头颈部创伤患者气道管理的研究进展

Research Progress on Airway Management in Patients with Head and Neck Trauma

在线阅读下载PDF

导出

摘要头颈部创伤对气道安全的威胁最大,其中创伤性脑损伤和喉气管创伤最具代表性。采用轴线稳定手法可防止创伤性脑损伤合并颈髓损伤患者气管插管时继发性颈髓损伤;饱胃患者建议使用快速序贯诱导插管和环状软骨按压,能有效预防反流误吸;BURP手法能在困难气道时改善喉镜视野,提高插管成功率;喉气管创伤现场即刻死亡率大于75%,纤维支气管镜和计算机断层扫描可明确诊断喉气管创伤,判断气管的完整性。头颈部创伤患者应根据创伤部位、程度和手术选择更合适的气管插管入路。避免缺氧是创伤气道管理的根本目标和出发点,体外膜肺氧合是解决创伤患者氧合问题的终极手段,但创伤性脑损伤患者使用体外膜肺氧合仍存在争议。本研究拟就头颈部创伤气道管理的研究进展进行综述,以期为临床医师提供理论与实践性参考。 Traumatic brain injury(TBI)and laryngotracheal trauma(LTT)in head and neck trauma(HNT)are the most significant threats to airway safety.Manual in-line stabilization(MILS)can prevent secondary cervical spinal cord injury during endotracheal intubation in patients with TBI and cervical spinal cord injury(CSCI).Rapid sequential induction intubation(RSII)and cricoid compression are recommended to prevent reflux and aspiration in full stomach patients.Manual BURP can improve laryngoscope field of view in difficult airway and increase the success rate of intubation.The immediate mortality rate of LTT is greater than 75%.Fiberbronchoscopy and computerized tomography(CT)can clearly diagnose LTT and judge the integrity of trachea.Patients with HNT can choose more appropriate endotracheal intubation approach according to the site,degree of trauma and operation.Avoiding hypoxia is the fundamental goal and starting point of traumatic airway management,and extracorporeal membrane oxygenation(ECMO)is the last resort to solve the problem of oxygenation for traumatic patients,but the use of ECMO in TBI patients is still controversial.This study reviews the research progress on airway management in HNT,in order to provide theoretical and practical reference for clinicians.

作者梁汉生李清月 LIANG Hansheng;LI Qingyue(Department of Anesthesiology,Peking University People′s Hospital,Beijing 100044,China)

机构地区北京大学人民医院

出处《中国医药导刊》 2023年第1期28-34,共7页 Chinese Journal of Medicinal Guide

关键词创伤气道创伤性脑损伤颈髓损伤误吸快速序贯诱导插管喉气管创伤气管插管窒息性氧合经鼻高流量给氧声门上喷射通气氧合体外膜肺氧合 Trauma Airway Traumatic brain injury(TBI) Cervical spinal cord injury(CSCI) Aspiration Rapid sequential induction intubation(RSII) Laryngotracheal trauma(LTT) Endotracheal intubation(ETI) Apnoeic oxygenation High-flow nasal oxygen(HFNO) Supraglottic jet oxygenation and ventilation(SJOV) Extracorporeal membrane oxygenation(ECMO)