摘要
背景尽管没有足够的文献基础来评估拔管方案的优劣，美国麻醉医师协会困难气道管理小组认为拔管方案是插管过程的合理延续。只有有限的文献报道了使用气道交换导管（AEC）来维持气道通畅。方法作者回顾性分析了所收集到的困难气道拔管使用AEC病情得到改善的病例数据，这些患者在ICU病房已知或预测为困难气道。本研究内容包括再次插管的时间、尝试再次气管内插管的次数、保证气道通畅的方法、再插管期间低氧血症的发生率，以及重新建立气道时出现的并发症。结果51例放置AEC的患者在尝试拔管时失败。其中有47例AEC期间重新插管成功（92％），一次成功的人数为41／47（87％）。使用AEC重新插管失败的4例中有3例是因为在再插管过程中AEC意外从声门脱出；另外一例是出现了严重的喉水肿妨碍了气管内导管置入。结论困难气道患者通过AEC维持拔管后气道通畅是拔管策略的重要组成部分。对于已知或预测为困难气道的患者，AEC能提高一次通过的成功率，减少不耐受拔管患者并发症发生率和再次气管内插管的发生率。
BACKGROUND： The American Society of Anesthesiologists Task Force on the Management of the Difficult Airway regards the concept of an extubation strategy as a logical extension of the intubation process, although the literature does not provide a sufficient basis for evaluating the merits of an extubation strategy. Use of an airway exchange catheter （AEC） to maintain access to the airway has been reported on on/y a limited basis. METHODS： I reviewed an observational analysis of a prospectively collected difficult airway quality improvement database for patients who were extubated over an AEC for a known or presumed difficult airway primarily in the intensive care unit. The data were reviewed for time to reintubation, number of attempts to reintubate the trachea, method of securing the airway, incidence of hypoxemia during reintu- bation, and complications encountered during reestablishment of the airway. RESULTS： Fifty-one patients with an indwelling AEC failed their extubation trial. Forty-seven of 51 AEC patients were successfully reintubated over the AEC （92%）, with 41 of 47 on the first attempt （ 87% ）. In three of the four AEC reintubation failures, the AEC was inadvertently removed from the glottis during the reintubation process, and one patient had significant laryngeal edema precluding endotracheal tube advancement. CONCLUSIONS： Maintaining continuous access to the airway postextubation via an AEC can be an important component of an extubation strategy in selected difficult airway patients. The indwelling AEC appears to increase the firstpass success rate in patients with known or suspected difficult airways and decrease the incidence of complications in patients intolerant nintolerant of extubation and requiring tracheal reintubation.
出处
《麻醉与镇痛》
2008年第5期12-17,共6页
Anesthesia & Analgesia
