经口明视气管内插管气流征象临床观察

The Clinical Observation of Air Current Signs in Endotracheal Intubation through Mouth

目的：观察气流征象检测气管内插管成功与否的实用性和可靠性。方法：选择较为标准的国人,剔除特别高大、矮小、肥胖、肢端肥大症、困难插管患者,100例ASAⅠ～Ⅱ级气管内麻醉患者,选择合适的导管,静脉快速诱导,普通弯喉镜片明视气管内插管。插管时看到导管插入声门,导管气囊后缘进入声门再进约1～2 cm停止进管,导管气囊充气,快速按压胸骨,耳听导管内是否有气流声及强弱,接麻醉机,检测潮气量大小,手控呼吸,观察呼末二氧化碳,听诊器听诊双肺和剑突下,确定导管在气管内。结果：100例插管成功病例,男女气流征阳性者91例,阳性率91%。其中73%为强阳性,潮气量在61～64 mL左右;弱阳性为18%,潮气量在19～22 mL左右,部分病例只能听到气流声音,而测不到潮气量;阴性者只占9%。结论：气流征可以作为确定气管内插管成功的标准之一,且最为快捷,简便易行,没有口咽腔、呼吸道组织损伤,可反复操作,操作性、实用性强,具有一定的可靠性。

Objective： To observe the practicability and dependability of air current signs in check the result of endotracheal intubation. Method： 100 cases of ASA I-Ⅱ who underwent endotracheal anesthesia were chosen, and the patients with too tall, too small, too fat, acromegaly and hard to intubation were excluded.Rapid sequence induction, endotracheal intubation by common bending laryngoscope. Looking steadily at the tuba, continue enter 1-2 cm and stop when the airbag posterior border get into glottis, gasing, quickly press the sternum, check the signs of air current in tube by our ears, connect to anesthetic machine, check the tidal volume by anaeshetic machine, manual control, observe etC02, auscultation with stethoscope two lungs and stomach to make sure the tube was get into the trachea.Result： 91 cases （ 91% ）were positive, 73 cases （ 73% ）were strong positive and the tidal volume was 61-64 mL; 18 cases （ l8% ） were weak positive and the tidal volume was about 19-22 mL, some cases only hear the signs of air current and no tidal volume; 9 （ 9% ） cases were negative.Conclusion ： The signs of air current in tube can be one of standard to make sure the success endotracheal intubation, shortcut, easy to do, no tissue damage on cavum oropharyngeum and respiratory tract, can operate repeatedly, has certainly practicability and dependability.