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- 呼吸道之處理
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題 名 | 呼吸道之處理=Airway Management |
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作 者 | 林恆毅; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 2:1 2000.01[民89.01] |
頁 次 | 頁77-84 |
專 輯 | 胸腔重症專題 |
分類號 | 415.415 |
關鍵詞 | 呼吸道; 呼吸衰竭; 氣管插管; Airway; Respiratory failure; Endotracheal tube; |
語 文 | 中文(Chinese) |
中文摘要 | 呼吸道之處理是指提供協助病患維持呼吸道之通暢。病患須要呼吸道之處理大多是因為呼吸衰竭,或是意識狀態改變,而影響他們維護呼吸道之能力。若是只有短時間維護,尚不須要藉助人工呼吸道。但若是長時間的呼吸道處理,則須藉著經口腔、鼻腔氣管插管,或經由外科氣管切開手術建立人工呼吸道。臨床上有五大情況須建立人工呼吸道: 一、維持呼吸道通暢:在意識不清的病患,咽喉的軟組織如舌根容易壓迫呼吸道造成阻塞。頭頸部外傷的病患,容易造成軟組織的腫脹,以及過敏性休克的病患均會造成呼吸道的阻塞。均須藉由氣管插管以較堅硬的管壁來維持呼吸道的通暢。 二、防止外物進入呼吸道:意識不清的病患非但容易造成呼吸道阻塞,而且聲門不能有效的關閉,會使口腔分泌物或胃液容易被吸入造成炎性反應。若置入氣管插管將環狀氣囊充氣,即可保護呼吸道防止外物吸入。 三、使用正壓呼吸機:若使用正壓呼吸機以維持病患呼吸時,必須先以氣管插管建立人工呼吸道才可。 四、使用高濃度氧氣:若病患須要使用高濃度氧氣時,則要將高分壓的氧氣釋放於氣管插管密閉的呼吸道内才可達到此目標。 五、利於呼吸道之清理:病患呼吸道有較黏稠的分泌物須常抽吸,此時若置入氣管插管,非但較易抽吸分泌物,且可減少對呼吸道之傷害。 |
英文摘要 | The term airway management encompasses the provision of assistance to a patient in maintaining a patent airway. Patients require management of the airway either because of respiratory failure or because of altered mental status that compromises their ability to maintain or guard the airway. For brief periods, the airway can be managed adequately without incubation of the trachea. However, prolonged airway management virtually always implies the need to intubate the trachea with an artificial airway. Artificial airways (endotracheal tubes, often abbreviated ETTs) can be placed translaryngeally via either the nose or mouth or surgically via a tracheotomy. The five major indications for placement of an ETT are. 1. Maintenance of the airway. The rigid walls of an ETT prevent occlusion of the airway in the unconscious patient. In the absence of an ETT in unconscious patients, the soft tissues of the pharynx, primarily the base of the tongue and the epiglottis, collapse to occlude the airway. Swelling resulting from facial or neck trauma and edema due to angioedema, anaphylaxis, or postoperative swelling also require a rigid-wall tube to maintain the airway. 2. Guarding the airway. Unconsciousness can produce not only occlusion of the airway but also the inability to close the glottis appropriately when liquid or solid maternal is introduced into the pharynx. This can result in either passive regurgitation and aspiration of a small quantities of oral secretions or aspiration of gastric contents. The inflated cuff of the tracheal tube provides significant protection against massive aspiration, although the patient may still aspirate small quantities of fluid even when the cuff is properly inflated. 3. Application of positive pressure to the airway. Positive pressure is applied to the airway as continuous positive airway pressure (CPAP) either to support oxygenation or to provide ventilatory assistance. Low levels of CPAP can be applied without an ETT in some circumstances. However, mechanical ventilation has generally required an intratracheal airway. 4. Use of high oxygen concentrations. Delivery of oxygen at high partial pressures is significantly facilitated by a sealed system. While high oxygen concentrations also can be delivered via a mask using high flows or a reservoir system, the failure rate is high without constant observation to ensure that the mask remains in place. 5. Facilitation of pulmonary toilet. Patients with copious secretions who require frequent suctioning of the trachea may require an ETT to minimize the trauma of repeatedly catheterizing the trachea via the nose or mouth. |
本系統中英文摘要資訊取自各篇刊載內容。