超聲在氣道管理中的應(yīng)用

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現(xiàn)在是1頁\一共有34頁\編輯于星期六頸部氣道解剖現(xiàn)在是2頁\一共有34頁\編輯于星期六定位喉上神經(jīng)Thethyrohyoidmembraneasatargetforultrasonography-guidedblockoftheinternalbranchofthesuperiorlaryngealnerveStopar-PintaricT,VlassakovK,AzmanJ.JClinAnesth.2015Nov;27(7):548-52.Inconclusion,weareproposingananatomicalconceptforanew,simpler,consistentlyreproducible

US-guidediSLNblocktechniqueusingthethyrohyoidmembraneto

definethetargetplaneforlow-volumelocalanestheticinjection.現(xiàn)在是3頁\一共有34頁\編輯于星期六外側(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，甲舌膜里尋喉上現(xiàn)在是4頁\一共有34頁\編輯于星期六定位環(huán)甲膜Theconventionalmethod,inspectionandpalpation,hasalowsuccessrate,especiallyinwomen(24–35%).ElliottDS,BakerPA,ScottMR,etal.Accuracyofsurfacelandmarkidentificationforcannulacricothyroidotomy.Anaesthesia2010;65:889–94

LambA,ZhangJ,HungO,etal.AccuracyofidentifyingthecricothyroidmembranebyanesthesiatraineesandstaffinaCanadianinstitution.CanJAnaesth2015;62:495–503現(xiàn)在是5頁\一共有34頁\編輯于星期六BarbeN,MartinP,PascalJ,etal.AnnFrAnesthReanim.2014Mar;33(3):163-6.定位環(huán)甲膜Locatingthecricothyroidmembraneinlearningphase:Valueofultrasonography?TheCTMwasaccuratelyidentifiedbypalpationandultrasoundby46%and100%ofresidentsrespectively(P<0.05).現(xiàn)在是6頁\一共有34頁\編輯于星期六KristensenMS,TeohWH,RudolphSS,etal.BrJAnaesth.2015Jun;114(6):1003-4.

定位環(huán)甲膜Structuredapproachtoultrasound-guidedidentificationofthecricothyroidmembrane:arandomizedcomparisonwiththepalpationmethodinthemorbidlyobeseWhenusingtheconventionaldigitalpalpationmethod,13of35anaesthetists(37%)wereabletolocatethecricothyroidmembranesuccessfullywithin2min,whereasthesuccessratewas29of35(83%)whenthestructuredstepwiseultrasonographymethodwasapplied(P=0.0008,McNemar’stest).現(xiàn)在是7頁\一共有34頁\編輯于星期六SiddiquiN,ArzolaC,FriedmanZ,etal.Anesthesiology.2015Nov;123(5):1033-41.

定位環(huán)甲膜UltrasoundImprovesCricothyrotomySuccessinCadaverswithPoorlyDefinedNeckAnatomyUltrasoundguidancesignificantlydecreasedtheincidenceofinjuriestothelarynxandtracheaIncreasedtheprobabilityofcorrectinsertionby5.6times

incadaverswithdifficultandimpossiblelandmarkpalpation.現(xiàn)在是8頁\一共有34頁\編輯于星期六外側(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現(xiàn)在是9頁\一共有34頁\編輯于星期六超聲影像環(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)現(xiàn)在是10頁\一共有34頁\編輯于星期六Ultrasound-guidedsuperiorlaryngealnerveblockandtranslaryngealblockforawaketrachealintubationinapatientwithlaryngealabscessIidaT,SuzukiA,KunisawaT,etal.JAnesth(2013)27:309–310臨床應(yīng)用1—清醒插管現(xiàn)在是11頁\一共有34頁\編輯于星期六SonographicallyGuidedSuperiorLaryngealNerveBlockDuringAwakeFiberopticIntubationSawkaA,TangR,VaghadiaH.AACaseRep.2015Apr15;4(8):107-10.Sonographicallyguidedsuperiorlaryngealnerveblockmaybeusefulinpatientswhereidentificationoflandmarksintheneckisdifficult

asaresultofpatientanatomy臨床應(yīng)用1—清醒插管現(xiàn)在是12頁\一共有34頁\編輯于星期六臨床應(yīng)用1—清醒插管Ultrasound-guided

CannulaCricothyroidotomySuzukiA,IidaT,kunisawaT,etal.Anesthesiology2012Nov;117(5):1128Ultrasound-assistedtranslaryngealblockforawakefibreopticintubationDeOliveiraGSJr,FitzgeraldP,KendallM.CanJAnesth.201158:664–665現(xiàn)在是13頁\一共有34頁\編輯于星期六臨床應(yīng)用1—清醒插管病態(tài)肥胖BMI60現(xiàn)在是14頁\一共有34頁\編輯于星期六臨床應(yīng)用1—清醒插管現(xiàn)在是15頁\一共有34頁\編輯于星期六臨床應(yīng)用1—清醒插管現(xiàn)在是16頁\一共有34頁\編輯于星期六臨床應(yīng)用2—判斷喉鏡顯露困難氣管軟骨外側(cè)食管甲狀腺WuJ,DongJ,

DingY,

etal.MedSciMonit,2014;20:2343-2350RoleofanteriornecksofttissuequantificationsbyultrasoundinpredictingdifficultlaryngoscopyAnteriornecksofttissuethicknessesmeasuredbyUSathyoidbone,thyrohyoidmembrane,andanteriorcommissurelevelsareindependentpredictorsofdifficultlaryngoscopy.CombinationsofthosescreeningtestsorriskfactorswithUSmeasurementsmightincreasetheabilitytopredictdifficultlaryngoscopy.現(xiàn)在是17頁\一共有34頁\編輯于星期六臨床應(yīng)用2—判斷喉鏡顯露困難氣管軟骨外側(cè)食管甲狀腺現(xiàn)在是18頁\一共有34頁\編輯于星期六Ultrasonographicmeasurementoftheminimaltransversediameterofthesubglotticairwayinthetransverseplane,typicallyatthecaudaloutletofthecricoidring臨床應(yīng)用3—選擇適合氣管導(dǎo)管現(xiàn)在是19頁\一共有34頁\編輯于星期六臨床應(yīng)用4—判斷氣管導(dǎo)管位置氣管軟骨外側(cè)食管甲狀腺排除食管內(nèi)插管證實(shí)氣管導(dǎo)管在氣管內(nèi)現(xiàn)在是20頁\一共有34頁\編輯于星期六臨床應(yīng)用4—判斷氣管導(dǎo)管位置THESENSITIVITYANDSPECIFICITYOFTRANSCRICOTHYROIDULTRASONOGRAPHYTOCONFIRMENDOTRACHEALTUBEPLACEMENTINACADAVERMODELDynamicassessmentresultedin97%sensitivityand100%specificityfordetectingesophagealETplacement.Staticassessmentresultedinonly51%sensitivityand91%specificity.MaG,DavisDP,SchmittJ,etal.JEmergMed.2007May;32(4):405-7.

現(xiàn)在是21頁\一共有34頁\編輯于星期六氣管插管過程中環(huán)甲膜改變現(xiàn)在是22頁\一共有34頁\編輯于星期六氣管導(dǎo)管氣囊充氣表現(xiàn)現(xiàn)在是23頁\一共有34頁\編輯于星期六臨床應(yīng)用5—判斷喉罩位置Laryngo-trachealultrasonographytoconfirmcorrectendotrachealtubeand

laryngealmaskairwayplacementSonographicupperairwayassessmentemergesasa

rapidandeasily

availablemethodtopredictdifficultintubation,toassessthelaryngealandhypopharyngealsizeandvisualizethepositionofthelaryngealmaskairwayinsitu.WojtczakJA,CattanoD.JournalofUltrasonography2014;14:362–366現(xiàn)在是24頁\一共有34頁\編輯于星期六臨床應(yīng)用5—判斷喉罩位置蝴蝶征Unique喉罩的位置ESupreme喉罩的位置E現(xiàn)在是25頁\一共有34頁\編輯于星期六臨床應(yīng)用6—定位氣管切開Real-timeultrasound-guidedpercutaneousdilatationaltracheostomy:afeasibilitystudyPercutaneoustracheostomyperformedunderreal-timeultrasoundguidanceisfeasibleandappears

accurateandsafe,includinginpatientswithmorbidobesityandcervicalspineprecautions.VenkatakrishnaRajajee,JeffreyJFletcher,LaurynRRochlen,etal.CriticalCare2011,15:R67現(xiàn)在是26頁\一共有34頁\編輯于星期六臨床應(yīng)用6—定位氣管切開Traditionallandmarkversusultrasoundguidedtrachealpunctureduringpercutaneousdilatationaltracheostomyinadultintensivecarepatients:arandomisedcontrolledtrialUltrasoundguidancesignificantlyimprovedtherateoffirst-passpunctureandpunctureaccuracy.Fewerproceduralcomplicationswereobserved;however,thisdidnotreachstatisticalsignificance.Theseresultssupportwidergeneraluseofreal-timeultrasoundguidanceasanadditionaltooltoimprovePDT.MátéRudas,IanSeppelt,RobertHerkes,etal.CriticalCare2014,18:514現(xiàn)在是27頁\一共有34頁\編輯于星期六臨床應(yīng)用6—定位氣管切開可視化操作才能有意識避開血管現(xiàn)在是28頁\一共有34頁\編輯于星期六臨床應(yīng)用6—定位氣管切開現(xiàn)在是29頁\一共有34頁\編輯于星期六其他的臨床應(yīng)用1—

迅速準(zhǔn)確建立通氣MallinM,CurtisK,DawsonM,etal.AmJEmergMed2014Jan;32(1):61-3.Accuracyofultrasound-guidedmarkingofthecricothyroidmembranebeforesimulatedfailedintubationUltrasound

markingoftheCTMofhealthyvolunteersbeforesimulatedintubatio