有創機械通氣患者人工氣道的選擇: 經鼻還是經口插管? 是否要早做氣管切開?_《中國呼吸與危重監護雜志》

作者：

俞森洋

解放軍總醫院南樓呼吸科（北京 100853）;

關鍵詞：

機械通氣

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一、經鼻或經口氣管插管的優劣有創機械通氣患者需建立人工氣道( 氣管插管或氣管切開) , 氣管插管經鼻或經口途徑何者優越的問題, 國內外始終存在爭論。20 世紀80 年代前, 我們和國內大多數醫院一樣, 較多采用經口插管, 理由是經口比較容易插入, 可用較大管徑的導管, 氣流阻力較小; 便于吸痰, 清除氣道內分泌物。但缺點是容易移位, 脫出, 如果脫出后重插, 將增加患者危險和呼吸機相關肺炎( VAP) 發生率; 患者不能閉口, 不能進行有效的口腔清潔護理, 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過氣管導管氣囊的微誤吸, 也增加VAP發生的危險。由于那時還沒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間保留, 故患者插管后1～3 d 均行氣管切開。

引用本文： 俞森洋. 有創機械通氣患者人工氣道的選擇: 經鼻還是經口插管? 是否要早做氣管切開?. 中國呼吸與危重監護雜志, 2009, 09(1): 3-5. doi: 復制

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.

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有創機械通氣患者人工氣道的選擇: 經鼻還是經口插管? 是否要早做氣管切開?

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有創機械通氣患者人工氣道的選擇: 經鼻還是經口插管? 是否要早做氣管切開?

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