超声在气道管理中的应用

1、上 海 交 通 大 学 附 属 第 六 人 民 医 院 麻 醉 科赵达强 超声在气道管理中的应用2016-5-27颈部气道解剖定位喉上神经the thyrohyoid membrane as a target for block of the internal branch of the superior laryngeal nervestopar-pintaric t, vlassakov k, azman j.j clin anesth.2015 nov ; 27(7): 548-52.in conclusion, we are proposing an anatomical concep

2、t for a us-guided isln block technique using the thyrohyoid membrane to define the target plane for low-volume local anesthetic injection.外侧舌骨外侧舌骨超声影像舌骨、喉上神经外侧过拱桥，甲舌膜里寻喉上定位环甲膜the conventional method, inspection and palpation, has a low success rate, especially in women (2435%).elliott ds, baker pa,

3、scott mr, et al. accuracy of surface landmark identification for cannula cricothyroidotomy.anaesthesia 2010; 65: 88994 lamb a, zhang j, hung o, et al. accuracy of identifying the cricothyroid membrane by anesthesia trainees and staff in a canadian institution. can j anaesth 2015; 62: 495503siddiqui

4、n, arzola c, friedman z, et al.anesthesiology.2015 nov;123(5):1033-41. 定位环甲膜 improves cricothyrotomy success incadavers with poorly defined neck anatomyultrasound guidance significantly decreased the incidence of injuries to the larynx and trachea increased the probability of correct insertion by 5.

5、6 times in cadavers with difficult and impossible landmark palpation.外侧甲状软骨声带声带环甲膜外侧超声影像甲状软骨、环甲膜外侧越尖峰，缺口伪影环甲膜甲状软骨声带声带伪影超声影像环状软骨外侧气管软骨甲状腺峡部外侧气管软骨外侧ultrasound-guided superior laryngeal nerve block and translaryngeal block for awake tracheal intubation in a patient with laryngeal abscessiida t,suzuki a

6、, kunisawa t,et al. j anesth (2013) 27:309310临床应用1清醒插管guided superior laryngeal nerve block during awake fiberoptic intubationsawka a, tang r, vaghadia h.a a case rep.2015 apr 15; 4(8): 107-10.sonographically guided superior laryngeal nerve block may be in patients where identification of landmarks

7、in the neck is as a result of patient anatomy临床应用1清醒插管临床应用1清醒插管ultrasound-guided cannula cricothyroidotomysuzuki a,iida t, kunisawa t,et al.anesthesiology 2012 nov;117(5):1128ultrasound-assisted translaryngeal block for awake fibreoptic intubationde oliveira gsjr, fitzgerald p, kendall m.can j anest

8、h. 2011 58:664665临床应用1清醒插管病态肥胖 bmi 60临床应用1清醒插管临床应用1清醒插管临床应用2判断喉镜显露困难气管软骨外侧食管甲状腺wu j,dong j, ding y, et al.med sci monit, 2014; 20: 2343-2350role of anterior neck soft tissue quantifications by ultrasound in predicting difficult laryngoscopyanterior neck soft tissue thicknesses measured by us at hyoi

9、d bone, thyrohyoid membrane, and anterior commissure levels are independent predictors of difficult laryngoscopy.combinations of those screening tests or risk factors with us measurements might increase the ability to predict difficult laryngoscopy.临床应用2判断喉镜显露困难气管软骨外侧食管甲状腺ultrasonographic measuremen

10、t of the minimal transverse diameter of the subglottic airway in the transverse plane, typically at the caudal outlet of the cricoid ring临床应用3选择适合气管导管临床应用4判断气管导管位置气管软骨外侧食管甲状腺临床应用4判断气管导管位置the sensitivity and specificity of transcricothyroid ultrasonography to confirm endotracheal tube placement in a

11、cadaver modeldynamic assessment resulted in sensitivity and specificity for detecting esophageal et placement. static assessment resulted in only sensitivity and specificity.ma g,davis dp, schmitt j, et al.j emerg med.2007 may;32(4):405-7. 气管插管过程中环甲膜改变气管导管气囊充气表现临床应用5判断喉罩位置laryngo-tracheal ultrasonog

12、raphy to confirm correct endotracheal tube and laryngeal mask airway placementsonographic upper airway assessment emerges as a to predict difficult intubation, to assess the laryngeal and hypopharyngeal size and visualize the position of the laryngeal mask airway in situ.wojtczak ja,cattano d.journa

13、l of ultrasonography 2014; 14: 362366临床应用5判断喉罩位置unique喉罩的位置esupreme喉罩的位置e临床应用6定位气管切开real-time ultrasound-guided percutaneousdilatational tracheostomy: a feasibility studypercutaneous tracheostomy performed under real-time ultrasound guidance is feasible and appears , including in patients with . ven

14、katakrishna rajajee, jeffrey j fletcher, lauryn r rochlen, et al.critical care 2011, 15:r67临床应用6定位气管切开traditional landmark versus ultrasound guided tracheal puncture during percutaneous dilatational tracheostomy in adult intensive care patients: a randomised controlled trialultrasound guidance signi

15、ficantly improved the rate of first-pass puncture and puncture accuracy. fewer procedural complications were observed; however, this did not reach statistical significance. these results support wider general use of real-time ultrasound guidance as an additional tool to improve pdt.mt rudas, ian sep

16、pelt, robert herkes,et al.critical care 2014, 18:514临床应用6定位气管切开临床应用6定位气管切开其他的临床应用1迅速准确建立通气mallin m, curtis k, dawson m,et al.am j emerg med 2014 jan;32(1):61-3.accuracy of ultrasound-guided marking of the cricothyroid membrane before simulated ultrasound marking of the ctm of healthy volunteers before simulated intubation identifies the ctm after neck manipulation expected during a .其他的临床应用2改良sellick法其他的临床应用3耐受插管advanced diagnostic bronchoscopy using conscious sedation