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气管内导管的管理和并发症

Authors
Kristy A Bauman, MD
Robert C Hyzy, MD
Section Editor
Scott Manaker, MD, PhD
Deputy Editor
Geraldine Finlay, MD
Translators
范红, 教授

引言

气管内导管(endotracheal tube, ETT)管理的主要目标是预防并发症。然而，尽管进行了适当的管理，不良事件仍然偶有发生。临床医生必须准备好识别并处理这类并发症。

本专题将总结ETT管理的几个基本方面，包括定位、套囊压力和吸引。也将论述气管插管相关的并发症。气管造口术将单独讨论。 (参见“气管切开术概述”)

插管并发症

插管过程的并发症是常见的。在一项纳入超过3400例急诊插管的病例系列研究中，困难插管的发生率为10%[1]。其中4%的患者发生了气道相关性并发症，包括误吸、食管插管、牙损伤及气胸。插管并发症的独立危险因素包括：3次或以上插管尝试，在普通病房或急诊室插管，以及Ⅲ或Ⅳ级气道显露(图 1)。73%的插管中使用了神经肌肉阻滞。

插管集束化护理可能有助于降低插管后并发症的发生率[2]。这类干预集束可能需要2名操作人员在场，进行预吸氧，血管内容量负荷测定(除非存在心源性水肿)，快速顺序插管技术，以及置管后二氧化碳图。

定位

经口气管插管法是插入ETT最常见的方法[3]。经鼻气管插管也可能使用，但远为少见。不管是采用经口还是经鼻气管插管，评估插管后ETT位置的方法都是一样的：

                    

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Literature review current through: 2017-07 . | This topic last updated: 2017-03-06.
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