医学课件-超声在气道管理中的应用课件.ppt

1、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 concept for a US-guided iSLN block technique using the thyrohyoid mem

2、brane to define the target plane for low-volume local anesthetic injection.外侧外侧舌骨舌骨外侧外侧舌骨舌骨超声影像舌骨、喉上神经外侧外侧过拱桥，甲舌膜里寻过拱桥，甲舌膜里寻喉上喉上定位环甲膜The conventional method,inspection and palpation,has a low success rate,especially in women(2435%).Elliott DS,Baker PA,Scott MR,et al.Accuracy of surface landmark iden

3、tification for cannula Elliott DS,Baker PA,Scott MR,et al.Accuracy of surface landmark identification for cannula cricothyroidotomy.Anaesthesia 2010;65:88994cricothyroidotomy.Anaesthesia 2010;65:88994 Lamb A,Zhang J,Hung O,et al.Accuracy of identifying the cricothyroid membrane by Lamb A,Zhang J,Hun

4、g O,et al.Accuracy of identifying the cricothyroid membrane by anesthesia trainees and staff in a Canadian institution.Can J Anaesth 2015;62:495503anesthesia trainees and staff in a Canadian institution.Can J Anaesth 2015;62:495503Barbe N,Martin P,Pascal J,et al.Ann Fr Anesth Reanim.2014 Mar;33(3):1

5、63-6.定位环甲膜定位环甲膜Locating the cricothyroid membrane in learning phase:Value of ultrasonography?The CTM was accurately identified by palpation and ultrasound by of residents respectively(P 0.05).Kristensen MS,Teoh WH,Rudolph SS,et al.Br J Anaesth.2015 Jun;114(6):1003-4.定位环甲膜定位环甲膜Structured approach to

6、identification of thecricothyroid membrane:a randomized comparison with the palpation method in the When using the conventional digital palpation method,13 of 35 anaesthetists(37%)were able to locate the cricothyroid membrane successfully within 2 min,whereas the success rate was 29 of 35(83%)when t

7、he structured stepwise ultrasonography method was applied(P=0.0008,McNemars test).Siddiqui N,Arzola C,Friedman Z,et al.Anesthesiology.2015 Nov;123(5):1033-41.定位环甲膜定位环甲膜 Improves Cricothyrotomy Success inCadavers with Poorly Defined Neck AnatomyUltrasound guidance significantly decreased the incidenc

8、e of injuries to the larynx and trachea Increased the probability of correct insertion by 5.6 times in cadavers with difficult and impossible landmark palpation.外侧外侧甲状软骨甲状软骨声带声带声带声带环甲膜环甲膜外侧外侧超声影像甲状软骨、环甲膜外侧外侧越尖峰，缺口越尖峰，缺口伪影伪影环甲膜环甲膜甲状软骨甲状软骨声带声带声带声带伪影伪影超声影像环状软骨环状软骨外侧外侧气管软骨气管软骨甲状腺峡部甲状腺峡部外侧外侧气管软骨气管软骨外侧外侧U

9、ltrasound-guided superior laryngeal nerve block and translaryngeal block for awake tracheal intubation in a patient with laryngeal abscessIida T,Suzuki A,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

10、.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 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 2

11、012 Nov;117(5):1128Ultrasound-assisted translaryngeal block for awake fibreoptic intubationDe Oliveira GSJr,Fitzgerald P,Kendall M.Can J Anesth.2011 58:664665临床应用1清醒插管病态肥胖病态肥胖 BMI 60BMI 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气管软骨外侧外侧食管食管甲状腺甲状腺Wu J,Dong J,Ding Y,et al.Med Sci Monit,2014;20:2343-2350Rol

12、e of anterior neck soft tissue quantifications by ultrasound in predicting difficult laryngoscopyAnterior neck soft tissue thicknesses measured by US at hyoid bone,thyrohyoid membrane,and anterior commissure levels are independent predictors of difficult laryngoscopy.Combinations of those screening

13、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气管软骨外侧外侧食管食管甲状腺甲状腺Ultrasonographic measurement of the minimal transverse diameter of the subglottic airway in the transverse plane,typically at the caudal outlet of the cricoid ri

14、ng临床应用临床应用3选择适合气管导管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气管软骨外侧外侧食管食管甲状腺甲状腺临床应用4判断气管导管位置THE SENSITIVITY AND SPECIFICITY OF TRANSCRICOTHYROID ULTRASONOGRAPHY TO CONFIRM ENDOTRACHEAL TUBE PLACEMENT IN A CADAVER MODELDynamic assessment resulted in sensitivity and specificity for detecting esophageal ET placement.St

15、atic 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 ultrasonography to confirm correct endotracheal tube and laryngeal mask airway placementSonographic upper airway assessment em

16、erges 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.Journal 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 percuta

17、neousdilatational tracheostomy:a feasibility studyPercutaneous tracheostomy performed under real-time ultrasound guidance is feasible and appears,including in patients with.Venkatakrishna 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 versu

18、s ultrasound guided tracheal puncture during percutaneous dilatational tracheostomy in adult intensive care patients:a randomised controlled trialUltrasound guidance significantly improved the rate of first-pass puncture and puncture accuracy.Fewer procedural complications were observed;however,this

19、 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 Seppelt,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 Me

20、d 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 Bro

21、nchoscopy Using Conscious Sedation and the Laryngeal Nerve Block:,Thoroughness,and Diagnostic YieldGoyal G,Pisani MA,Murphy TE,et al.Lung(2014)192:905913如何更好如何更好耐受耐受长期气管插管？长期气管插管？或许或许喉上神经阻滞喉上神经阻滞是一个选择是一个选择1.清醒插管超声引导喉上神经阻滞和环甲膜穿刺 总 结 4.判断气管导管的位置环甲膜 5.判断喉罩位置6.定位气管切开7.迅速建立紧急通气8.改良Sellick法2.判断喉镜显露困难3.选择气管导管型号