• 上海交通大學(xué)醫(yī)學(xué)院附屬仁濟醫(yī)院麻醉科( 上海 200127);

氣道管理是危重患者救治過程中最重要的操作技術(shù), 而危重患者進行氣管插管操作時心肺功能和內(nèi)環(huán)境往往處于失代償狀態(tài), 對缺氧的耐受性明顯降低, 易發(fā)生誤吸及心搏驟停等嚴重并發(fā)癥[ 1] 。因此, 完善對危重患者困難氣道的管理策略, 掌握熟練的氣道開放技術(shù), 對于提高危重患者搶救成功率, 降低并發(fā)癥發(fā)生率和死亡率具有重要意義。

引用本文： 何征宇,王祥瑞. 危重患者困難氣道管理策略. 中國呼吸與危重監(jiān)護雜志, 2010, 9(2): 220-222. doi: 復(fù)制

1. Jaber S, Amraoui J, Lefrant JY, et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: A prospective, multiple-center study. Critical Care Medicine, 2006 , 34 : 2355-2361.
2. Koh LK, Kong CE, Ip-Yam PC. The modified Cormack-Lehane score for the grading of direct laryngoscopy: evaluation in the Asian population. Anaesth Intensive Care, 2002, 30: 48 -51 .
3. Yildiz TS, Solak M, Toker K. The incidence and risk factors of difficult mask ventilation. J Anesth, 2005, 19: 7-11.
4. Langeron O, Masso E, Huraux C, et al. Prediction of difficult mask ventilation. Anesthesiology, 2000, 92 : 1229 -1236 .
5. Murphy M, WilliamsW. Manual of emergency airway management. IL: Lippincott, 2000 .
6. Reed MJ, Dunn MJG, McKeown DW. Can an airway assessment score predict difficulty at intubation in the emergency department?Emerg Med J, 2005, 22: 99-102.
7. Cobley M, Vaughan RS. Recognition and management of difficult airway problems. Br J Anaesth, 1992 , 68: 90-97.
8. Christie JM, Dethlefsen M, Cane RD. Unplanned endotracheal extubation in the intensive care unit. J Clini Anesth,1996,8:289-293.
9. Adnet F, Borron SW, Dumas JL, et al. Study of the “sniffing position” by magnetic resonance imaging. Anesthesiology, 2001 ,94: 83-86 .
10. Adnet F, Baillard C, Borron SW, et al. Randomized study comparing the “sniffing position“with simple head extension for laryngoscopic view in elective surgery patients. Anesthesiology,2001, 95: 836-841.
11. Mort TC. Preoxygenation in critically ill patients requiring emergency tracheal intubation. Criti Care Med, 2005, 33: 2672-2675.
12. Baillard C, Fosse JP, Sebbane M, et al. Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients. AmJ Respir Criti Care Med, 2006 , 174: 171-177 .
13. Lippmann M, Kakazu C. Hemodynamics with propofol: Is propofol dangerous in classes III-V patients? Anesth Analg, 2006, 103 : 260.
14. Zed PJ, Abu-Laban RB, Harrison DW. Intubating conditions and hemodynamic effects of etomidate for rapid sequence intubation in the emergency department: An observational cohort study. Acad Emerg Med, 2006, 13: 378-383 .
15. Mokhlesi B. Corticosteroids for patients with septic shock. JAMA,2003, 289: 43, author reply 43 -44.
16. Bloomfield R, Noble DW. Etomidate and fatal outcome - even a single bolus dose may be detrimental for some patients. Br J of Anaesth, 2006, 97: 116 -117.
17. Martin E, Ramsay G, Mantz J, et al. The role of the alpha2 -adrenoceptor agonist dexmedetomidine in postsurgical sedation in the intensive care unit. J Intensive Care Med, 2003 , 18 : 29-41.
18. Hsu YW, Cortinez LI, Robertson KM, et al. Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers.Anesthesiology, 2004, 101 : 1066-1076.
19. Avitsian R, Lin J, Lotto M, et al. Dexmedetomidine and awake fiberoptic intubation for possible cervical spine myelopathy -a clinical series. J Neurosurg Anesthesiol, 2005, 17: 97 -99 .
20. Leykin Y, Pellis T, Lucca M, et al. Intubation conditions following rocuronium: influence of induction agent and priming. Anaesth Intensive Care, 2005, 33 : 462-468.
21. Ledowski T, Wulf H. The influence of fentanyl vs. s-ketamine on intubating conditions during induction of anaesthesia with etomidateand rocuronium. Eur J Anaesthesiol, 2001, 18 : 519-523.
22. Hughes M, Grant IS, Biccard B, et al. Suxamethonium and critical illness polyneuropathy. Anaesth Intensive Care, 1999, 27: 636-638 .
23. Sluga M, Ummenhofer W, Studer W, et al. Rocuronium versus succinylcholine for rapid sequence induction of anesthesia and endotracheal intubation: a prospective, randomized trial in emergent cases. Anesth Analg, 2005, 101: 1356-1361.
24. Mencke T, Knoll H, Schreiber JU, et al. Rocuronium is not associated with more vocal cord injuries than succinylcholine after rapid-sequence induction: a randomized, prospective, controlled trial. Anesth Analg, 2006 , 102: 943-949.
25. Divatia JV, Kulkarni AP, Sindhkar S, et al. Failed intubation in the intensive care unit managed with laryngeal mask airway and percutaneous tracheostomy. Anaesth Intensive Care,1999,27:409-411.
26. Ferson DZ, Rosenblatt WH, Johansen MJ, et al. Use of the Intubating LMA-Fastrach in 254 patients with difficult-to-manage airways. Anesthesiology, 2001, 95: 1175-1181.
27. Frappier J, Guenoun T, Journois D, et al. Airway management using the intubating laryngeal mask airway for the morbidly obese patient.Anesth Analg, 2003, 96: 1510-1515.
28. Goldman AJ, Rosenblatt WH. Use of the fibreoptic intubating LMACTrach ( TM) in two patients with difficult airways. Anaesthesia,2006, 61: 601-603 .
29. Noguchi T, Koga K, Shiga Y, et al. The gum elastic bougie eases tracheal intubation while applying cricoid pressure compared to a stylet. Can J Anesth, 2003, 50: 712-717 .
30. Yardy N, Hancox D, Strang T. A comparison of two airway aids for emergency use by unskilled personnel: The Combitube and laryngeal mask. Anaesthesia, 1999 , 54: 181-183.
31. Ault MJ, Ault B, Ng PK. Percutaneous dilatational tracheostomy for emergent airway access. J Intensive Care Med, 2003, 18: 222-226.
32. Polderman KH, Spijkstra JJ, de Bree R, et al. Percutaneous dilatational tracheostomy in the ICU: optimal organization, low complication rates, and description of a new complication. Chest,2003, 123: 1595-1602.
33. 俞森洋. 有創(chuàng)機械通氣患者人工氣道的選擇: 經(jīng)鼻還是經(jīng)口插管.是否要早做氣管切開. 中國呼吸與危重監(jiān)護雜志, 2009,8:3-5.
  1. 1. Jaber S, Amraoui J, Lefrant JY, et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: A prospective, multiple-center study. Critical Care Medicine, 2006 , 34 : 2355-2361.
  2. 2. Koh LK, Kong CE, Ip-Yam PC. The modified Cormack-Lehane score for the grading of direct laryngoscopy: evaluation in the Asian population. Anaesth Intensive Care, 2002, 30: 48 -51 .
  3. 3. Yildiz TS, Solak M, Toker K. The incidence and risk factors of difficult mask ventilation. J Anesth, 2005, 19: 7-11.
  4. 4. Langeron O, Masso E, Huraux C, et al. Prediction of difficult mask ventilation. Anesthesiology, 2000, 92 : 1229 -1236 .
  5. 5. Murphy M, WilliamsW. Manual of emergency airway management. IL: Lippincott, 2000 .
  6. 6. Reed MJ, Dunn MJG, McKeown DW. Can an airway assessment score predict difficulty at intubation in the emergency department?Emerg Med J, 2005, 22: 99-102.
  7. 7. Cobley M, Vaughan RS. Recognition and management of difficult airway problems. Br J Anaesth, 1992 , 68: 90-97.
  8. 8. Christie JM, Dethlefsen M, Cane RD. Unplanned endotracheal extubation in the intensive care unit. J Clini Anesth,1996,8:289-293.
  9. 9. Adnet F, Borron SW, Dumas JL, et al. Study of the “sniffing position” by magnetic resonance imaging. Anesthesiology, 2001 ,94: 83-86 .
  10. 10. Adnet F, Baillard C, Borron SW, et al. Randomized study comparing the “sniffing position“with simple head extension for laryngoscopic view in elective surgery patients. Anesthesiology,2001, 95: 836-841.
  11. 11. Mort TC. Preoxygenation in critically ill patients requiring emergency tracheal intubation. Criti Care Med, 2005, 33: 2672-2675.
  12. 12. Baillard C, Fosse JP, Sebbane M, et al. Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients. AmJ Respir Criti Care Med, 2006 , 174: 171-177 .
  13. 13. Lippmann M, Kakazu C. Hemodynamics with propofol: Is propofol dangerous in classes III-V patients? Anesth Analg, 2006, 103 : 260.
  14. 14. Zed PJ, Abu-Laban RB, Harrison DW. Intubating conditions and hemodynamic effects of etomidate for rapid sequence intubation in the emergency department: An observational cohort study. Acad Emerg Med, 2006, 13: 378-383 .
  15. 15. Mokhlesi B. Corticosteroids for patients with septic shock. JAMA,2003, 289: 43, author reply 43 -44.
  16. 16. Bloomfield R, Noble DW. Etomidate and fatal outcome - even a single bolus dose may be detrimental for some patients. Br J of Anaesth, 2006, 97: 116 -117.
  17. 17. Martin E, Ramsay G, Mantz J, et al. The role of the alpha2 -adrenoceptor agonist dexmedetomidine in postsurgical sedation in the intensive care unit. J Intensive Care Med, 2003 , 18 : 29-41.
  18. 18. Hsu YW, Cortinez LI, Robertson KM, et al. Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers.Anesthesiology, 2004, 101 : 1066-1076.
  19. 19. Avitsian R, Lin J, Lotto M, et al. Dexmedetomidine and awake fiberoptic intubation for possible cervical spine myelopathy -a clinical series. J Neurosurg Anesthesiol, 2005, 17: 97 -99 .
  20. 20. Leykin Y, Pellis T, Lucca M, et al. Intubation conditions following rocuronium: influence of induction agent and priming. Anaesth Intensive Care, 2005, 33 : 462-468.
  21. 21. Ledowski T, Wulf H. The influence of fentanyl vs. s-ketamine on intubating conditions during induction of anaesthesia with etomidateand rocuronium. Eur J Anaesthesiol, 2001, 18 : 519-523.
  22. 22. Hughes M, Grant IS, Biccard B, et al. Suxamethonium and critical illness polyneuropathy. Anaesth Intensive Care, 1999, 27: 636-638 .
  23. 23. Sluga M, Ummenhofer W, Studer W, et al. Rocuronium versus succinylcholine for rapid sequence induction of anesthesia and endotracheal intubation: a prospective, randomized trial in emergent cases. Anesth Analg, 2005, 101: 1356-1361.
  24. 24. Mencke T, Knoll H, Schreiber JU, et al. Rocuronium is not associated with more vocal cord injuries than succinylcholine after rapid-sequence induction: a randomized, prospective, controlled trial. Anesth Analg, 2006 , 102: 943-949.
  25. 25. Divatia JV, Kulkarni AP, Sindhkar S, et al. Failed intubation in the intensive care unit managed with laryngeal mask airway and percutaneous tracheostomy. Anaesth Intensive Care,1999,27:409-411.
  26. 26. Ferson DZ, Rosenblatt WH, Johansen MJ, et al. Use of the Intubating LMA-Fastrach in 254 patients with difficult-to-manage airways. Anesthesiology, 2001, 95: 1175-1181.
  27. 27. Frappier J, Guenoun T, Journois D, et al. Airway management using the intubating laryngeal mask airway for the morbidly obese patient.Anesth Analg, 2003, 96: 1510-1515.
  28. 28. Goldman AJ, Rosenblatt WH. Use of the fibreoptic intubating LMACTrach ( TM) in two patients with difficult airways. Anaesthesia,2006, 61: 601-603 .
  29. 29. Noguchi T, Koga K, Shiga Y, et al. The gum elastic bougie eases tracheal intubation while applying cricoid pressure compared to a stylet. Can J Anesth, 2003, 50: 712-717 .
  30. 30. Yardy N, Hancox D, Strang T. A comparison of two airway aids for emergency use by unskilled personnel: The Combitube and laryngeal mask. Anaesthesia, 1999 , 54: 181-183.
  31. 31. Ault MJ, Ault B, Ng PK. Percutaneous dilatational tracheostomy for emergent airway access. J Intensive Care Med, 2003, 18: 222-226.
  32. 32. Polderman KH, Spijkstra JJ, de Bree R, et al. Percutaneous dilatational tracheostomy in the ICU: optimal organization, low complication rates, and description of a new complication. Chest,2003, 123: 1595-1602.
  33. 33. 俞森洋. 有創(chuàng)機械通氣患者人工氣道的選擇: 經(jīng)鼻還是經(jīng)口插管.是否要早做氣管切開. 中國呼吸與危重監(jiān)護雜志, 2009,8:3-5.