氣管插管術(shù)(谷風(fēng)醫(yī)療)課件

氣管插管術(shù)新疆醫(yī)科大學(xué)第一附屬醫(yī)院麻醉科氣管插管術(shù)新疆醫(yī)科大學(xué)第一附屬醫(yī)院麻醉科Contents定義及概述1適應(yīng)癥及禁忌癥2操作3并發(fā)癥42醫(yī)療學(xué)識(shí)Contents定義及概述1適應(yīng)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(dǎo)管經(jīng)聲門(mén)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(xué)識(shí)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(guò)鼻腔或口腔，經(jīng)過(guò)咽喉、聲門(mén)、把插管插到氣管或總支氣管內(nèi)。4醫(yī)療學(xué)識(shí)呼吸道解剖Anatomy4醫(yī)療學(xué)識(shí)5醫(yī)療學(xué)識(shí)5醫(yī)療學(xué)識(shí)適應(yīng)癥Indications心跳、呼吸驟停。Cardiacorrespiratoryarrest喪失氣道保護(hù)功能者。Failuretoprotecttheairway嚴(yán)重呼吸衰竭不能滿(mǎn)足機(jī)體通氣和氧供需要需機(jī)械通氣者。Inadequateoxygenationorventilation6醫(yī)療學(xué)識(shí)適應(yīng)癥Indications心跳、呼吸驟停。6醫(yī)療學(xué)識(shí)適應(yīng)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(hù)理需要。Careofcriticallyillpatientswithmulti-systemdiseaseorinjuries.外科手術(shù)麻醉需要。Controloftheairwayinsurgicalproceduresrequiringgeneralanesthesia.7醫(yī)療學(xué)識(shí)適應(yīng)癥Indications即將發(fā)生或已發(fā)生的氣道阻塞7禁忌癥Contraindications無(wú)絕對(duì)禁忌癥，以下所列為相對(duì)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(jìn)食腐蝕性物質(zhì)Ingestionofcausticsubstances下顎骨折Mandibularfractures喉頭水腫Laryngealedema燙傷或化學(xué)藥劑灼傷Thermalorchemicalburns8醫(yī)療學(xué)識(shí)禁忌癥Contraindications無(wú)絕對(duì)禁忌癥，以下所插管前準(zhǔn)備Equipmentpreparation1.氣管導(dǎo)管導(dǎo)管的選擇Sizeofendotrachealtube按導(dǎo)管的內(nèi)徑計(jì)算internaldiameter(ID)男性Male:ID8.0mms女性Female:ID7.5mms

9醫(yī)療學(xué)識(shí)插管前準(zhǔn)備Equipmentpreparation1.氣管插管前準(zhǔn)備Equipmentpreparation

兒童的導(dǎo)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(xué)識(shí)插管前準(zhǔn)備Equipmentpreparation兒童插管前準(zhǔn)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(xué)識(shí)插管前準(zhǔn)備Equipmentpreparation插管插管前準(zhǔn)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(xué)識(shí)插管前準(zhǔn)備Equipmentpreparation2.喉插管前準(zhǔn)備Equipmentpreparation操作前務(wù)必檢查喉鏡是否明亮13醫(yī)療學(xué)識(shí)插管前準(zhǔn)備Equipmentpreparation操作前務(wù)插管前準(zhǔn)備Equipmentpreparation其他Otherequipments導(dǎo)絲Stylet

手套Gloves吸痰器SuctionDevice5ML注射器syringe固定器Endotrachealtubeholder14醫(yī)療學(xué)識(shí)插管前準(zhǔn)備Equipmentpreparation其他操作步驟PROCEDURALSTEPS

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

Positionbedheighttobringthepatient'sheadtoamid-abdominalheight.Flexthecervicalspineandextendtheheadattheatlanto-occipitaljoint.Longaxisoftheoralcavity,pharynx,andtrachealiealmostinastraightline.15醫(yī)療學(xué)識(shí)操作步驟PROCEDURALSTEPS1．仰臥，頭墊16醫(yī)療學(xué)識(shí)16醫(yī)療學(xué)識(shí)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(dá)舌根與會(huì)厭交界處，上提喉鏡，撬起會(huì)厭,顯露聲門(mén)。advancethelaryngoscopeuntiltheepiglottisisinview.17醫(yī)療學(xué)識(shí)17醫(yī)療學(xué)識(shí)操作步驟PROCEDURALSTEPS

4.右手以握筆式手勢(shì)持氣管導(dǎo)管，插過(guò)聲門(mén),進(jìn)入氣管。liftthelaryngoscopeupwardandforward.Inserttheendotrachealtubefromtherightwithitsconcavecurvefacingdownwardandtotherightsideofthepatient.Maneuvertheendotrachealtubeintothelarynx,midwaybetweenthecricoidcartilageandthesternalangle

18醫(yī)療學(xué)識(shí)操作步驟PROCEDURALSTEPS18醫(yī)療學(xué)識(shí)操作步驟PROCEDURALSTEPS5.放牙墊，退喉鏡.確定位置后，妥善固定導(dǎo)管與牙墊．注套囊空氣(3-5m1).inflatethecuffandapplypositivepressureventilationwhiletheassistantauscultates.Securetheendotrachealtubeinposition。19醫(yī)療學(xué)識(shí)操作步驟PROCEDURALSTEPS19醫(yī)療學(xué)識(shí)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(dòng)過(guò)緩Bradycardia20醫(yī)療學(xué)識(shí)并發(fā)癥Complications20醫(yī)療學(xué)識(shí)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(xué)識(shí)并發(fā)癥Complications21醫(yī)療學(xué)識(shí)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(jìn)入，便于吸痰和積血。⒉便于進(jìn)行人工和機(jī)械通氣，用于呼衰、復(fù)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(xué)識(shí)氣管內(nèi)插管術(shù)（ENDOTRACHEALINTUBATION

Laryngoscopes23醫(yī)療學(xué)識(shí)L

Trachealtubes24醫(yī)療學(xué)識(shí)T

Anatomyofthroat25醫(yī)療學(xué)識(shí)

Anatomyofbronchus26醫(yī)療學(xué)識(shí)A

Themaneuoverofliftingmandible27醫(yī)療學(xué)識(shí)Thema

Vocalgateexposurebycurvedlaryngoscope28醫(yī)療學(xué)識(shí)Vocalgateexposur

Vocalgateexposurebystraightlaryngoscope29醫(yī)療學(xué)識(shí)Vocalgateexposure

Blindintubationthroughnasalcavity30醫(yī)療學(xué)識(shí)Blindintubationth經(jīng)鼻盲插管圖31醫(yī)療學(xué)識(shí)經(jīng)鼻盲插管圖31醫(yī)療學(xué)識(shí)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(zhǎng)時(shí)間充氣壓迫，局部粘膜和纖毛缺血，粘膜脫落。纖毛活動(dòng)停止３~５天，局部潰瘍，軟骨軟化，壞死。32醫(yī)療學(xué)識(shí)氣管內(nèi)插管的并發(fā)癥（Complications)32醫(yī)療學(xué)識(shí)確認(rèn)1.壓胸有氣流。

2.人工通氣：雙側(cè)胸廓對(duì)稱(chēng)，聽(tīng)雙肺肺泡呼吸音。3.吸氣管壁清亮：呼氣時(shí)有白霧。4.自主呼吸時(shí)，呼吸囊隨呼吸張縮5.ETCO2：最科學(xué)33醫(yī)療學(xué)識(shí)確認(rèn)1.壓胸有氣流。33醫(yī)療學(xué)識(shí)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(dǎo)時(shí)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(yù)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(hù)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(xué)識(shí)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(xué)第一附屬醫(yī)院麻醉科氣管插管術(shù)新疆醫(yī)科大學(xué)第一附屬醫(yī)院麻醉科Contents定義及概述1適應(yīng)癥及禁忌癥2操作3并發(fā)癥437醫(yī)療學(xué)識(shí)Contents定義及概述1適應(yīng)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(dǎo)管經(jīng)聲門(mén)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(xué)識(shí)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(guò)鼻腔或口腔，經(jīng)過(guò)咽喉、聲門(mén)、把插管插到氣管或總支氣管內(nèi)。39醫(yī)療學(xué)識(shí)呼吸道解剖Anatomy4醫(yī)療學(xué)識(shí)40醫(yī)療學(xué)識(shí)5醫(yī)療學(xué)識(shí)適應(yīng)癥Indications心跳、呼吸驟停。Cardiacorrespiratoryarrest喪失氣道保護(hù)功能者。Failuretoprotecttheairway嚴(yán)重呼吸衰竭不能滿(mǎn)足機(jī)體通氣和氧供需要需機(jī)械通氣者。Inadequateoxygenationorventilation41醫(yī)療學(xué)識(shí)適應(yīng)癥Indications心跳、呼吸驟停。6醫(yī)療學(xué)識(shí)適應(yīng)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(hù)理需要。Careofcriticallyillpatientswithmulti-systemdiseaseorinjuries.外科手術(shù)麻醉需要。Controloftheairwayinsurgicalproceduresrequiringgeneralanesthesia.42醫(yī)療學(xué)識(shí)適應(yīng)癥Indications即將發(fā)生或已發(fā)生的氣道阻塞7禁忌癥Contraindications無(wú)絕對(duì)禁忌癥，以下所列為相對(duì)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(jìn)食腐蝕性物質(zhì)Ingestionofcausticsubstances下顎骨折Mandibularfractures喉頭水腫Laryngealedema燙傷或化學(xué)藥劑灼傷Thermalorchemicalburns43醫(yī)療學(xué)識(shí)禁忌癥Contraindications無(wú)絕對(duì)禁忌癥，以下所插管前準(zhǔn)備Equipmentpreparation1.氣管導(dǎo)管導(dǎo)管的選擇Sizeofendotrachealtube按導(dǎo)管的內(nèi)徑計(jì)算internaldiameter(ID)男性Male:ID8.0mms女性Female:ID7.5mms

44醫(yī)療學(xué)識(shí)插管前準(zhǔn)備Equipmentpreparation1.氣管插管前準(zhǔn)備Equipmentpreparation

兒童的導(dǎo)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(xué)識(shí)插管前準(zhǔn)備Equipmentpreparation兒童插管前準(zhǔn)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(xué)識(shí)插管前準(zhǔn)備Equipmentpreparation插管插管前準(zhǔn)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(xué)識(shí)插管前準(zhǔn)備Equipmentpreparation2.喉插管前準(zhǔn)備Equipmentpreparation操作前務(wù)必檢查喉鏡是否明亮48醫(yī)療學(xué)識(shí)插管前準(zhǔn)備Equipmentpreparation操作前務(wù)插管前準(zhǔn)備Equipmentpreparation其他Otherequipments導(dǎo)絲Stylet

手套Gloves吸痰器SuctionDevice5ML注射器syringe固定器Endotrachealtubeholder49醫(yī)療學(xué)識(shí)插管前準(zhǔn)備Equipmentpreparation其他操作步驟PROCEDURALSTEPS

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

Positionbedheighttobringthepatient'sheadtoamid-abdominalheight.Flexthecervicalspineandextendtheheadattheatlanto-occipitaljoint.Longaxisoftheoralcavity,pharynx,andtrachealiealmostinastraightline.50醫(yī)療學(xué)識(shí)操作步驟PROCEDURALSTEPS1．仰臥，頭墊51醫(yī)療學(xué)識(shí)16醫(yī)療學(xué)識(shí)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(dá)舌根與會(huì)厭交界處，上提喉鏡，撬起會(huì)厭,顯露聲門(mén)。advancethelaryngoscopeuntiltheepiglottisisinview.52醫(yī)療學(xué)識(shí)17醫(yī)療學(xué)識(shí)操作步驟PROCEDURALSTEPS

4.右手以握筆式手勢(shì)持氣管導(dǎo)管，插過(guò)聲門(mén),進(jìn)入氣管。liftthelaryngoscopeupwardandforward.Inserttheendotrachealtubefromtherightwithitsconcavecurvefacingdownwardandtotherightsideofthepatient.Maneuvertheendotrachealtubeintothelarynx,midwaybetweenthecricoidcartilageandthesternalangle

53醫(yī)療學(xué)識(shí)操作步驟PROCEDURALSTEPS18醫(yī)療學(xué)識(shí)操作步驟PROCEDURALSTEPS5.放牙墊，退喉鏡.確定位置后，妥善固定導(dǎo)管與牙墊．注套囊空氣(3-5m1).inflatethecuffandapplypositivepressureventilationwhiletheassistantauscultates.Securetheendotrachealtubeinposition。54醫(yī)療學(xué)識(shí)操作步驟PROCEDURALSTEPS19醫(yī)療學(xué)識(shí)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(dòng)過(guò)緩Bradycardia55醫(yī)療學(xué)識(shí)并發(fā)癥Complications20醫(yī)療學(xué)識(shí)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(xué)識(shí)并發(fā)癥Complications21醫(yī)療學(xué)識(shí)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(jìn)入，便于吸痰和積血。⒉便于進(jìn)行人工和機(jī)械通氣，用于呼衰、復(fù)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(xué)識(shí)氣管內(nèi)插管術(shù)（ENDOTRACHEALINTUBATION

Laryngoscopes58醫(yī)療學(xué)識(shí)L

Trachealtubes59醫(yī)療學(xué)識(shí)T

Anatomyofthroat60醫(yī)療學(xué)識(shí)