1、气 管 插 管 术,新疆医科大学第一附属医院麻醉科,,Company Logo,Contents,,Company Logo,定 义Definition,气管插管术是一种将一特制的气管内导管经声门置入气管的技术，这一技术能为气道通畅、通气供氧、呼吸道吸引和防止误吸提供最佳条件。The insertion of a tubeinto the trachea to allow air to enter the lungs.,,Company Logo,呼吸道解剖Anatomy,气管插管的途径是通过鼻腔或口腔，经过咽喉、声门、把插管插到气管或总支气管内。,,Company Logo,,Company
2、 Logo,适 应 症Indications,心跳、呼吸骤停。Cardiac or respiratory arrest 丧失气道保护功能者。Failure to protect the airway 严重呼吸衰竭不能满足机体通气和氧供需要需机械通气者。Inadequate oxygenation or ventilation,,Company Logo,适 应 症Indications,即将发生或已发生的气道阻塞Impending or existing airway obstruction 多系统疾病或损伤的护理需要。Care of critically ill patients with
3、 multi-system disease or injuries. 外科手术麻醉需要。Control of the airway in surgical procedures requiring general anesthesia.,,Company Logo,禁忌症Contraindications,无绝对禁忌症，以下所列为相对禁忌症。 由于外部原因所致上气道梗阻Obstruction of the upper airway due to foreign objects 颈椎骨折Cervical fractures 食道疾病Esophageal disease 进食腐蚀性物质Ingest
4、ion of caustic substances 下颚骨折Mandibular fractures 喉头水肿Laryngeal edema 烫伤或化学药剂灼伤Thermal or chemical burns,,Company Logo,插管前准备Equipment preparation,1.气管导管 导管的选择Size of endotracheal tube按导管的内径计算 internal diameter (ID)男性Male: ID 8.0 mms 女性Female : ID 7.5 mms,,Company Logo,插管前准备Equipment preparation,儿童的
5、导管选择Size of endotracheal tube0-3月（New born - 3 months ）: ID 3.0 mm3-9月 （3-9months） : ID 3.5 mm9-18月（ 9-18 months ）: ID 4.0 mms2- 6岁（2-6years）: ID= (Age/3) + 3.5 6岁 （ 6 years）: ID = (Age/4) + 4.5,,Company Logo,插管前准备Equipment preparation,插 管 深 度Depth of endotracheal tube成人Adult 男性Male = 23 cms 女性Femal
6、e = 21 cms 儿童Children 经口气管插管= (Age/2) + 12 (cm) 经鼻气管插管= (Age/2) + 15 (cm),,Company Logo,插管前准备Equipment preparation,2.喉 镜Laryngoscope 气管插管使用的为直 接喉镜。直接喉镜分 直镜（miller）和弯镜 （macintosh）两 种。,,Company Logo,插管前准备Equipment preparation,操作前务必检查喉镜是否明亮,,Company Logo,插管前准备Equipment preparation,其 他 Other equipments
7、导丝Stylet 手套Gloves 吸痰器Suction Device 5ML注射器 syringe 固定器Endotracheal tube holder,,Company Logo,操作步骤PROCEDURAL STEPS,1仰卧，头垫高10cm，置入导管芯,将病人头部尽量向后伸仰，使三轴线完全重叠，让插管径路接近为一直线。Position bed height to bring the patients head to a mid-abdominal height.Flex the cervical spine and extend the head at the atlanto-occ
8、ipital joint.Long axis of the oral cavity, pharynx, and trachea lie almost in a straight line.,,Company Logo,,Company Logo,2.左手持喉镜沿右口角置入口腔，左推舌体，使喉镜移至正中位。Introduce the blade into the right side of the patients mouth, move the blade posteriorly and toward the midline, sweeping the tongue to the left a
9、nd keeping it away from the visual path with the flange of the blade3喉镜片抵达舌根与会厌交界处，上提喉镜，撬起会厌,显露声门。advance the laryngoscope until the epiglottis is in view.,,Company Logo,操作步骤PROCEDURAL STEPS,4.右手以握笔式手势持气管导管，插过声门,进入气管。lift the laryngoscope upward and forward.Insert the endotracheal tube from the righ
10、t with its concave curve facing downward and to the right side of the patient.Maneuver the endotracheal tube into the larynx, midway between the cricoid cartilage and the sternal angle,,Company Logo,操作步骤PROCEDURAL STEPS,5.放牙垫，退喉镜.确定位置后，妥善固定导管与牙垫注套囊空气(3-5m1).inflate the cuff and apply positive pressu
11、re ventilation while the assistant auscultates.Secure the endotracheal tube in position。,,Company Logo,并发症Complications,声音嘶哑及咽痛Postintubation hoarseness and sore throat 呕吐Vomiting Aspiration 局限性肺炎Pneumonitis 肺炎Pneumonia 心动过缓Bradycardia,,Company Logo,并发症Complications,喉痉挛Laryngospasm 支气管痉挛Bronchospasm
12、 呼吸暂停Apnea 牙齿、嘴唇、声带的损伤。Trauma to teeth,lips and vocal cords. 颈椎损伤加重。Exacerbation of cervical spine injuries.,,Company Logo,气管内插管术（ENDOTRACHEAL INTUBATION),目的： 麻醉期间维持病人呼吸道通畅 ，防止异物进入， 便于吸痰和积血。 便于进行人工和机械通气，用于呼衰、复苏、中毒、新生儿窒息。 便于吸入全身麻醉药 气管内插管的器械与方法：,,Company Logo,Laryngoscopes,,Company Logo,Tracheal tubes
13、,,Company Logo,Anatomy of throat,,Company Logo,Anatomy of bronchus,,Company Logo,The maneuover of lifting mandible,,Company Logo,Vocal gate exposure by curved laryngoscope,,Company Logo,Vocal gate exposure by straight laryngoscope,,Company Logo,Blind intubation through nasal cavity,,Company Logo,经鼻盲
14、插管图,,Company Logo,气管内插管的并发症（Complications) 齿、舌、咽喉部等损伤。 心血管反射。 呼吸道梗阻。 误入一侧支气管或导管脱出。 .长时间充气压迫，局部粘膜和纤毛缺血，粘膜脱落。纤毛活动停止天，局部溃疡，软骨软化，坏死。,,Company Logo,确认,1.压胸有气流。2.人工通气：双侧胸廓对称，听双肺肺泡呼吸音。 3.吸气管壁清亮： 呼气时有白雾。 4.自主呼吸时，呼吸囊随呼吸张缩 5.ETCO2 ：最科学,,Company Logo,全身麻醉的并发症及其处理（1）,返流与误吸（Regurgitation and Aspiration） 原因：诱导时气道梗阻，饱胃、上消化道出血、肠梗阻 表现：急性呼吸道梗阻、吸入性肺炎、肺不张 处理：预防为主，原则为减少胃内容物和提高胃液PH 值； 降低胃压；保护气道；(4)麻醉方法 ) 呼吸道梗阻（Airway Obstruction 上呼吸道梗阻（upper airway obstruction) 原因：舌后坠、分泌物或异物阻塞、喉痉挛、喉水肿 表现：不全梗阻：呼吸困难，鼾声完全梗阻：三凹征,Thank You !,
