如何轻松与人交谈(How-to-talk-to-people-easily)(常用版)

如何轻松与人交谈（Howtotalktopeopleeasily）（常用版）(可以直接使用，可编辑完整版资料，欢迎下载）

如何轻松与人交谈（Howtotalktopeopleeasily）如何轻松与人交谈（Howtotalktopeopleeasily）（常用版）(可以直接使用，可编辑完整版资料，欢迎下载）"Thespeechway,tactics".Theconversation,noteveryonecandobutmustmaintainpropersparklingdiscourse,Grace:sincerityandcourtesytoeachotherwhiletalkingtoyou,alsofeelforhisthoughtful,understandingandrespect.Learntotalkwitheyesandsmile1,eyesWhentalking,lookingattheotherperson'seyesisakindofminimumetiquettetoshowinterestintheconversationandrespectforeachother.Italsocreatesapleasantandharmoniousconversationatmosphere.Iftwopeopletalkindoors,theeyedistanceisbestbetween1-2meters.Therangeofeyegazeistheso-called"publicgaze"and"socialgaze"".Fromtheconversationofinterest,praiseeachother,careforeachotherandevenwithhiseyesandnoddedhisinterestintalkingtoeachother,canreflectrespectforeachother,andasthetopicdevelopment,laythefoundationforfurther.Whenyousaygoodbyeorshakehands,youshouldlookintotheotherperson'seyes.Manypeopleareembarrassedtolookateachother'seyeswhiletalking.Infact,thisisnotnecessary.Itisalsosincereandpolitetolookateachotherwhenyouaretalkingtoeachother.Withoutlookingattheotherperson'seyesandwanderingvision,itcanonlygivepeoplethefeelingofabsenceofmind.LuoYong,anewDepartmentManager,istalkingwithcustomersovercoffeeinthecompanycoffeeshop.Hesoonbeganapositiveconversation.Hewasinterestingandpositive,butevenso,throughoutthemeeting,heneverlookedathisclient.Fromtimetotimeheavoidedcustomersandlookedaroundtheroomasifabsentmindedness.CustomersbegantofeelLuoveryboring,hefeltthecoffeedistrictwhowasmoreinterestedintalkingtohimisreallymiserable.Ofcourse,thisconversationcertainlyfailedtoachievethedesiredeffect.2smileChineseproverb:smileoften,fortune.Asmileisawarmandkindexpression.Itisonlyforamoment,butitleavesalastingmemoryforpeople.Inbusinesssituations,ifyoucanuseasmiletoaccepteachother,canreflecttheirrelaxedstateofmind,goodmanners,sincerityofothers,caneffectivelyshortenthedistancebetweenthetwosides,thusformingaharmoniousatmospherebetween.Thehighestlevelisthe"eyessmilesmile",isintheeyesofsmilingtenderness."Practiceeyessmile":takeapieceofpapertocoverthelowerpartofthemirror,eyes,thinkingofthethingsthatmakeyoufeelhappy.Inthisway,yourwholefacewillshowanaturalsmile.Atthispoint,themusclesaroundyoureyesareinastateofsmiles.Thenrelaxfacialmuscles,thelipsareback,butthistimeeyesstillsmilingtenderness,whichisthe"eyessmile"realm.Learntouseyoureyestocommunicatewithpeople,sothatthesmilewillbemorevividandmorecordial.(two)thegeneralrulesofetiquetteforconversation1,theattitudeofconversationWhentalking,youshouldbesincere,naturalandgenerous.Thetoneshouldbekindandkind,andtheexpressionshouldbetactful.Theconversationistobeprepared,shouldfranklyexplaintohimortalktothemselves,orafterafewpleasantriesquicklyentered.Thatkindoftalkisnotonlyawasteoftime,draginallsortsofirrelevantmatters,theotherwouldevendoubtyoursincerity.Don'tinterruptotherpeople'sconversationeasily.Whenyouspeak,togiveotherstheopportunitytoexpresstheirviews,notoffthereel,andallWhatIsaygoes.self-assuredorsupercilious.Whentalkingtoeachothertolistenpatiently,eyestolookateachother,don'tlookaround,don'thavewatch,stretching,yawningandcasualmovements.Iftheotherpartymentionedsomeinconvenientquestions,donoteasilystandout,youcantaketheopportunitytotransferthetopic.Ifyouhaveanurgentneedtoleave,sayhellotoeachother.2,thecontentofconversation(1)suitableconversationcontent;Establishedtheme.Thatis,businesscontacts,thetwosidesagreedonthetheme.Elegantsubject.Suchasliterature,art,history,philosophy,etc.Thepremiseofthistopicistaboosmatter,laughable.Easytheme.Suchastheatricalperformances,tourism,localconditionsandcustoms,popularfashion.Goodsubject.Forexample,whentalkingtoalawyer,youcantalkaboutthesubjectoflaw;whentalkingtoliteraryandartworkers,youcantalkaboutliterarycreation.2)inappropriateconversationcontentBusinesscontactsaregenerallyonbothsidesandsoon,aboutage,income,marriage,religion,address,personalexperience,ifnototheroffersorworkneedtobeawareofthecontent,don'ttalkabout.What'smore,theconversationdoesnotinvolveunpleasanttopicssuchasillnessordeath,notaboutbizarre,sensational,orpornographicthings.Moreover,topicssuchaswrongtendencies,suchasviolationofsocialethics,lifedegradationandpoliticalerrors,arenotappropriateforconversation.(3)notesofconversation;Don'tshowyourselfafavorfrompeople,thisseemstobesynonymouswithloveintheperformanceofothers,bigwithpride.Don'ttalkabouthumanrights;ventyourgrievances.Sinceitisbusinessconversation,andtalkaboutbusiness,thereisnoneedtoinvolveirrelevantthirdparties,nottotalkaboutthirdparties,donotattackotherpeople'sshortcomings,donotexpressdissatisfactionwiththeirdissatisfactionwithpeopleandthings.Otherwise,especiallyabouttheotherwillthinkthatyouhave"innuendo"meaning,goodgossiptoo.Norhetoric,noceremony.Inbusinessdealings,attitudesshouldbesincere,realisticandwithoutexcessivehypocrisyandceremony.Ofcourse,payattentiontoyourspeech.Nomonologue.Sincetheconversationpaysattentiontotwo-waycommunication,intheconversation,weshouldhavepeopleinoureyesandshoweachother'scomity.Weshouldgiveeachothermoreopportunitiestospeakandcommunicatewitheachother.Notamonologue,"dominatetheworld",andalwaysdonotgivepeopletheopportunitytoopentheirmouth.Smalltalkonordinaryoccasions,preferablywithinhalfanhour,shouldlastnomorethan1hours.Ifmorepeople,inconversation,eachperson'sspeech,itisbestnotmorethan5minutes.Don'tinterrupt,bickering.Forthesakeofrespect,donotinterruptorarguewithotherswhileyouarespeaking.It'sagainstthesubjectofconversation.Evenifyouhavesomethingtosay,waituntiltheotherpersonfinishesoneortheother.Don'tsay,"you'rewrong."".Whentalkingaboutatopic,eveniftheotherperson'spointofviewiswrong,don'tjustsay"you'rewrong"andsoon.Ifyousayso,notonlycannotchangetheattitudeoftheotherside,butwillleadtotheotherside'sresentment,hostility.Attentiontogesturesshouldnotbetoolarge,dancing,actionshouldbeappropriate.Don'tstaytoocloseortoofar,donotpayparticularattentiontolalacheche,patplaying,don'tspitflew.(three)theskillofconversationThetechniqueofconversation,firstofall,istochoosethetopicproperly,ashasbeensaidbefore.Othertipsareasfollows:1rememberandaddresseachother'snamesWeallhavetheexperience,eveninthenoisystreets,ifsomeonecallsourname,thesoundissmall,butalsoletusearup.Becausenamesarespecialtothemselves,itiseasierthananyotherwordtofilterthroughoursenses.Inbusinessconversations,ifpeoplementionyourname,youwillreactunconsciouslyandpositively.Similarly,whenyoumentiontheotherperson'sname,theyalsoreactunintentionallyandreactpositivelytoyoupersonally.Mentiontheotherperson'sname,showingthatyouarenotonlyinterestedineachother,butalsonoteandremembertheirnames,respectandcareforthem.2.AskquestionsingoodtimeBusinessoccasionsareforbusinessandconversationiseveryone'sduty.Inadditiontogivingeachotherfullviewsandrespectingotherpeople'sopinionsandsuggestions,youshouldalsolearntoaskquestionsinatimelymanner,suchas:"whatdoyouthink?"""Howdoyoulikeit?"""Isthatso?""Etc..Askwhichyouhopetherelevantinformation,understandeachotheraboutitnoworotherrelevantopinionshopeviewsabouttheproblem,talkorlackofcontentisdull,weneedtofurtherdiscussissuesrelatedtotime.3,usewittyandhumorouslanguageInordertoimprovetheuseoflanguage,wemustalsolearnandusethelanguageofwitandhumorproperly.Humorcanenliventheatmosphere.WhileaforeigntouristgroupwasvisitingChina,anAmericangirlaccidentallysprainedherankle.Thetourguideandothertouristswereworried.Atthistime,afewAmericanmalecolleaguessaidtoher:"haha,wehavetheopportunitytocarryyouback!"!"Thegirlalsoansweredhumorously:"youcanonlybackmyfeetandshoes!"Everyonewentonatourinacheerfulatmosphere.Humormakescriticismtactfulandhumorouseffect,alsooftenisthetenseatmosphereofthebuffer,whichcanmakethemgetridofthedilemma,butalsoselfmockery.4.LearntobepoliteandrefusetheotherpersonSometimestherearesomeofthemorecomplexsituation:theotherproposedrequirements,orarenotrequired,fromthepointofviewoftheintereststoeachother,butthereisnoneedtohurteachother'sself-esteemandenthusiasm.It'saskilltomaster,sayno,andlearntosay"no"".Fromtheceremonialpointofview,donotadvocatetheuseofbodylanguage,propsandothernonlanguagebehaviortorefusetheotherparty,otherwiseitwillshowarrogantandrude.Thebasicrequirementshouldbe"politeandforceful."".Theso-called"ritual"ispolite,totrytotakecareofothersemotions,sowordstospeakwillbetactful,shouldnotrigidlycontradictothers.Powerful",Itmeanshavingthepowertosayexactlywhatyouwanttosay,tolettheotherpersonknowhowyoufeelinside,andtolettheotherpersonknowthatitisunacceptableandunacceptable.Thetimeofrejectionofpsychologicalsubconsciouswithenoughcourageandself-confidence,don'tthinktoomuch,butIthinkitispossibletoexpress,itisimportanttopayattentiontothewaysofexpression,thatisrefusedinthereasonable,handexpressionprinciplesandtheirattitude,ontheotherhand,protectioneachother'sself-esteemandface,avoidtheincoherentorrefused.TechnicaldirectorLiHuawasinvitedtovisitacompany.Duringhisvisittothetalks,thecompanyaskedvicepresidentLiHuaaboutthedetailsofthecompany'slatesttechnology.LiHuarefusestomakeapositiverefusalandasks,"XiaoZong,canyoukeepasecret?""Can."Xiaodeputyanswered."Ican,too,"LiHuasaidwithasmile."Xiaovicegenerallistenstohahahasmile,alsoembarrassedaskagain.5.EnrichyourvocabularyReadmorebooks,seefreshusefulwordscanoftenreadnotestogether.Youcanevenlookitupinthedictionarytoimpressit.Paymoreattentiontothewisewordsofteachersandstudents,payattentiontothedialogueandspeechesonTVandradio,andabsorbandusethem.Thisisalong-termaccumulationprocess,butforimprovingthequalityofbusinesspeople,isindeedaverygoodway.6.LearntolistenBeinggoodatsayingisakindofnature,andlisteningcarefullyisakindofaccomplishment,andisakeytoasuccessfulconversation.Itshowsrespectforpeopleandcreatesaconversationalatmospherethatblendswitheachother.(1)concentrationandcourtesyWhentalkingtoothers,lookateachotherandconcentrate.Youcanalsofeelitbynodding,smiling,andusingotherbodylanguage.Allsortsofinterferencetotheoutsidecause,trytobeblind,deaf.Subjectivepsychologicaldisturbancesshouldbecontrolledasmuchaspossible.Agoodlistener,itselfhasastrongappeal,cancausetheconversationofinterest.(2)echocoordinationWhentheytalkedaboutthewonderfulplace,canclapresponse;whentheothertalkedabouthumorplace,canbelaughed;eachotherabouttension,toavoidthenoise;whenthespeakersexpressedthesameviewsandtheirown,canalsogentlynodandagree.Echoing,tosomeextent,cangreatlymobilizethespeaker'semotions.(3)correctjudgementInorderforinformationtobeacceptedmoreaccurately,itisbettertogettheapprovalofsomeimportantopinions,suchas"whatdoyoumean?"......""Iseewhatyoumean."......"Ifitmeetseachother'sintentions,hewillgetapproval.Ifitdoesn'tmatch,theotherpersonwillexplainittoyou.Inthiscase,youwillleaveagoodimpressionontheotherpersonthatyouarelisteningcarefully.Inshort,intalkingwithothers,shouldneverforgettheselfdenial,respectpeople,formalitiesdolaw-abiding,whenneedto"say"thisisalsotothistimeneedto"listen".7,goodatbreakingthedeadlockBusinesscontacts,youwillinevitablyencounter,donotknowwhattosayfirst,especiallywhentheotherpartyisindifferentorevenhostile.Howtobreakthedeadlockisaheadacheformanyprofessionals.Butintermsofways,it'snothingmorethantalkingaboutsomethingthat'seasytoidentify,easytoengage,unambiguous,andsomethingthat'sbestassociatedwiththeotherperson.Thiswillmakeiteasyfortheotherpartytoeliminatethealertmentalityandproceedtothenextstepofcommunication.Let'sgiveanexample:TheclerktoacompanytovisitXiaoCaiZhao,thetwosidesmaybetheidentityofthepoor,orbecauseofZhaofeellittleCaiShiyouaskinghim,soZhaoisverycold.XiaoCaisaid:"listeningtotheaccent,ZhaoisalwaysnotSubeipeople?"""Oh,peoplefromShandong,Zaozhuang."!""Zaozhuang?"Zaozhuangisagoodplace!WhenIwasachild,Ireadthe"littlebook"of"railwayguerrillas".""Isit?TherailwayguerrillasareoursinZaozhuang."Zhaoalwayssaidproudly."Yes.".IwenttoZaozhuangtheyearbeforelastandhadatrip.Zaozhuangisreallybeautiful."Afterhearingthis,Zhaocameimmediatelyinterested,twopeoplefromZaozhuangandtherailwayguerrillastotalkabout,andthoseaffectionate,Idonotknowtheactualsituation,Iamafraidtheyshouldthinkthattheyareyearsofoldfriends.浅谈《悲惨世界》（Abrieftalkonmiserableworld）AbriefanalysisofthetragiccharactersinLesLesles[Abstract]aspeoplecommentedonthisbook:"thisistheEncyclopediaofhumansuffering.""."Thepoormandown,hungermakeswomenfall,darkchildrenweak."WhenHugowroteabook,hehadpointedoutthesourceofthemiserylife,anddeeplyexposedthedarknessanddepravityofthesocietyundertheruleoftheFrenchfeudaldynastyaftertherestoration.Keywordsmisery;struggle;realityandideal"Awordisprintedonthefrontispieceofthetragicworld":"aslongasthelandisignorantandmiserable,likeabook,thenatureofthebookwasenormously."Victor.Hugo(1802-1885)isarepresentativeofFrenchromanticism.Hisliterarycreationlastedformorethan60years,andleftarichandpreciousliteraryheritageformankind.InexileintheAtlanticonJune30,1861,Guernsey,Victor?Hugo,finishedhisnovel"lesmiserables"."Lesmiserables"isoneoftherepresentativeworksofHugo,thisisarealisticandromanticcombinationofworks,novelsinthecontextofthenineteenthCenturyFrenchsocietythetrueface,buttheplot,language,charactersarefilledwithromanticcolor.Inthenovelthepicturepainted,farbeyondthehistoricalbackgroundandnarrativecharactersneedstories,Hugohadtoleaveforfuturegenerationsofconsciousnessofhistory,hedescribedtwomajoreventsinthehistoryofWaterlooandthebattleofthe1832uprisinginParis,isextremelybrilliantintwocases.What'smore,hechangestowrite"thecentury"inthehistoryofupsanddowns,likewithmanytwistsandturnsinthenovel,andinallofthehistorysceneandprocesscenter,placingashockingsocialreality,namelythelowerpeople'stragicfate.Inhisview,inthehalfcenturyaftertherevolution,theplightofthelowerclasseswasequallytragicanddifficult,withoutanychange.HeillustratedthestorywithJeanValjean,Fantineandcosette.jeanvalJeanJeanValjeanwasafigurethroughoutthewholetext,andanimagethattheauthortriedtoportray.Thehero,JeanValjean,waskindandhonest,butlivedinthe"miserableworld"becauseofsocialreality.JeanValjeanwasaconvictfrombeginningtoend,andthesocietyseemedtohavecommittedanunwarrantedbutdeephatredofslavery.JeanValjeanhadbeeninservitudefor19years,onlytobreakapieceofglassandstealaloafofbread!Duringthehard19years,heenduredmuchmorethanhehadtoaccept,andsufferedseverephysicalandmentaldamage.Hewasreleasedfromprisonafteronlyignorealleyesandlookat.However,hewassaved,whenCafubishopRuhandinvitedhiminatthesametime,notonlytoJeanValjean'sbodywaswarm,hisheartalsograduallytouched,wrappedinicecracksbegantoappear.Toregainhislife,withhiswisdom,courage,kindness,andthespiritoffirmandindomitablechangedtheirtragicfate,hebecameamayorwithnumerousproperty,butheputmostofhismoneytocharityandpoorpeople.Usually,heoftenwentoutwithapocketfullofmoney,butcamebackempty;inaddition,healsooftengivebreadtothehungry,puttheclothestothosewhowerecold;visitthepoorandthesufferingeverywhere.Forthepoor,hewas,likeCafu,thebishop,whohadenteredtheheartsofthepeople,agodsentjustice,abenevolentincarnationoftheLordinthetown.However,theshadowofthepastalwaysseemtolinger,overheardsomeoneforhehadmadeasmallrap,JeanValjeanwasswaying,longmeditation.Asamayor,itcandosomethingmeaningfulforsociety,andhetakesonthefutureofamotherandherchildrenaswellasthewholecity.Theoldmanisonlyold,uselesspeople.Yes,nooneknewhewasJeanValjean,aformerconvict.Awretchedsoulstruggleswithfear.Atthelastminute,however,hegaveupallhisplaceandRongHua,Rescuedtheoldman,becauseofhiskindness,helosteverything,beganafrightenedescapelife.Hehadspentinthedark,themonasteryforseveralyears,andthenthroughtheParisuprising,andfinallyexperiencedCosetteandMariussuspicion.However,hewasfinallyfree,andreceivedCosette'sapproval.Attheendofhislifecanbesummedupin4sentencesofthebook:"he'salive,althoughthefateofstrangeisallwrongbecausehe;rest,lostangelssleep;borntodie,lifeisanaturallaw;nightanddaytogotoisthissamereason."Thispoemisbriefandpithybutgivesendlessvicissitudesandsadness,everythinghasanend,buriedintheundergroundpeoplelikethesong"flowerwascrushedintomudsoil,onlyasincense."JavertJavertisanonthejobduediligence,therigidsystemoffrenziedmaintenancepeople.Heseemedtohaveonlyblackandwhiteinhismind,rightandwrong,andneverthoughtanyonewhohaddoneanythingwrongwoulddoanythinggood.HeblindlyadheretohisnospeculationspiritOvergeneralizationjudgment,untilthetragictoseeawickedmanhethoughtwashisSavior.WhenJeanValjeansavedFantine'sdaughter,Cosette,JavertJeanValjeanissuspectedtobetheprisoner.WhenJeanValjeanbelievedhimselftosavethepeoplepubliclyincourtwhentheyareprisonersofJeanValjeanandJaverthadcapturedJeanValjeanashislifelongbelief.Javertneveranalysisofhisstickintheendisnotthelegaljusticeofthelaw,headheretojusticeisgoodforoppression,actuallythiskindofblindtothelawthencompletefaithandforgoodandbadpeopledonothaveacorrectmeasure,isthereasonforthefairnessofJaverttolawenforcementrulesoflifetragedythe.InthebattlewiththerevolutionaryarmyintherevolutionaryarmycapturedbyJavert,therevolutionaryarmywillexecutehistasktoJeanValjean,butJeanValjeandrewhiminnooneplacetoairroomtwogun,andthenputhim.JeanValjean'skindandgeneroustosubvertthehehasbeenproudoftheintegrityoftheconscientiouscharacter,hisfirstheartaccordingtotheremnantsoftheconceptsofgoodandevilratherthanlegalact,heisalsothefirsttimetherationalityofsocialsystem,thelegalquestion,butonlyasmallsteptowardslight,butlethiminapanic,thiscontradictionbetweenrealityandbelief,JavertchoseDutchact.FangDingDingFang'slifeistragic,herlifeis"hungrywomenfall".Atthattimedidnotallowfantasy,butFangwasholdingfortheworldoffantasy,thefirstisfortheloveoffantasy,Fantineonherboyfriend'sloveisagenuineillusion,hecannotentertherealobjectiveanalysisoflove,willtheirlovetotheirboyfriend.Thisisanillusionofchoice,butalsoablindchoice.Thus,whenFantinehadaman'schild,themandesertedfantine.Shewantedtofindagoodhomeforthechildrentofosterchildren,thistimeonahotelownercouple.Fantinedidnotknowwhethertheyweregoodornot,andchosetheirownfancyasagoodman.Becauseofthisillusionandtherealityofthegap,butalsobecauseofthegapbetweenhopeandreality,ledtothetragedyofFantine,butalsoledtoCosette'stragedy.Becauseofpoverty,fallintothewhoreFangDing,lifeislivinginthebottomofsocietyin.FangDingbecameaprostitute,justtoletoneselfcanliveandcosette.Thebourgeoisieofthedarkdescriptionwasveryclearhere:HugoJeanValjean'sfactoryworkworker,becauseseenotpleasingtotheeyeandputherFangDingoutofthefactory,shelostherlife;andshebecameaprostituteafterthetragiclife,butbytheso-called"upperclasscitizens"insult;sheresistedinsult,butsuppressedbythebourgeoislaw,shewillcatchinprison.Fantinediedatlastinhallucinations,atthecriticalmoment,Shesawherchildinthedoorway,butitwasjustanillusion.Inthesocietyofmoney,theThenardiersdidn'tputCosette,justbecauseCosettecanbringmoneyforthem,iftheycannotletgoofCosettefromFangDingthereagaincheatmoney.CosetteFangDingsishengnvCosette,"darkchildrenweak".Asshesawinfostercare,ragsandknifecanplaytheirownThenardierschildrenplayingwithdolls,eventhetouchoftheThenardierschildrendollshavebeenbeaten;onlyafewyearsofher,butalmostallworktodotoopentheThenardiersInn;inseverewinter,shewouldwearthinclothesandwalkedmilestofetchwater......Andherownexistence,butbecamethebossofthehoteltodotheThenardierspressthefleshandbloodofhermother'stools,fromtheinitialbloominglikearosetobecomenaivenotsinging"lark"Cosette'stragiclifeascanbeimagined.IfyoudonotencounterJeanValjean,FangDingafterhermotherdied,theThenardierscouldn'tgetmoneywhenCosettewillencounterwhatmorecrueldark.ThetragedywasnotonlyperformedbyCosette,butalmostallthepeopleinthesociety,suchasthelowermiddleclass,playedanimportantroleinthetragedy.Cosettewasonlyacommonfigureinthelongtragedyofthisscene,butherlifeexperiencerepresentedthestoryofalmostalltheoppressionofchildren.Reference1Victor,Hugo,LiDan,Fanglieinmiserableworld,1984,Beijing:People'sLiteraturePublishingHouse2highYunqingfrom"lesmiserables"JournalofChinaForeignAffairsUniversity1998(03)3,PengMin'sexplorationandpursuitofhumanbeings.OntheideologicalsystemofHugo'snovels.1997(02)JournalofGanNanNormalUniversity4KongXiangxia,onBaJinandHugo.1997(01)JournalofZhejiangUniversity(HUMANITIESANDSOCIALSCIENCES)5ZhengKelu'spsychologicaldescriptionofHugo'snovel.2002(06)JournalofShanghaiNormalUniversity(PHILOSOPHYANDSOCIALSCIENCES)危重病人紧急人工气道的建立一、紧急人工气道的概念与范畴

人工气道是指为保证气道通畅而在生理气道与空气或其他气源之间建立的有效连接。紧急人工气道的范畴包括(1)识别引起气道急症的原因。(2)在建立确定性人工气道前处理气道急症。(3)运用各种辅助设备及特殊技术来建立、维持、监测有效通气。紧急人工气道技术大致可分为确定性和非确定性。所谓确定性指能保证可靠的有效的通气并适宜长时间使用，而非确定性则相反，但往往非确定性人工气道技术操作简便，易于被广泛掌握。

二、紧急人工气道建立的适应证

下列情况下需要紧急建立人工气道(1)短时间内气道完整性受到破坏或气道受阻。(2)呼吸衰竭需要呼吸机辅助呼吸。(3)紧急保护气道以防止可预见的影响气道通畅性的因素。临床上需要建立紧急人工气道的常见危重病症包括深昏迷、呼吸衰竭或呼吸停止、心跳骤停、严重气道痉挛、气道异物梗阻、镇静剂或麻醉剂作用、颅脑及颈部外伤、误吸或有误吸危险、意外拔管、大量难以控制的上呼吸道出血、急性上呼吸道梗阻等。紧急建立人工气道无绝对禁忌证，关键在于选择最合适的方法，除非患者或法定监护人明确表示拒绝。

三、常见非确定性紧急人工气道技术

1．手法开放气道：根据气道解剖知识，当患者处于头后仰时，气道开放程度最佳，常用提颏和双手抬颌法。

2．口咽和鼻咽通气管：口咽通气管通常呈“Ｓ”形，横截面呈管状或“工”型，可以通气。鼻咽通气管形状类似气管导管，较短。它们是最简单的气道辅助物，易于插入，其作用在于限制舌后坠，维持开放气道。它们应大小合适，位置准确，在相应环境中使用，也可以和面罩通气结合使用。

3．面罩加简易呼吸器：面罩的优点是简便，快捷，无创。缺点在于(1)不容易密封，使有效通气量减少。(2)昏迷病人使用正压通气，易使气体进入胃肠道，随之而来的是返流和误吸。面罩适用于患者本身上呼吸道通畅而出现呼吸衰竭的病人，通常用于在准备建立可靠人工气道以前辅助通气、无创通气。每一个参与抢救的医务人员均应熟练掌握此项技术。

4．喉罩：喉罩头端呈匙勺形，边缘为气囊，像个小面罩，尾端为一硬质通气管，与头端呈30度角相连。有多种尺寸。操作技术：最好采用标准插管位。患者张口，喉罩远端气孔面朝前，气囊尖端贴着上颚滑行推进，直至感到有特征性的阻力，提示到达上食管括约肌。松手，用10～３０

ml空气将气囊充气。喉罩尾管轴线应在上唇正中。其主要适用于没有气管插管经验的非专业医护人员和困难气道，特别是由于解剖原因使插管困难，或怕搬动颈椎造成神经系统损伤。相对禁忌证包括：①饱食或产科病人有误吸危险者。在紧急情况下，当通气成为首要选择时，也可选择喉罩。②俯卧位，或屈曲位。

5．气管食管联合通气管：是一种双腔管。操作时操作者将该管盲目插入，直至标志刻度线到达牙齿。将兰色咽气囊充入100ml空气，将白色远端气囊充入15

ml气体。通过较长的兰色导管通气，检查导管位置，如果有效，则提示该管已插入食管，继续用该管腔通气。如果未闻及呼气音，未见胸廓抬起，则提示该管已插入气管，改用另一短管通气，并继续检查并确认位置。气管食管联合通气管可在多种场合使用，有较多优点，易于掌握，从专业人员到护士、急救士均可掌握使用。禁忌证：(1)年龄＜16岁；(2)身高不足于150

cm；(3)张口反射强烈；(4)食道病变或急性腐蚀性食管炎。

四、常见确定性紧急人工气道技术

1．经口气管插管术：最经典最常用的插管方法，也是快速建立可靠人工气道的方法。经口直视下气管插管的关键在于用喉镜暴露声门。在声门无法暴露的情况下，常易导致插管失败或出现较多并发症，因此其禁忌证或相对禁忌证主要包括：(1)呼吸衰竭不能耐受仰卧位的病人；(2)由于张口困难或口腔空间小，无法经口插管者；(3)无法后仰者(疑有颈椎骨折者)。

2．经口气管插管要点及注意事项：(1)准备：插管箱内物品应随时保持齐备，根据患者体型选择气管导管。给患者高流量面罩吸氧，并保证在插管过程中及插管后予以高流量吸氧。摆体位，头、颈、肩相应垫高，使头后仰并抬高8～10

cm。对于肥胖病人，可将外耳道与剑突摆在同一水平线上。2%利多卡因对口咽部及下咽区喷雾局麻。(2)插管：用右手拇指和中脂呈剪刀手法，使患者张口。用左手持喉镜沿口角右侧置入口腔，将舌体推向左，使喉镜片至正中位，此时可见悬雍垂(为显露声门的第一标志)，慢慢推进喉镜使其顶端抵达舌根，稍上提喉镜，可看到会厌的边缘(为显露声门的第二标志)。将口腔内吸引干净，清楚地暴露视野。继续推进喉镜，使其顶端抵达舌根与会厌交界处，然后上提喉镜，间接拉起会厌而显露声门。右手执气管导管，斜口对声门裂，在吸气末顺势将导管轻柔插入。导管插入气管内的长度，成人为5

cm，小儿为2～３cm。如果用导丝塑型，在导管斜面进入声门2cm后，要及时抽出导丝。导管插入气管后，立即塞入牙垫，然后退出喉镜，检查确认导管在气管内，而非在食管内。如果导管误入食道，应将导管退至口咽部重插。最后将导管与牙垫一起妥加固定。

3．经鼻气管插管术：(1)盲探经鼻气管插管：适应证基本与经口插管的禁忌证相同，也就是说，在经口途径有困难时应首先考虑经鼻途径。禁忌证或相对禁忌证主要包括呼吸停止；严重鼻或颌面骨折；凝血功能障碍；鼻或鼻咽部梗阻，如鼻中隔偏曲、息肉、囊肿、脓肿、水肿、过敏性鼻炎、异物、血肿等；颅底骨折。操作要点：先将鼻腔内滴数滴呋麻滴鼻液，石蜡油润滑并作表面麻醉(2%利多卡因喷雾剂)。操作时导管—进入鼻腔就将导管与面部作垂直方向插入鼻孔，使导管沿下鼻道推进，经鼻后孔至咽腔，切忌将导管向头顶方向推进，否则极易引起严重出血。操作者可一面注意倾听通过导管的气流，一面用左手调整头颈方向角度，当感到气流最强烈时，然后迅速在吸气相时推入导管，通常导管通过声门时患者会出现强烈咳嗽反射。不要施加暴力。如果推进导管时呼吸气流声中断，提示导管前端已触状窝，或误入食管，或进入舌根会厌间隙。应稍稍退出，重试。成功率在70%左右，需要较多经验。插入后务必确认气管导管在气管内而不是在食管内。反复尝试插管易造成喉头水肿，喉痉挛、及出血，导致急性缺氧，诱发心跳骤停。建议在3次不成功后改其他方法。(2)明视经鼻气管插管：气管导管通过鼻腔方法同盲插，声门暴露方法基本同明视经口插管法。当导管通过鼻腔后，用左手持喉镜显露声门，右手继续推进导管进入声门，如有困难，可用插管钳夹持导管前端送入声门。检查确认导管位置并固定。

4．逆行气管插管术：所谓逆行气管插管是相对常规气管插管而言，指先行环甲膜穿刺，将导丝经环甲膜送入气管，通过喉部，到达口咽部，由口腔或鼻腔引出，再将气管导管沿导丝插入气管。清醒、麻醉病人均可实施。根据逆行气管插管的原理，可选用不同材质的替代品做导丝。适应证：由于上呼吸道解剖因素或病理条件下，无法看到声带甚至会厌，无法完成经口或经鼻气管插管者。禁忌证：(1)甲状腺肿大，如甲亢或甲状腺癌；(2)无法张口；(3)穿刺点肿瘤或感染；(4)凝血机能障碍；(5)病人不合作又无法控制。此法体位要求低，一次成功率高，插管过程中缺氧时间短。

5．环甲膜切开术：需要经验、技巧、及特殊器械。环甲膜切开造口术的优点：比气管切开造口术快；安全，很少由于外科技术失误，对于不常操作的人相对容易；对纵隔