有创机械通气患者人工气道的选择: 经鼻还是经口插管? 是否要早做气管切开?_Chinese Journal of Respiratory and Critical Care Medicine

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俞森洋

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机械通气

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一、经鼻或经口气管插管的优劣有创机械通气患者需建立人工气道( 气管插管或气管切开) , 气管插管经鼻或经口途径何者优越的问题, 国内外始终存在争论。20 世纪80 年代前, 我们和国内大多数医院一样, 较多采用经口插管, 理由是经口比较容易插入, 可用较大管径的导管, 气流阻力较小; 便于吸痰, 清除气道内分泌物。但缺点是容易移位, 脱出, 如果脱出后重插, 将增加患者危险和呼吸机相关肺炎( VAP) 发生率; 患者不能闭口, 不能进行有效的口腔清洁护理, 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经过气管导管气囊的微误吸, 也增加VAP发生的危险。由于那时还没有使用高容低压气囊, 使用的高压低容气囊的橡胶插管只能短时间保留, 故患者插管后1～3 d 均行气管切开。

Citation： 俞森洋. 有创机械通气患者人工气道的选择: 经鼻还是经口插管? 是否要早做气管切开?. Chinese Journal of Respiratory and Critical Care Medicine, 2009, 09(1): 3-5. doi: Copy

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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有创机械通气患者人工气道的选择: 经鼻还是经口插管? 是否要早做气管切开?

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