital临

22、床应用临床应用6定位气管切开定位气管切开上海市第六人民医院Shanghai Sixth Peoples Hospital临床应用临床应用6定位气管切开定位气管切开上海市第六人民医院Shanghai Sixth Peoples Hospital其他的临床应用其他的临床应用1迅速准确建立通气迅速准确建立通气Mallin M, Curtis K, Dawson M,et al.Am J Emerg Med 2014 Jan;32(1):61-3.Accuracy of ultrasound-guided marking of the cricothyroid membrane before simulated Ultrasound marking of the CTM of h