Page 19 - 麻醉与监护论坛2015年第6期

Review and CME Lecture

在建立安全气道或患者清醒前，这种方法能够提供暂时 4．盲探技术具有一定的失败率，并可导致气道组织损伤。
的有效肺通气。具体操作是一人采用双手紧闭面罩，另一人
挤压通气环路的呼吸囊，必要时可能还需要另外一个人协助 5．如果可能，让患者清醒，并延期手术。
实施托下颌操作[1]。
6．如果在应用肌肉松弛药的患者发生气管插管失败、
（2）喉罩通气道通气
对于非预知性困难气管插管，喉罩通气道是维持通气的 低氧血症进行性加重，并且通气困难，首先采用双手面罩通
极好设备。在气管插管困难时它能够替代气管插管，而且对
通气和气管插管同时发生困难的窘境也极为有用[15]。 气技术或/和喉罩通气道获得满意地通气。如果这些方法失

六、指南和处理方案 败，则需采用有创通气技术，例如套管穿刺环甲膜切开术。

虽然小儿困难气管插管相对少见，但是仍需制定一个在 7．采用套管穿刺环甲膜切开术建立紧急气道时需要带有
紧急情况下容易遵守的清晰、简洁操作指南。虽然目前许多
国家均有成年人困难气道处理指南，但是至今仅有一个小儿 减压阀的高压通气气源。
困难气道处理指南[25]。因此，仍然需要以困难气道协会颁布
的成年人困难气道处理指南为模式[26]，制定一套针对小儿麻 8．需要对上述技术进行培训。
醉实践的清晰、简洁困难气道处理指南。该指南文件应列出
一系列有相应备用处理方案的流程图，因为目前尚无任何一 在颁布清晰、简洁的小儿困难气道处理指南之前，遵循
项技术能够保证在所有情况下均获得成功。笔者概括了几条
同样适用于小儿的困难气道处理原则（图11）： 成年人困难气道处理指南的基本原则是合理的。麻醉医师必

【基本处理原则】[1] 须获得处理非预知性困难气道的经验，并练习处理气管插管
1．维持氧合和通气是首要的问题。
2．硬质喉镜显露应在最佳条件下进行尝试。 失败的技能和紧急氧合的操作技术。每个麻醉科均应培训这
3．多次或长时间喉镜显露尝试常常可导致并发症，而且
在光导纤维支气管镜检查或拔管前并发症的表现可能并不明 些急救技能，并可采用现代化模拟人进行仿真演习。
显。因此，应限制喉镜显露尝试不超过4次。
七、结论
图11 常规麻醉诱导中非预知性困难气管插管的处理流程图
Figure11 Flow charts of the processing of unanticipated difficult 预知的和非预知的小儿困难气管插管的处理均需要预先

intubation in the routine anesthesia induction 的计划和培训，并且这种培训应该是所有小儿麻醉医师优先

考虑的问题。

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