喉梗阻、气管切开

Laryngealobstruction喉阻塞Theupperairwayobstruction(UAO)Oneofthemostseriouslife-threateningemergenciesfacedbycriticalcarephysicians.MostUAOisrelatedtotheoropharynxandlarynxLaryngealobstruction喉阻塞Anatomy--RespiratorySystemAnatomy--theupperairwayTheupperrespiratorytractorupperairwayprimarilyreferstothepartsoftherespiratorysystemlyingoutsideofthethorax[1]orabovethesternalangleOralcavity,nose,pharynx,larynx,extra-thoracictracheaEtiology--infection急性会厌炎Itisbettertoinitiatea“false”epiglottisdrillthantomissthisdiseaseEtiology--infection小儿急性喉炎特点：易于发生呼吸困难可为多种急性传染病的前驱症状典型临床表现为犬吠样咳嗽、吸气性喘鸣、吸气三凹征Etiology--edemaEtiology--traumaEtiology--Foreignbodies咽喉异物引起喉阻塞常见于老年人和小儿

Etiology–neoplasmEtiology--abnormalitiesEtiology--othersBilateralAbductorParalysisOSAHSClinicalmanifestationInspiratorydyspnea

吸气期呼吸困难Inspiratorystridor

吸气期喘鸣Suprasternalandintercostalindrawing

吸气期三凹征hoarsenessorAphonia失音anoxia

缺氧ClinicalmanifestationHand-to-throat

“chokingsign”differentialdiagnosis吸气性呼吸困难呼气性呼吸困难混合性呼吸困难differentialdiagnosis呼吸系统疾病（呼吸科，胸外科等）循环系统疾病（心内外科）神经精神系统疾病（神经内外科，精神科）其他：血液系统疾病、中毒、腹部疾病等Management--principles

检查寻找病因对因治疗对症支持治疗气管插管或切开一度积极积极酌情二度积极积极积极三度慎重酌情积极准备四度气管切开后生命体征基本稳定后进行气管切开后生命体征基本稳定后进行积极抢救多科合作立即Tracheotomy气管切开术TracheostomyisanoperativeprocedurethatcreatesasurgicalairwayinthecervicaltracheaSurgical

orPercutaneousTracheotomy气管切开术IndicationAirwayobstructionVentilationDeadspaceandsecretionsProtectionofairwayTracheotomy气管切开术PreoperationElectiveoremergency体位麻醉器械准备(设备、套管等，考虑充分后开始）气管套管的选择类型材质大小长短tracheotomyanatomytracheotomytracheotomytracheotomytracheotomytracheotomytracheotomyPostTracheotomyCareAssessmentofthepatientSecuretracheotomytubeinplace！！！Preventinfection(Stoma，pulmonary、、）Tracheotomy

PostTracheotomyCareSkincareInnertubecareSuctioningHumidificationTubepositioncareTubeexchangeTracheotomy

Age:infantsandadultsover75

Obesity

Smoking

Poornutrition

Recentillness,especiallyanupper- respiratoryinfection

Alcoholism

Chronicillness

Diabetes

Tracheotomy--RiskfactorsforcomplicationsTracheotomy--complicationsimmediateApneaInjurytoadjacentstructures:recurrentlaryngealnerves,thegreatvessels,andtheesophagus.BleedingPneumothoraxorpneumomediastinumearlyTracheotomy--complicationsSubcutaneousemphysemaEarlybleeding:Thisisusuallytheresultofincreasedbloodpressureasthepatientemergesfromanesthesiaandbeginstocough.Pluggingwithmucus粘液封堵TracheitisCellulitisTubedisplacementlateTracheotomy--complicationsBleeding–tracheoinnominate无名fistulaTracheo-andlaryngomalaciaStenosisTracheoesophagealfistulaTracheocutaneousfistulaGranulationScarringFailuretodecannulateSpeechwithtracheotomyWhen？病因解决Resolutionofpathologythatnecessitatedthetracheotomy(upperairwayobstruction,pneumonia)

吞咽呼吸功能正常Normalprotective