超声在气道管理中的应用剖析.ppt

临床应用6—定位气管切开 Real-time ultrasound-guided percutaneous dilatational tracheostomy: a feasibility study Percutaneous tracheostomy performed under real-time ultrasound guidance is feasible and appears accurate and safe, including in patients with morbid obesity and cervical spine precautions. Venkatakrishna Rajajee, Jeffrey J Fletcher, Lauryn R Rochlen, et al. Critical Care 2011, 15:R67 临床应用6—定位气管切开 Traditional landmark versus ultrasound guided tracheal puncture during percutaneous dilatational tracheostomy in adult intensive care patients: a randomised controlled trial Ultrasound guidance significantly improved the rate of first-pass puncture and puncture accuracy. Fewer procedural complications were observed; however, this did not reach statistical significance. These results support wider general use of real-time ultrasound guidance as an additional tool to improve PDT. Máté Rudas, Ian Seppelt, Robert Herkes,et al. Critical Care 2014, 18:514 临床应用6—定位气管切开 临床应用6—定位气管切开 其他的临床应用1—迅速准确建立通气 Mallin M, Curtis K, Dawson M,et al. Am J Emerg Med 2014 Jan;32(1):61-3. Accuracy of ultrasound-guided marking of the cricothyroid membrane before simulated failed intubation Ultrasound marking of the CTM of healthy volunteers before simulated intubation accurately identifies the CTM after neck manipulation expected during a failed intubation. 其他的临床应用2—改良Sellick法 其他的临床应用3—耐受插管 Advanced Diagnostic Bronchoscopy Using Conscious Sedation and the Laryngeal Nerve Block: Tolerability, Thoroughness, and Diagnostic Yield Goyal G,Pisani MA,Murphy TE,et al. Lung (2014) 192:905–913 如何更好耐受长期气管插管？ 或许喉上神经阻滞是一个选择 1.清醒插管—超声引导喉上神经阻滞和环甲膜穿刺 过拱桥，甲舌膜里寻喉上 越尖峰，缺口伪影环甲膜 总 结 4. 判断气管导管的位置—环甲膜 气管插管进行时更敏感 5. 判断喉罩位置—蝴蝶征 6. 定位气管切开—准确定位、避免损伤 7. 迅速建立紧急通气—超声引导环甲膜穿刺 8. 改良Sellick法—向左后方压迫环状软骨 2. 判断喉镜显露困难—颈前部软组织厚度 3. 选择气管导管型号—气管最小内径 * . * * 上海市第六人民医院 Shanghai Sixth People’s Hospital 上海市第六人民医院 Shanghai Sixth People’s Hospital 上海市第六人民医院 Shanghai Sixth People’s Hospital 上海市第六人民医院 Shanghai Sixth People’s Hospita