超聲在氣道管理中的應(yīng)用

1、上 海 交 通 大 學(xué) 附 屬 第 六 人 民 醫(yī) 院 麻 醉 科趙達(dá)強(qiáng) 超聲在氣道管理中的應(yīng)用2016-5-27頸部氣道解剖定位喉上神經(jīng)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.外側(cè)舌骨外側(cè)舌骨超聲影像舌骨、喉上神經(jīng)外側(cè)過拱橋，甲舌膜里尋喉上定位環(huán)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. 定位環(huán)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.外側(cè)甲狀軟骨聲帶聲帶環(huán)甲膜外側(cè)超聲影像甲狀軟骨、環(huán)甲膜外側(cè)越尖峰，缺口偽影環(huán)甲膜甲狀軟骨聲帶聲帶偽影超聲影像環(huán)狀軟骨外側(cè)氣管軟骨甲狀腺峽部外側(cè)氣管軟骨外側(cè)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臨床應(yīng)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臨床應(yīng)用1清醒插管臨床應(yīng)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臨床應(yīng)用1清醒插管病態(tài)肥胖 bmi 60臨床應(yīng)用1清醒插管臨床應(yīng)用1清醒插管臨床應(yīng)用2判斷喉鏡顯露困難氣管軟骨外側(cè)食管甲狀腺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.臨床應(yīng)用2判斷喉鏡顯露困難氣管軟骨外側(cè)食管甲狀腺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臨床應(yīng)用3選擇適合氣管導(dǎo)管臨床應(yīng)用4判斷氣管導(dǎo)管位置氣管軟骨外側(cè)食管甲狀腺臨床應(yīng)用4判斷氣管導(dǎo)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. 氣管插管過程中環(huán)甲膜改變氣管導(dǎo)管氣囊充氣表現(xiàn)臨床應(yīng)用5判斷喉罩位置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臨床應(yīng)用5判斷喉罩位置unique喉罩的位置esupreme喉罩的位置e臨床應(yīng)用6定位氣管切開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臨床應(yīng)用6定位氣管切開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臨床應(yīng)用6定位氣管切開臨床應(yīng)用6定位氣管切開其他的臨床應(yīng)用1迅速準(zhǔn)確建立通氣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 .其他的臨床應(yīng)用2改良sellick法其他的臨床應(yīng)用3耐受插管advanced diagnostic bronchoscopy using conscious sedation