氣管內插管的

1絕jue對禁忌: 喉頭水腫 ， 急(ji)性喉hou炎，喉頭粘膜下，插(cha)管(guan)(guan)損傷(shang)可引起嚴重出血;除非急(ji)救，禁忌氣管(guan)(guan)內插(cha)管(guan)(guan)。

2相對(dui)(dui)禁忌(ji): 呼吸道(dao)(dao)不(bu)全梗(geng)阻者有插(cha)(cha)管(guan)(guan)適(shi)應癥，兒童氣(qi)管(guan)(guan)插(cha)(cha)管(guan)(guan)，但禁忌(ji)快(kuai)速(su)誘導插(cha)(cha)管(guan)(guan)。并存血xue液病(如血友病，血小(xiao)板減少性(xing)等)者。插(cha)(cha)管(guan)(guan)損傷易(yi)誘發喉頭(tou)聲門或氣(qi)管(guan)(guan)粘膜下出血或，繼發呼吸道(dao)(dao)急(ji)性(xing)梗(geng)阻，一次性(xing)使(shi)用(yong)氣(qi)管(guan)(guan)插(cha)(cha)管(guan)(guan)包，因此宜(yi)列(lie)為(wei)(wei)相對(dui)(dui)禁忌(ji)證。主動(dong)月永瘤壓迫氣(qi)管(guan)(guan)者，插(cha)(cha)管(guan)(guan)可能導致(zhi)主動(dong)月永瘤，宜(yi)列(lie)為(wei)(wei)相對(dui)(dui)禁忌(ji)證。麻ma醉者對(dui)(dui)插(cha)(cha)管(guan)(guan)基(ji)本知(zhi)識未掌握，插(cha)(cha)管(guan)(guan)技術不(bu)熟練或插(cha)(cha)管(guan)(guan)設(she)備不(bu)完善者，江(jiang)門氣(qi)管(guan)(guan)插(cha)(cha)管(guan)(guan)，均宜(yi)列(lie)為(wei)(wei)相對(dui)(dui)禁忌(ji)證。

借助(zhu)喉鏡在直視下(xia)暴露(lu)聲門后(hou)，將導管經(jing)口(kou)腔插入氣管內。

1.將(jiang)頭后仰(yang)，雙(shuang)手(shou)將(jiang)下(xia)頜向(xiang)前、向(xiang)上(shang)托起以(yi)使口張開，或以(yi)右手(shou)拇指(zhi)(zhi)對(dui)著(zhu)下(xia)齒列、示指(zhi)(zhi)對(dui)著(zhu)上(shang)齒列，借旋轉力量使口腔張開。

2.左手(shou)持喉鏡柄將(jiang)喉鏡片由(you)右(you)口角放入口腔，將(jiang)舌體推(tui)向(xiang)側后緩慢推(tui)進，可見到懸雍(yong)垂。將(jiang)鏡片垂直提(ti)起(qi)前(qian)進，直到會厭顯露。挑起(qi)會厭以顯露聲門。 

3.如(ru)采用(yong)(yong)彎鏡(jing)(jing)片(pian)(pian)插管(guan)(guan)(guan)(guan)(guan)(guan)(guan)則(ze)將(jiang)(jiang)鏡(jing)(jing)片(pian)(pian)置于(yu)會(hui)厭(yan)(yan)與舌(she)(she)根交界(jie)處(會(hui)厭(yan)(yan)谷(gu))，用(yong)(yong)力向前上(shang)方提起，使舌(she)(she)骨會(hui)厭(yan)(yan)韌帶緊張，會(hui)厭(yan)(yan)翹(qiao)起緊貼喉(hou)鏡(jing)(jing)片(pian)(pian)，即顯(xian)露聲(sheng)門(men)(men)(men)(左圖(tu))。如(ru)用(yong)(yong)直鏡(jing)(jing)片(pian)(pian)插管(guan)(guan)(guan)(guan)(guan)(guan)(guan)，應直接(jie)挑起會(hui)厭(yan)(yan)，聲(sheng)門(men)(men)(men)即可顯(xian)露(右圖(tu))。 顯(xian)露聲(sheng)門(men)(men)(men)4.以右手拇指(zhi)、食指(zhi)及(ji)中(zhong)指(zhi)如(ru)持筆式(shi)持住導(dao)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)的中(zhong)、上(shang)段(duan)，由右口角進入(ru)口腔，直到導(dao)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)接(jie)近喉(hou)頭時(shi)再(zai)將(jiang)(jiang)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)端移至喉(hou)鏡(jing)(jing)片(pian)(pian)處，同時(shi)雙目經過鏡(jing)(jing)片(pian)(pian)與管(guan)(guan)(guan)(guan)(guan)(guan)(guan)壁間(jian)的狹窄(zhai)間(jian)隙(xi)監(jian)視導(dao)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)前進方向，準確輕巧地(di)將(jiang)(jiang)導(dao)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)插入(ru)聲(sheng)門(men)(men)(men)。借助管(guan)(guan)(guan)(guan)(guan)(guan)(guan)芯插管(guan)(guan)(guan)(guan)(guan)(guan)(guan)時(shi)，當導(dao)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)入(ru)聲(sheng)門(men)(men)(men)后，應拔出管(guan)(guan)(guan)(guan)(guan)(guan)(guan)芯后再(zai)將(jiang)(jiang)導(dao)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)插入(ru)氣(qi)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)內。導(dao)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)插入(ru)氣(qi)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)內的深度成人為4~5cm，導(dao)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)至門(men)(men)(men)齒的距離約18~22cm。

氣管內插管的并發fa癥(zheng)

1.插管(guan)操作技術(shu)不規(gui)范(fan)，嬰兒氣管(guan)插管(guan)，可致(zhi)牙齒(chi)損傷(shang)或脫落，口腔、咽喉部和(he)鼻(bi)腔的粘膜損傷(shang)引起出血。用(yong)力不當或過猛(meng)，還可引起下頜關節tuo脫位。

2.淺麻ma醉(zui)下氣(qi)(qi)管(guan)內插管(guan)可引起劇(ju)烈嗆咳、喉(hou)頭及支氣(qi)(qi)管(guan)痙攣;心率增快及血(xue)壓(ya)劇(ju)烈波動而導致心肌缺血(xue)。嚴重(zhong)的(de)迷走神經(jing)反射(she)可導致心律(lv)lv失常，甚至心跳驟停(ting)。預防方(fang)法有:適當加深麻ma醉(zui)，插管(guan)前行喉(hou)頭和氣(qi)(qi)管(guan)內表面麻ma醉(zui)，應(ying)用麻ma醉(zui)性鎮zhem痛(tong)藥或短(duan)效降jiang壓(ya)藥等。