一、經(jīng)鼻或經(jīng)口氣管插管的優(yōu)劣有創(chuàng)機(jī)械通氣患者需建立人工氣道( 氣管插管或氣管切開(kāi)) , 氣管插管經(jīng)鼻或經(jīng)口途徑何者優(yōu)越的問(wèn)題, 國(guó)內(nèi)外始終存在爭(zhēng)論。20 世紀(jì)80 年代前, 我們和國(guó)內(nèi)大多數(shù)醫(yī)院一樣, 較多采用經(jīng)口插管, 理由是經(jīng)口比較容易插入, 可用較大管徑的導(dǎo)管, 氣流阻力較小; 便于吸痰, 清除氣道內(nèi)分泌物。但缺點(diǎn)是容易移位, 脫出, 如果脫出后重插, 將增加患者危險(xiǎn)和呼吸機(jī)相關(guān)肺炎( VAP) 發(fā)生率; 患者不能閉口, 不能進(jìn)行有效的口腔清潔護(hù)理, 且使不少患者口咽分泌物增加,口咽部定植菌的增加和分泌物經(jīng)過(guò)氣管導(dǎo)管氣囊的微誤吸, 也增加VAP發(fā)生的危險(xiǎn)。由于那時(shí)還沒(méi)有使用高容低壓氣囊, 使用的高壓低容氣囊的橡膠插管只能短時(shí)間保留, 故患者插管后1～3 d 均行氣管切開(kāi)。
引用本文： 俞森洋. 有創(chuàng)機(jī)械通氣患者人工氣道的選擇: 經(jīng)鼻還是經(jīng)口插管? 是否要早做氣管切開(kāi)?. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2009, 09(1): 3-5. doi: 復(fù)制
| 1. | Rouby JJ, LU Q. Sinus infections in the ventilated patients. see Tobin MJ. ed. Principles & practice of mechanical ventilation. New York:McGraw-Hill medical publishing division, 2006, 1019-1032. |
| 2. | Holzapfel L, Chevret S, Madinier G, et al. Influence of longterm oro-or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: results of a prospective, randomized clinical trial. Crit Care Med, 1993, 21: 1132. |
| 3. | Rouby JJ, Laurent P, Gosnach M, et al. Risk factors and clinical relevance of nosocominal maxillary sinusitis in the critical ill see comments . Am J Respir Crit Care Med, 1994, 150: 776. |
| 4. | rd ed York:McGraw-Hill medical publishing division, 2005, 599 -623. |
| 5. | Chatre J, Fagon JY. Ventilator-associated pneumonia. See Hall JB, Schmidt GA, Wood LD, et al. Principels of critical care. |
| 6. | MacIntyre NR. Evidence-Based Guidelines for Weaning and Discontinuing Ventilatory Support: A Collective Task Force Facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine.Chest, 2001, 120( 6 suppl) : 375S-396S. |
| 7. | Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation.Eur Respir J, 2007, 29: 1033-1056. |
| 8. | L’Her E, LelloucheF, Ferrand E, et al. Is tracheostomy less comfortable than translaryngeal intubation? Am J Respir Crit Care Med,2003, 167: A302. |
- 1. Rouby JJ, LU Q. Sinus infections in the ventilated patients. see Tobin MJ. ed. Principles & practice of mechanical ventilation. New York:McGraw-Hill medical publishing division, 2006, 1019-1032.
- 2. Holzapfel L, Chevret S, Madinier G, et al. Influence of longterm oro-or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: results of a prospective, randomized clinical trial. Crit Care Med, 1993, 21: 1132.
- 3. Rouby JJ, Laurent P, Gosnach M, et al. Risk factors and clinical relevance of nosocominal maxillary sinusitis in the critical ill see comments . Am J Respir Crit Care Med, 1994, 150: 776.
- 4. rd ed York:McGraw-Hill medical publishing division, 2005, 599 -623.
- 5. Chatre J, Fagon JY. Ventilator-associated pneumonia. See Hall JB, Schmidt GA, Wood LD, et al. Principels of critical care.
- 6. MacIntyre NR. Evidence-Based Guidelines for Weaning and Discontinuing Ventilatory Support: A Collective Task Force Facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine.Chest, 2001, 120( 6 suppl) : 375S-396S.
- 7. Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation.Eur Respir J, 2007, 29: 1033-1056.
- 8. L’Her E, LelloucheF, Ferrand E, et al. Is tracheostomy less comfortable than translaryngeal intubation? Am J Respir Crit Care Med,2003, 167: A302.