人工气道的建立

1、复旦大学附属中山医院麻醉和复旦大学附属中山医院麻醉和危重病学科危重病学科 朱彪朱彪n简易人工气道简易人工气道n气管插管气管插管n气管切开气管切开The Upper Airway简易人工气道简易人工气道n 口咽导管口咽导管 鼻咽导管鼻咽导管 目的：解除上呼吸道梗阻目的：解除上呼吸道梗阻Airway Management The BasicsMechanical AirwaysnNPAsnOPAsnDescriptionnAdvantagesnDisadvantagesnIndicationsnContraindicationsnMethods of Insertion气管插管气管插管适应症适应症

2、1.严重低氧或高碳酸血症严重低氧或高碳酸血症2.气道分泌过多气道分泌过多3.上气道损伤、狭窄、阻塞、气上气道损伤、狭窄、阻塞、气管食道漏管食道漏插管前的准备插管前的准备n物品的准备物品的准备（简易人工呼吸器（简易人工呼吸器 、负压吸引器）、负压吸引器）n病人的准备病人的准备插管的途径插管的途径-经口经口n易操作易操作 易移位易移位 3min 缺氧、抽搐、心跳停止缺氧、抽搐、心跳停止2. 插入食道插入食道3. 插入右主支气管插入右主支气管4. 鼻出血鼻出血5. 自行拔管自行拔管人工气道的并发症与处理人工气道的并发症与处理n口腔感染口腔感染n切口出血、感染切口出血、感染n气道粘膜的损伤气道粘膜的损

3、伤n 气管狭窄气管狭窄n气道出血气道出血n鼻窦炎鼻窦炎n肺炎肺炎n声嘶、声带水肿声嘶、声带水肿n纵膈气肿纵膈气肿n皮下气肿皮下气肿n气管食管瘘气管食管瘘n脱位脱位n气道阻塞气道阻塞n漏气漏气困难气道nReview the use of the CombitubenReview the use of the King LT-DnReview the steps in performing a cricothyroidotomyElbow deflectorSuction catheterSmall syringe:20 ml distal cuffLarge (blue) syringe:140

4、 ml large balloonRingmarksDistalcuffOropha-ryngealballonPharyngeal“ lumen No. 1Esophago-tracheal“ lumen No. 2Esophageal - trachealCOMBITUBEOropharyngealballoonDistalcuffPerforationsThe Basic ProcedureOpen mouth,press away tongueHead:NeutralpositionThe Basic ProcedureFlatinsertionalong tongueThe Basi

5、c ProcedureEmergency:No. 2: 10 mlEmergency:No. 1: 85 ml (or more)The Basic ProcedureEsophageal positionSelf-fixationBehindhard palate Activedecom-pressionVentilationvia longerblue tubeNo. 1The Basic ProcedureVentilationvia shortercleartubeNo. 2Tracheal positionKING LT-DCM DEPTH MARKINGSORIENTATION /

6、 X-RAY LINESINGLE VALVE /PILOT BALLOONInflates both the proximaland distal cuffs.TWO VENTILATION OUTLETSIn front of the larynx forefficient ventilation andallows passage offiberoptic bronchoscopeor tube exchange catheter.LATEX FREE AND SINGLEPATIENT USEPROXIMAL CUFFStabilizes KING LT-Dand seals theo

7、ropharynx.BI-LATERAL EYESAdditional eyelets tosupplement ventilation.DISTAL CUFFBlocks entry of esophagus.Reduces the possibility of gastric insufflation.Required Equipment for Emergency CricothyroidotomyQuicktrachQuicktrachNu-TrakePerforming the cricothyroidotomynPalpate the thyroid and cricoid car

8、tilage for orientationnA - Cricoid CartilagenB - Cricothyroid MembranenC - Incision SitenD - Thyroid CartilagePerforming the cricothyroidotomynMake a transverse incision into the cricothyroid membranenDO NOT make the incision more than 1/2 inch deep or you may perforate the esophagusPerforming the c

9、ricothyroidotomynApply petroleum gauze dressing to insertion sitenApply a dry, sterile dressing to the insertion sitenTape around the tube then completely around the neck.nSutures not needed. This is a temporary airway!Performing the cricothyroidotomyBougieSource: LaerdalSource: LaerdalSource: LMA N

10、orth Americaskip insertion techniqueSource: LMA North Americaskip insertion techniqueSource: LMA North Americaskip insertion techniqueSource: LMA North Americaskip insertion techniqueSource: LMA North Americaskip insertion techniqueO2 Delivery SystemsO2 Delivery SystemsnNasal cannulaenDouble rate -

11、add to room air FiO2nex.3 L / min + 21 % FiO2= 27 %nLimitations:nrates 3 L / min uncomfortablenmouth breathingO2 Delivery SystemsnSimple Face Maskn6 10 L / min flown35 55 % FiO2 entrainment of room air through exhalation portsO2 Delivery SystemsnPartialnRebreathingnFace Maskreservoir bag first 1/3 of exhaled gas is directed into bag(that which was in patients upper airway) up to 60 % FiO2O2 Delivery SystemsnNon-Rebreathin