光棒引导气管插管临床应用.docVIP

光棒引导气管插管临床应用[摘要] 光棒是一项利用颈部软组织透光的原理实施气管插管的新技术。光棒插管具有容易掌握、耗时短、插管成功率高及并发症少等优点，在国外已广泛应用于临床麻醉、急救医学等领域。美国麻醉医师协会在困难气道管理指导中，将光棒插管列为困难气道插管的技术之一。二十世纪末，光棒插管技术被引进到国内，在临床工作中得到了很好的应用。对于光棒颈前透光原理及适应证、禁忌证、局限性的明确认识，有助于提高使用光棒插管的有效性，减少并发症的发生率。笔者查阅近年来光棒的相关文献资料，就光棒的临床应用作一综述，为临床更好的应用提供参考。 [关键词] 光棒；气管插管；综述 [中图分类号] R614 [文献标识码] A [文章编号] 1673-7210（2012）08（a）-0036-03 Clinical application of lightwand-guided tracheal intubation LU Yan XU Mingjun Department of Anesthesiology, the Affiliated Beijing Obstetrics and Gynecology Hospital of Capital Medical University, Beijing 100006, China [Abstract] Lightwand is a new tracheal intubation technique using the nonopaque principle of cervical soft tissues. Lightwngd-guided intubation is easy to operate, is fast, has a high success rate and causes few complications, so it has been widely applied in clinical anesthesia, emergency treatment and other areas. In the guidelines for management of difficult airway, the American Society of Anesthesiologists lists lightwand-guided intubation as one of the difficult airway intubation techniques. In the late 20th century, lightwand-guided intubation is introduced into China and well applied in clinical anesthesia. A clear understanding of the nonopaque principle of cervical tissues and indications, contraindications and limitations of lightwand can improve the effectiveness of lightwand-guided intubation and reduce the incidence of complications. Through the study of recent literatures on lightwand, the clinical application of lightwand is reviewed in order to provide reference for its better application. [Key words] Lightwand; Tracheal intubation; Review 1957年Macewan首次报道使用光棒气管插管，1978年Raybum正式将这项技术命名为光棒插管。光棒气管插管技术在国外已广泛用于临床麻醉，美国麻醉医师协会在困难气道管理指导中，将光棒插管列为困难气道插管的技术之一[1]。二十世纪末，光棒插管技术被引进到国内，在临床工作中得到了很好的应用。本文就光棒的临床应用作一综述。 1 光棒构造及原理 光棒又称光索、照明插管芯，是一根可弯曲的金属导管，前端装有灯泡，尾部配有电池和开关。光棒是利用颈部软组织透光原理引导导管进入气管内。当带有光棒的气管导管通过声门时，光斑应位于环甲膜正中或向气管方向延伸。颈前光亮点在喉结上方，光强度稍弱，表明气管导管前端可能位于会厌谷；光亮点在喉部两侧，表明气管导管可能位于梨状窝；颈前观察不到亮点或光亮点非常弥