氣管插管術(shù)新疆醫(yī)科大學第一附屬醫(yī)院麻醉科氣管插管術(shù)新疆醫(yī)科大學第一附屬醫(yī)院麻醉科Contents定義及概述1適應癥及禁忌癥2操作3并發(fā)癥42醫(yī)療學識Contents定義及概述1適應癥及禁忌癥2定義Definition

氣管插管術(shù)是一種將一特制的氣管內(nèi)導管經(jīng)聲門置入氣管的技術(shù)，這一技術(shù)能為氣道通暢、通氣供氧、呼吸道吸引和防止誤吸提供最佳條件。

Theinsertionofatubeintothetracheatoallowairtoenterthelungs.

3醫(yī)療學識定義Definition

氣管插管術(shù)是一種將一特呼吸道解剖Anatomy

氣管插管的途徑是通過鼻腔或口腔，經(jīng)過咽喉、聲門、把插管插到氣管或總支氣管內(nèi)。4醫(yī)療學識呼吸道解剖Anatomy4醫(yī)療學識5醫(yī)療學識5醫(yī)療學識適應癥Indications心跳、呼吸驟停。Cardiacorrespiratoryarrest喪失氣道保護功能者。Failuretoprotecttheairway嚴重呼吸衰竭不能滿足機體通氣和氧供需要需機械通氣者。Inadequateoxygenationorventilation6醫(yī)療學識適應癥Indications心跳、呼吸驟停。6醫(yī)療學識適應癥Indications即將發(fā)生或已發(fā)生的氣道阻塞Impendingorexistingairwayobstruction多系統(tǒng)疾病或損傷的護理需要。Careofcriticallyillpatientswithmulti-systemdiseaseorinjuries.外科手術(shù)麻醉需要。Controloftheairwayinsurgicalproceduresrequiringgeneralanesthesia.7醫(yī)療學識適應癥Indications即將發(fā)生或已發(fā)生的氣道阻塞7禁忌癥Contraindications無絕對禁忌癥，以下所列為相對禁忌癥。由于外部原因所致上氣道梗阻Obstructionoftheupperairwayduetoforeignobjects頸椎骨折Cervicalfractures食道疾病Esophagealdisease進食腐蝕性物質(zhì)Ingestionofcausticsubstances下顎骨折Mandibularfractures喉頭水腫Laryngealedema燙傷或化學藥劑灼傷Thermalorchemicalburns8醫(yī)療學識禁忌癥Contraindications無絕對禁忌癥，以下所插管前準備Equipmentpreparation1.氣管導管導管的選擇Sizeofendotrachealtube按導管的內(nèi)徑計算internaldiameter(ID)男性Male:ID8.0mms女性Female:ID7.5mms

9醫(yī)療學識插管前準備Equipmentpreparation1.氣管插管前準備Equipmentpreparation

兒童的導管選擇Sizeofendotrachealtube

0-3月（Newborn-3months

）:ID3.0mm

3-9月

（3-9months）

:ID3.5mm

9-18月（9-18

months

）:ID4.0mms

2-6歲（2-6years）:ID=(Age/3)+3.5

>6歲

（>6

years）:ID=(Age/4)+4.510醫(yī)療學識插管前準備Equipmentpreparation兒童插管前準備Equipmentpreparation插管深度Depthofendotrachealtube

成人Adult

男性Male=23cms

女性Female=21cms兒童Children經(jīng)口氣管插管=(Age/2)+12(cm)經(jīng)鼻氣管插管=(Age/2)+15(cm)11醫(yī)療學識插管前準備Equipmentpreparation插管插管前準備Equipmentpreparation2.喉鏡Laryngoscope氣管插管使用的為直接喉鏡。直接喉鏡分直鏡（miller）和彎鏡（macintosh）兩種。12醫(yī)療學識插管前準備Equipmentpreparation2.喉插管前準備Equipmentpreparation操作前務必檢查喉鏡是否明亮13醫(yī)療學識插管前準備Equipmentpreparation操作前務插管前準備Equipmentpreparation其他Otherequipments導絲Stylet

手套Gloves吸痰器SuctionDevice5ML注射器syringe固定器Endotrachealtubeholder14醫(yī)療學識插管前準備Equipmentpreparation其他操作步驟PROCEDURALSTEPS

1．仰臥，頭墊高10cm，置入導管芯,將病人頭部盡量向后伸仰，使三軸線完全重疊，讓插管徑路接近為一直線。

Positionbedheighttobringthepatient'sheadtoamid-abdominalheight.Flexthecervicalspineandextendtheheadattheatlanto-occipitaljoint.Longaxisoftheoralcavity,pharynx,andtrachealiealmostinastraightline.15醫(yī)療學識操作步驟PROCEDURALSTEPS1．仰臥，頭墊16醫(yī)療學識16醫(yī)療學識2.左手持喉鏡沿右口角置入口腔，左推舌體，使喉鏡移至正中位。Introducethebladeintotherightside

ofthepatient'smouth,movethebladeposteriorlyandtowardthemidline,sweepingthetonguetotheleftandkeepingitawayfromthevisualpathwiththeflangeoftheblade

3．喉鏡片抵達舌根與會厭交界處，上提喉鏡，撬起會厭,顯露聲門。advancethelaryngoscopeuntiltheepiglottisisinview.17醫(yī)療學識17醫(yī)療學識操作步驟PROCEDURALSTEPS

4.右手以握筆式手勢持氣管導管，插過聲門,進入氣管。liftthelaryngoscopeupwardandforward.Inserttheendotrachealtubefromtherightwithitsconcavecurvefacingdownwardandtotherightsideofthepatient.Maneuvertheendotrachealtubeintothelarynx,midwaybetweenthecricoidcartilageandthesternalangle

18醫(yī)療學識操作步驟PROCEDURALSTEPS18醫(yī)療學識操作步驟PROCEDURALSTEPS5.放牙墊，退喉鏡.確定位置后，妥善固定導管與牙墊．注套囊空氣(3-5m1).inflatethecuffandapplypositivepressureventilationwhiletheassistantauscultates.Securetheendotrachealtubeinposition。19醫(yī)療學識操作步驟PROCEDURALSTEPS19醫(yī)療學識并發(fā)癥Complications

聲音嘶啞及咽痛Postintubationhoarsenessandsorethroat嘔吐VomitingAspiration局限性肺炎Pneumonitis肺炎Pneumonia心動過緩Bradycardia20醫(yī)療學識并發(fā)癥Complications20醫(yī)療學識并發(fā)癥Complications喉痙攣Laryngospasm支氣管痙攣Bronchospasm呼吸暫停Apnea牙齒、嘴唇、聲帶的損傷。Traumatoteeth,lipsandvocalcords.頸椎損傷加重。Exacerbationofcervicalspineinjuries.21醫(yī)療學識并發(fā)癥Complications21醫(yī)療學識氣管內(nèi)插管術(shù)（ENDOTRACHEALINTUBATION)目的：⒈麻醉期間維持病人呼吸道通暢，防止異物進入，便于吸痰和積血。⒉便于進行人工和機械通氣，用于呼衰、復蘇、中毒、新生兒窒息。⒊便于吸入全身麻醉藥氣管內(nèi)插管的器械與方法：22醫(yī)療學識氣管內(nèi)插管術(shù)（ENDOTRACHEALINTUBATION

Laryngoscopes23醫(yī)療學識L

Trachealtubes24醫(yī)療學識T

Anatomyofthroat25醫(yī)療學識

Anatomyofbronchus26醫(yī)療學識A

Themaneuoverofliftingmandible27醫(yī)療學識Thema

Vocalgateexposurebycurvedlaryngoscope28醫(yī)療學識Vocalgateexposur

Vocalgateexposurebystraightlaryngoscope29醫(yī)療學識Vocalgateexposure

Blindintubationthroughnasalcavity30醫(yī)療學識Blindintubationth經(jīng)鼻盲插管圖31醫(yī)療學識經(jīng)鼻盲插管圖31醫(yī)療學識氣管內(nèi)插管的并發(fā)癥（Complications)⒈齒、舌、咽喉部等損傷。⒉心血管反射。⒊呼吸道梗阻。⒋誤入一側(cè)支氣管或?qū)Ч苊摮?。?長時間充氣壓迫，局部粘膜和纖毛缺血，粘膜脫落。纖毛活動停止３~５天，局部潰瘍，軟骨軟化，壞死。32醫(yī)療學識氣管內(nèi)插管的并發(fā)癥（Complications)32醫(yī)療學識確認1.壓胸有氣流。

2.人工通氣：雙側(cè)胸廓對稱，聽雙肺肺泡呼吸音。3.吸氣管壁清亮：呼氣時有白霧。4.自主呼吸時，呼吸囊隨呼吸張縮5.ETCO2：最科學33醫(yī)療學識確認1.壓胸有氣流。33醫(yī)療學識全身麻醉的并發(fā)癥及其處理（1）㈠返流與誤吸（RegurgitationandAspiration）原因：誘導時氣道梗阻，飽胃、上消化道出血、腸梗阻表現(xiàn)：急性呼吸道梗阻、吸入性肺炎、肺不張?zhí)幚恚侯A防為主，原則為⑴減少胃內(nèi)容物和提高胃液PH

值；⑵降低胃壓；⑶保護氣道；(4)麻醉方法)㈡呼吸道梗阻（AirwayObstruction⒈上呼吸道梗阻（upperairwayobstruction)原因：舌后墜、分泌物或異物阻塞、喉痙攣、喉水腫表現(xiàn)：不全梗阻：呼吸困難，鼾聲完全梗阻：三凹征

34醫(yī)療學識全身麻醉的并發(fā)癥及其處理（1）㈠返流與誤吸（RegurgitThankYou!ThankYou!氣管插管術(shù)新疆醫(yī)科大學第一附屬醫(yī)院麻醉科氣管插管術(shù)新疆醫(yī)科大學第一附屬醫(yī)院麻醉科Contents定義及概述1適應癥及禁忌癥2操作3并發(fā)癥437醫(yī)療學識Contents定義及概述1適應癥及禁忌癥2定義Definition

氣管插管術(shù)是一種將一特制的氣管內(nèi)導管經(jīng)聲門置入氣管的技術(shù)，這一技術(shù)能為氣道通暢、通氣供氧、呼吸道吸引和防止誤吸提供最佳條件。

Theinsertionofatubeintothetracheatoallowairtoenterthelungs.

38醫(yī)療學識定義Definition

氣管插管術(shù)是一種將一特呼吸道解剖Anatomy

氣管插管的途徑是通過鼻腔或口腔，經(jīng)過咽喉、聲門、把插管插到氣管或總支氣管內(nèi)。39醫(yī)療學識呼吸道解剖Anatomy4醫(yī)療學識40醫(yī)療學識5醫(yī)療學識適應癥Indications心跳、呼吸驟停。Cardiacorrespiratoryarrest喪失氣道保護功能者。Failuretoprotecttheairway嚴重呼吸衰竭不能滿足機體通氣和氧供需要需機械通氣者。Inadequateoxygenationorventilation41醫(yī)療學識適應癥Indications心跳、呼吸驟停。6醫(yī)療學識適應癥Indications即將發(fā)生或已發(fā)生的氣道阻塞Impendingorexistingairwayobstruction多系統(tǒng)疾病或損傷的護理需要。Careofcriticallyillpatientswithmulti-systemdiseaseorinjuries.外科手術(shù)麻醉需要。Controloftheairwayinsurgicalproceduresrequiringgeneralanesthesia.42醫(yī)療學識適應癥Indications即將發(fā)生或已發(fā)生的氣道阻塞7禁忌癥Contraindications無絕對禁忌癥，以下所列為相對禁忌癥。由于外部原因所致上氣道梗阻Obstructionoftheupperairwayduetoforeignobjects頸椎骨折Cervicalfractures食道疾病Esophagealdisease進食腐蝕性物質(zhì)Ingestionofcausticsubstances下顎骨折Mandibularfractures喉頭水腫Laryngealedema燙傷或化學藥劑灼傷Thermalorchemicalburns43醫(yī)療學識禁忌癥Contraindications無絕對禁忌癥，以下所插管前準備Equipmentpreparation1.氣管導管導管的選擇Sizeofendotrachealtube按導管的內(nèi)徑計算internaldiameter(ID)男性Male:ID8.0mms女性Female:ID7.5mms

44醫(yī)療學識插管前準備Equipmentpreparation1.氣管插管前準備Equipmentpreparation

兒童的導管選擇Sizeofendotrachealtube

0-3月（Newborn-3months

）:ID3.0mm

3-9月

（3-9months）

:ID3.5mm

9-18月（9-18

months

）:ID4.0mms

2-6歲（2-6years）:ID=(Age/3)+3.5

>6歲

（>6

years）:ID=(Age/4)+4.545醫(yī)療學識插管前準備Equipmentpreparation兒童插管前準備Equipmentpreparation插管深度Depthofendotrachealtube

成人Adult

男性Male=23cms

女性Female=21cms兒童Children經(jīng)口氣管插管=(Age/2)+12(cm)經(jīng)鼻氣管插管=(Age/2)+15(cm)46醫(yī)療學識插管前準備Equipmentpreparation插管插管前準備Equipmentpreparation2.喉鏡Laryngoscope氣管插管使用的為直接喉鏡。直接喉鏡分直鏡（miller）和彎鏡（macintosh）兩種。47醫(yī)療學識插管前準備Equipmentpreparation2.喉插管前準備Equipmentpreparation操作前務必檢查喉鏡是否明亮48醫(yī)療學識插管前準備Equipmentpreparation操作前務插管前準備Equipmentpreparation其他Otherequipments導絲Stylet

手套Gloves吸痰器SuctionDevice5ML注射器syringe固定器Endotrachealtubeholder49醫(yī)療學識插管前準備Equipmentpreparation其他操作步驟PROCEDURALSTEPS

1．仰臥，頭墊高10cm，置入導管芯,將病人頭部盡量向后伸仰，使三軸線完全重疊，讓插管徑路接近為一直線。

Positionbedheighttobringthepatient'sheadtoamid-abdominalheight.Flexthecervicalspineandextendtheheadattheatlanto-occipitaljoint.Longaxisoftheoralcavity,pharynx,andtrachealiealmostinastraightline.50醫(yī)療學識操作步驟PROCEDURALSTEPS1．仰臥，頭墊51醫(yī)療學識16醫(yī)療學識2.左手持喉鏡沿右口角置入口腔，左推舌體，使喉鏡移至正中位。Introducethebladeintotherightside

ofthepatient'smouth,movethebladeposteriorlyandtowardthemidline,sweepingthetonguetotheleftandkeepingitawayfromthevisualpathwiththeflangeoftheblade

3．喉鏡片抵達舌根與會厭交界處，上提喉鏡，撬起會厭,顯露聲門。advancethelaryngoscopeuntiltheepiglottisisinview.52醫(yī)療學識17醫(yī)療學識操作步驟PROCEDURALSTEPS

4.右手以握筆式手勢持氣管導管，插過聲門,進入氣管。liftthelaryngoscopeupwardandforward.Inserttheendotrachealtubefromtherightwithitsconcavecurvefacingdownwardandtotherightsideofthepatient.Maneuvertheendotrachealtubeintothelarynx,midwaybetweenthecricoidcartilageandthesternalangle

53醫(yī)療學識操作步驟PROCEDURALSTEPS18醫(yī)療學識操作步驟PROCEDURALSTEPS5.放牙墊，退喉鏡.確定位置后，妥善固定導管與牙墊．注套囊空氣(3-5m1).inflatethecuffandapplypositivepressureventilationwhiletheassistantauscultates.Securetheendotrachealtubeinposition。54醫(yī)療學識操作步驟PROCEDURALSTEPS19醫(yī)療學識并發(fā)癥Complications

聲音嘶啞及咽痛Postintubationhoarsenessandsorethroat嘔吐VomitingAspiration局限性肺炎Pneumonitis肺炎Pneumonia心動過緩Bradycardia55醫(yī)療學識并發(fā)癥Complications20醫(yī)療學識并發(fā)癥Complications喉痙攣Laryngospasm支氣管痙攣Bronchospasm呼吸暫停Apnea牙齒、嘴唇、聲帶的損傷。Traumatoteeth,lipsandvocalcords.頸椎損傷加重。Exacerbationofcervicalspineinjuries.56醫(yī)療學識并發(fā)癥Complications21醫(yī)療學識氣管內(nèi)插管術(shù)（ENDOTRACHEALINTUBATION)目的：⒈麻醉期間維持病人呼吸道通暢，防止異物進入，便于吸痰和積血。⒉便于進行人工和機械通氣，用于呼衰、復蘇、中毒、新生兒窒息。⒊便于吸入全身麻醉藥氣管內(nèi)插管的器械與方法：57醫(yī)療學識氣管內(nèi)插管術(shù)（ENDOTRACHEALINTUBATION

Laryngoscopes58醫(yī)療學識L

Trachealtubes59醫(yī)療學識T

Anatomyofthroat60醫(yī)療學識