1、復旦大學附屬中山醫院麻醉和復旦大學附屬中山醫院麻醉和危重病學科危重病學科 朱彪朱彪n簡易人工氣道簡易人工氣道n氣管插管氣管插管n氣管切開氣管切開The Upper Airway簡易人工氣道簡易人工氣道n 口咽導管口咽導管 鼻咽導管鼻咽導管 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氣管插管氣管插管適應癥適應癥

2、1.嚴重低氧或高碳酸血癥嚴重低氧或高碳酸血癥2.氣道分泌過多氣道分泌過多3.上氣道損傷、狹窄、阻塞、氣上氣道損傷、狹窄、阻塞、氣管食道漏管食道漏插管前的準備插管前的準備n物品的準備物品的準備（簡易人工呼吸器（簡易人工呼吸器 、負壓吸引器）、負壓吸引器）n病人的準備病人的準備插管的途徑插管的途徑-經口經口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. 插入右主支氣管插入右主支氣管4. 鼻出血鼻出血5. 自行拔管自行拔管人工氣道的并發癥與處理人工氣道的并發癥與處理n口腔感染口腔感染n切口出血、感染切口出血、感染n氣道粘膜的損傷氣道粘膜的損

3、傷n 氣管狹窄氣管狹窄n氣道出血氣道出血n鼻竇炎鼻竇炎n肺炎肺炎n聲嘶、聲帶水腫聲嘶、聲帶水腫n縱膈氣腫縱膈氣腫n皮下氣腫皮下氣腫n氣管食管瘺氣管食管瘺n脫位脫位n氣道阻塞氣道阻塞n漏氣漏氣困難氣道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