经鼻盲探气管插管术在创伤院前急救中的应用徐尚刚 梁隆斌 罗 斌 余明海 王 媛 刘 礼四川省成都市铁路中心医院急诊科(610081) 【摘要】 目的 强调经鼻盲探气管插管术在院前急救中的重要性。
方法 对我院院前急救中采用经鼻盲探气管插管(BNTI)42例病人的插管指征、时机及影响插管的因素进行回顾性分析。
结果 42例病人在院前急救中均成功进行BNTI,患者有无意识障碍对一次插管成功率有影响。
结论 BNTI在院前急救中能有效的解除患者的通气障碍,为患者提供了基本的生命支持,是挽救患者生命的重要手段。
【关键词】 经鼻盲探气管插管术;院前急救;创伤 随着人类现代文明的高速发展,创伤的发生也在逐年增加,在我国创伤致死居死因第4位。
严重创伤患者的急诊救治包括紧急处理危及生命的外科急症和为明确诊断而实施的有针对性的辅助检查。
因此,在院前急救中为争取救治时间、保障重要脏器功能、确保各项救治工作的顺利进行,有效的呼吸支持是不容忽视的重要环节。
我院急诊科2006年10月至2008年3月院前急救中采用BNTI的创伤患者42例的应用体会总结如下。
1 资料与方法1.1 临床资料:全部42例患者到现场均存在自主呼吸。
其中男27例,女15例,年龄14～70岁,平均32岁。
颅脑损伤11例,腹部损伤10例,胸腹联合伤6例,坠落伤4例,颈椎损伤7例,烧伤3例,电击伤1例。
无意识障碍27例,有意识障碍15例。
创伤评分(traumascore,TS)<6分3例,6～8分8例,9～10分13例,11～12分18例。
1.2 方法:根据患者的情况选择不同规格的气管导管。
无意识障碍的病人先做插管思想工作。
插管前用1%的丁卡因和麻黄素混合液行喷雾器表面麻醉(紧急情况下可不予麻醉)。
导管润滑剂充分润滑。
患者仰卧,左手调整头部体位,右手持导管,左耳倾听导管内气流。
经一侧鼻孔缓慢推进导管,到达声门时能明显听到较强气流声;4例导管出后鼻孔达咽部套囊充气15ml,依靠气流的强弱来判断导管前端位置,当气流较强时提示导管前端达声门,此时迅速抽出套囊内气体,缓慢推进导管成功。
不同剂量右美托咪定用于清醒经鼻盲探气管插管的效果曹丙玉【期刊名称】《国际医药卫生导报》【年(卷),期】2011(17)2【摘要】目的观察不同剂量右美托咪定用于清醒经鼻肓探气管插管的效果.方法择期气管插管全麻下行手术病人51例,年龄32～46岁,ASA Ⅰ～Ⅱ级,所有病人均无心、脑血管疾病.随机分为单纯表面麻醉组(S组)、表面麻醉+右美托咪定0.5μg/kg组(D1组)和表面麻醉+右美托咪定1.0 μg/kg组(D2组),每组17例.三组病人均用1%丁卡因行鼻腔、咽喉,及气管粘膜表面麻醉,D1组和D2组将盐酸右美托咪定注射液(艾贝宁批号10061434国药准字H20090248江苏恒瑞医药股份有限公司)用0.9%的氯化钠溶液稀释至浓度4μg/ml后缓慢静注,输注时间15min.1 min后行经鼻肓探气管捅管.记录入室后麻酢前(T0)、插管前即刻(T1)、气管导管插入鼻腔即刻(T2)、气管导管越过声门插入气管即刻(T3)的MAP、HR、SpO2;记录插管过程中有无恶心、呛咳、躁动等插管反应;术后随访病人对插管过程的知晓情况.结果与T0比较,S组T2、T3时MAP及HR明显升高,差异具有显著性(P<0.05); D1组T1时MAP明显降低,T3时MAP及HR却明显升高,差异均有显著性(P<0.05); D2组T1、T2及T3时MAP均明显降低,T1时HR明显降低,差异均有显著性(P<0.05).与D1组、D2组比较,S组T1、T2及T3时MAP、HR均明显高于D1组、D2组,而T3时SpO2明显低于D1组、D2组差异均有极显著性(P<0.01);与D1组比较,D2组T1、T2及T3时MAP均明显降低,D2组T2、T3时HR明显降低,差异具有显著性(P<0.05).与S组比较,D1组呛咳、躁动及插管知晓发生率明显减少,差异有显著性(P<0.05); D2组恶心、呛咳、躁动及插管知晓发生率明显减少,差异有极显著性(P<0.01);与D1组比较,D2组恶心、呛咳、躁动及插管知晓发生率明显减少,差异有显著性(P<0.05).结论在表面麻醉的基础上,缓慢静注右美托咪定1.0 μg/kg可为施行清醒经鼻盲探气管插管提供良好的条件,是安全、有效的.%Objective To investigate the effect of different doses of dexmedetomidine for conscious blind nasotracheal intubation. Methods Fifty-one ASA?～? patients undergoing general anesthesia for elective surgery were randomly divided into 3 groups.The type of anesthesia for tracheal intubation (n = 17 each ): group ? received surface anesthesia only; group ? and ? received dexmedetomidine 0.5 or 1.0 礸/kg on top of surface anesthesia. All patients received surface anesthesia of nasal cavity, pharynx and larynx, trachea with 1% tetracaine. In group ? and group ? Dexmedetomidine 燞 ydrohloride 營 njection (batch number 10061434, approved number H20090248, produced by Jiangsu HengRui pharmaceutical Co., LTD) was diluted reach to 4 μ g/ml with the 0.9% sodium chloride solution. Then Dexmedetomidine 0.5 or 1.0 礸/kg Ⅳ 15 min. 1 min later conscious blind nasotracheal intubation was operated. MAP, HR and SpO2 were continuously monitored and recorded before anesthesia (T0), before trachea cannula (T1), when tracheal tube was inserted into nasal (T2) and advanced through vocal cords into trachea (T3). Responses like nausea,coughing and restlessness were also recorded. The patient 抯 awareness of the intubation was noted after operation. Results MAP and HR were significantly increased at T2 and T3, compared with them at T0 in group ?(P＜ 0.05). MAP was significantly decreased at T1, compared with it at T0 (P＜ 0.05); while MAP and HR were significantlyincreased at T3, compared with then at T0 in group Ⅱ (P＜ 0.05).MAP was significantly decreased at T1 、 T2and T3, compared with it at T0 (P＜0.05);and HR was significantly decreased at T1,compared with it at T0 (P＜0.05) in group ?. MAP and HR were significantly increased at T1、 T2 and T3 in group ?, compared with them in group ? and ? (P＜ 0.01). SpO2 was significantly decreased at T3in group ?,compared with it in group ? and ? (P＜ 0.01). MAP was significantly decreased at T1 、T2and T3 ingroup ?,compared with it in group ? (P＜ 0.05). HR was significantly decreased at T2and T3 in group ? ,compared with it in group ? (P＜ 0.05). The incidence of coughing, restlessness and awareness of the intubation were significantly lower in group ? than in group ? (P＜ 0.05). The incidence of nausea coughing, restlessness and awareness of the intubation were significantly lower in group ? than in group ? (P＜ 0.01). The incidence of nausea, coughing, restlessness and awareness of the intubation were significantly lower in group ? than in group ? (P＜ 0.05). Conclusion Dexmedetomidine 1.0 礸/kg given via Ⅳ slowly on top of surface anesthesia with 1% tetracaine can provide a good intubation condition with less intubation response for conscious blind nasotracheal intubation. It抯 safe and effective.【总页数】4页(P192-195)【作者】曹丙玉【作者单位】271200,新泰市人民医院麻醉科【正文语种】中文【相关文献】1.右美托咪定用于患者清醒经鼻盲探气管插管的效果 [J], 陈永学;李红;苑进革;程艳欣;赵森明;徐贯杰2.右美托咪定和咪唑安定复合芬太尼用于清醒经鼻盲探气管插管的比较 [J], 张霞;白晓峰;周青;张倩3.右美托咪定复合芬太尼在清醒经鼻盲探气管插管中的应用效果比较 [J], 张梁4.右美托咪定和咪唑地西泮复合瑞芬太尼用于清醒经鼻盲探气管插管的比较 [J], 姚林川;颜玉桦;刘睿5.右美托咪定和咪唑地西泮复合瑞芬太尼用于清醒经鼻盲探气管插管的比较 [J], 姚林川;颜玉桦;刘睿因版权原因，仅展示原文概要，查看原文内容请购买。
