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1、【文摘发布】新英格兰杂志 4 月 26 日公布的气管插管规范（编译完毕，中文版 PDF）RESOURCE: NEJM，Volume 356:e15 April 26, 2007 Number 17 TITLE: Orotracheal IntubationAUTHOR: Christopher Kabrhel, M.D., Todd W. Thomsen, M.D., Gary S. Setnik, M.D., and Ron M. Walls, M.D.Chapters:1、Indications2、Contraindications3、Equipment4、Preparation5、Sed
2、ation and Paralysis6、The Procedure7、Troubleshooting8、Confirmation9、Securing the Tube10、Complications本文是新英格兰杂志4 月 26 日发表的，气管插管在临床上常用，本文提供了一个指南，请有兴趣的战友翻译，分成 12，3，4，5，6，7，8，9、10 部分，8 人完成 e15.pdf (192.06k) INDICATIONSOrotracheal intubation is indicated in any situation that requires definitive control o
3、f the airway. Orotracheal intubation is commonly performed to facilitate control of the airway in a patient undergoing general anesthesia. It is also performed as part of the care of critically ill patients with multisystem disease or injuries. Emergency indications include cardiac or respiratory ar
4、rest, failure to protect the airway from aspiration, inadequate oxygenation or ventilation, and existing or anticipated airway obstruction.适应症气管插管适用于任何确实需要气道管理的状况。为了便于气道管理，患者全身麻醉时常常需要气管插管;气管插管也是多系统疾病或损害的危重患者监护的一部分。紧急适应症包括心跳或呼吸骤停、气道不能防止误吸、缺氧或通气不足、气道阻塞。CONTRAINDICATIONS禁忌症In urgent situations or emerg
5、encies, such as when a patient is in cardiac arrest,airway management is of paramount importance, and there are very few contraindications to orotracheal intubation. Orotracheal intubation by direct laryngoscopy is somewhat contraindicated in a patient with partial transection of the trachea, becaus
6、e the procedure can cause complete tracheal transection and loss of the airway.在紧急状态下或急症时，如患者心跳骤停，气道管理极为重要，但气管插管仍有极少的禁忌症。直接喉镜下气管插管对已行部分气管切除的患者相对禁忌，因为气管插管步骤导致气管全部横断及气道损伤。In these cases, surgical airway management may be necessary. Unstable cervical spine injury is not a contraindication, but strict,
7、in-line stabilization of the cervical spine must be maintained during intubation. An assistant should stand at the side of the bed and hold the patients head, neck, and shoulders in an anatomically neutral position. The anterior portion of the cervical collar is opened or removed to permit the patie
8、nts mouth to be fully opened.在这些患者中，手术气道管理可能是必需的，不稳定颈椎损伤不是禁忌症，但是插管时颈椎必须保持严格的、呈线性固定。助手应该站在床旁一侧托住患者的头、颈，使患者双肩保持自然体位。敞开或去掉患者颈部衣领口，保持患者口腔全部张开。When immediate intubation is not required, the difficulty of intubation should first be assessed. This assessment is discussed in detail in the Preparation sectio
9、n,under Sedation and Paralysis.当不需要紧急插管，则应该首先评估插管的难点，在下面的术前准备、镇静与麻醉章节中详细讨论评估。编译：适应症气管插管适用于任何确实需要气道管理的状况。为了便于气道管理，患者全身麻醉时常常需要气管插管;气管插管也是多系统疾病或损害的危重患者监护的一部分。紧急适应症包括心跳或呼吸骤停、气道不能防止误吸、缺氧或通气不足、气道阻塞。禁忌症在紧急状态下或急症时，如患者心跳骤停，气道管理极为重要，但气管插管仍有极少的禁忌症。直接喉镜下气管插管对已行部分气管切除的患者相对禁忌，因为气管插管步骤导致气管全部横断及气道损伤。在这些患者中，手术气道管理可能
10、是必需的，不稳定颈椎损伤不是禁忌症，但是插管时颈椎必须保持严格的、呈线性固定。助手应该站在床旁一侧托住患者的头、颈，使患者双肩保持自然体位。敞开或去掉患者颈部衣领口，保持患者口腔全部张开。当不需要紧急插管，则应该首先评估插管的难点，在下面的术前准备、镇静与麻醉章节中详细讨论评估。 本人认领 9、10 部分。如在 48 小时内未能提交译文，其他战友可自由认领。 第一时间权威内容热点内容赞一个 EQUIPMENT（插管所需）器材You will need the following equipment: gloves, a protective face shield, a workingsuct
11、ion system, a bag-valve mask attached to an oxygen source, an endotracheal tubewith stylet, a 10-ml syringe, an endotracheal-tube holder (cloth tape may be used ifa tube holder is not available), an end-tidal carbon dioxide detector, a stethoscope,and laryngoscopes with appropriate blades. 进行插管前你需要准
12、备好以下器材：手套，口罩，吸引器（确保其工作正常），球瓣面罩(连接好氧气源),气管插管及管芯， 10ml 注射器，口咽通气道（或用布带代替）潮气末二氧化碳检测器,喉镜及合适的叶片。The two main types of laryngoscope blades are the Macintosh blade, which is curved, and the Miller blade, which is straight. Each is available in various sizes, and each requires a slightly different technique.
13、 The choice of blade depends on the operators experience and personal preference. 主要使用的喉镜叶片有两种：Macintosh 叶片(弯)和 Miller 叶片(直). 每种叶片都有多种型号可供选择，而且不同叶片的操作技术上略有差异。 使用那种叶片主要取决于术者的经验和个人喜好。A size 3 or 4 Macintosh blade or size 2 or 3 Miller blade can be used in most adult patients.3 号或 4 号 Macintosh 叶片及 2 号
14、或 3 号 Miller 叶片适用于大多数的成年病人。Endotracheal tubes are sized according to the internal diameter of the tube;7.0-, 7.5-, or 8.0-mm tubes are appropriate for most adults.1-3 The appropriate tube size for use in children can be determined by adding 4 to the patients age in years and then dividing by 4 (age
15、in years + 4 4 = tube size), by matching the external diameter of the tube to the width of the patients little fingernail, or by using a system based on the childs height or length (such as the BroslowLuten resuscitation tape).气管内插管的型号取决于气管内径 .7.0-, 7.5-, or 8.0-mm 的气管内插管适用于大多数成年人， 对于小儿可用如下方法推算：1、 年
16、龄 + 4 4 =插管型号, 2、小儿的手指宽度插管的外径 3、根据小儿的身高或身长推算（如使用 BroslowLuten resuscitation tape）Tubes can be cuffed or uncuffed. Cuffed tubes are appropriate for adults andolder children. Uncuffed tubes are used for younger patients (those requiring atube smaller than 5.5 mm).1,2 After inserting a cuffed tube, you must inflate theballoon on the distal end to create a seal between the tube and the tracheal lumen.This seal will prevent leakage of air and aspiration of gastri
