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全麻快速顺序诱导插管

Author
Lauren Berkow, MD
Section Editor
Carin A Hagberg, MD
Deputy Editor
Marianna Crowley, MD
Translators
伍静, 副主任医师，副教授

引言

全麻快速顺序诱导插管(rapid sequence induction and intubation,RSII)是一种用于误吸风险较高的患者中以最小化发生肺误吸机会的技术。通常使用的全麻非快速顺序诱导插管包括以下步骤：给予诱导药物、证实能够用面罩通气、使用神经肌肉阻断药(neuromuscular blocking agent, NMBA)，一旦肌松后即行气管内插管(通常大约为诱导之后3min)。由于麻醉诱导会使得气道失去保护性的反射，故而在患者失去意识与气管内导管套囊充气的这段时间中，患者有肺误吸的风险。

RSII使用带套囊的气管内导管在诱导后尽快保护气道，并减少主动或被动反流的可能性。RSII的基本目标是取得足够深的麻醉，最常见的目标是达到足够的肌松以利于喉镜镜检，并预防气道操作时发生咳嗽、肌肉收缩及活动性呕吐。

虽然RSII与常规的麻醉诱导有所不同，但与其等同的快速气道控制是急诊室控制气道的最常用方法，通常被称为“快速顺序插管(rapid sequence intubation, RSI)”。

本专题将讨论全麻RSII的组成部分、技术和相关药物。术前禁食的指南、麻醉诱导的气道管理、急诊科中的RSI，以及用于麻醉诱导的药物将单独进行更全面的讨论。 (参见“全身麻醉诱导”和“术前禁食指南”和“全身麻醉诱导的气道管理”和“手术室外成人快速诱导气管插管”)

适应证

一般指征 — 对于麻醉诱导期间误吸风险增加的患者，应考虑进行RSII。这包括饱胃、合并胃肠道病变、腹内压增高或妊娠20周以上的患者(表 1)：

                                       

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-17.
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