经环状软骨下区逆行导引插管术用于困难气管插管的效果观察  

The observation of Retrograde intubation using the subcricoid Region in difficult tracheal Intubation cases

作　　者：龚玉华[1] 于建设[1] 解雅瑛 赵丽云[1] 吴曼[1] 温再和[1] 丁翠霞[1] 

机构地区：[1]内蒙古医学院附属医院麻醉科,内蒙古呼和浩特010050

出　　处：《内蒙古医学杂志》2000年第4期257-258,共2页Inner Mongolia Medical Journal

摘　　要：目的 :探讨经环状软骨下区逆行气管插管的效果。方法 :常规颈部皮肤消毒 ,用食指和中指将环状软骨固定 ,在其下缘中点刺入 ,有气泡溢出证明穿刺针进入气管内 ,针与皮肤成 45°角 ,针口指向喉侧 ,将导引管经硬膜外穿刺针进入气管通过喉经口或鼻腔拉出 ,然后将导引管通过气管导管将两端拉紧 ,缓慢将气管导管顺导引管推入口喉 ,进而进入气管内 ,完成气管插管。结果 :2 2例病人中 ,2 1例均成功完成气管插管 ,1例失败 ,均无并发症。结论 :经环软骨下区逆行气管插管用于困难气管插管安全可行 ,优于其它方法。Objective:To discuss the practice of retrograde intubation using subcricoid region.Methods:The skin is prepared using routine procedure.The index and middle fingers are placed in the cricothyroid and subcricoid groove and the cricoid cartilage is steadied between the tow fingers.The cricoid and Subcricoid areas are infiltrated with local anesthetic.The extradual needle is held perpendicular to the cricoid cartilage and inserted until it touches the cricoid cartilage.The needle is passed downwards until it slips below the inferior border of cricoid cartilage,when it passed backwards another 6 mm inside the trachea by piercing the cricotracheal ligment,The presence of the tip of the needle inside the trachea is confirmed by aspiration of the air from the trachea,The needle is angled 45°to the skin,with the beveled tip directed toward the larynx.The catheter is passed through the extradual needle.The catheter emerges from and is evident in the pharynx or back of the mouth,or may emerge through the nose.The catheter from the pharynx is retrieved.The catheter tip is passed through tracheal held taut by pulling at both ends.The tracheal tube and the attached catheter are held taut and gently lowered into the larynx and trachea by pulling the catheter from the subcricoid region at the skin entrance.Correct positioning of the tracheal tube inside the trachea is comfirmed by auscultation.Results:Among 22 cases.21 cases were successful and l case failed and no serious complication was caused.Conclusion:Retrograde intubation using the subcricoid region is valuable in clinical practice and a safe alternative for difficult intubation. [

关 键 词：逆行气管插管 环状软骨下区 困难气管插管 麻醉 

分 类 号：R614.2[医药卫生—麻醉学]