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气 管 插 管 术

气 管 插 管 术. 适应症及禁忌症. 定 义 及 概 述. 操 作. 并 发 症. 1. 2. 3. 4. Contents. 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 tube into the trachea to allow air to enter the lungs. 呼吸道解剖 Anatomy. 气管插管的途径是

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气 管 插 管 术

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  1. 气 管 插 管 术

  2. 适应症及禁忌症 定 义 及 概 述 操 作 并 发 症 1 2 3 4 Contents Company Logo

  3. 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 tube into the trachea to allow air to enter the lungs. Company Logo

  4. 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

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  6. 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

  7. 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 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

  8. 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Ingestion 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

  9. 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

  10. 插管前准备Equipment preparation 儿童的导管选择Size of endotracheal tube 0-3月（New born - 3 months）: ID 3.0 mm 3-9月 （3-9months） : ID 3.5 mm 9-18月（ 9-18months）: ID 4.0 mms 2- 6岁（2-6years）: ID= (Age/3) + 3.5 > 6岁 （ > 6years）: ID = (Age/4) + 4.5 Company Logo

  11. 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Female = 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

  12. 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

  13. 插管前准备Equipment preparation • 操作前务必检查喉镜是否明亮 Company Logo

  14. 插管前准备Equipment preparation • 其 他 Other equipments 导丝Stylet 手套Gloves 吸痰器Suction Device 5ML注射器 syringe 固定器Endotracheal tube holder Company Logo

  15. 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 patient's head to a mid-abdominal height.Flex the cervical spine and extend the head at the atlanto-occipital joint.Long axis of the oral cavity, pharynx, and trachea lie almost in a straight line. Company Logo

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  17. 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 sideof the patient's mouth, move the blade posteriorly and toward the midline, sweeping the tongue to the left and keeping it away from the visual path with the flange of the blade 3．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

  18. 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 right 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

  19. 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 pressure ventilation while the assistant auscultates.Secure the endotracheal tube in position。 Company Logo

  20. 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

  21. 并发症Complications • 喉痉挛Laryngospasm • 支气管痉挛Bronchospasm • 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

  22. 气管插管 Company Logo

  23. Thank You !

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