青年医师读书会第一期：气道管理

1001

原帖由 wudengyou 于 2008-10-13 16:51 发表

                               
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“做为一名医生，为了应付生活中的各种不测，钥匙上挂个法国生产的LIFESTAT也很酷哦!既可以通气，还可以气胸排气。

                               
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http://ff.a.5d6d.com/userdirs/c/0/xy ...

知道了原理，很多器材可以找到替代品。比如用动脉导管鞘就可以取代Quicktrach。相对18G导管针而言，导管鞘的优点是管径粗。而且这些东西是国内到处都能买到的。

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xgy1968

    谢谢祥子的无私奉献。

jerryanest

弱弱问一句：
那些麻醉指南（国内或国外）有法律效用吗？

好像某些指南开篇就提到“只作为参考，不作为法律依据……”之类的字眼哦。

lencho83

在《麻醉与镇痛》杂志上看到了一种判断插管困难程度的方法：咬上唇实验
用下切牙尽量去咬上唇，超过上唇线为一级，低于上唇线为二级，不能咬住上唇为三级
比改良的Mallampati评分系统有更高的特异性，准确度，可作为独立，简易预测指标

1: AANA J. 2007 Jun;75(3):177-82.
Links
A comparison of preoperative airway assessment techniques: the modified Mallampati and the upper lip bite test.
Hester CE, Dietrich SA, White SW, Secrest JA, Lindgren KR, Smith T.

Redmond Regional Medical Center, Rome, Ga, USA.

The purpose of this study was to compare the preoperative anesthetic airway evaluation methods of the modified Mallamapti test (MMT) and upper lip bite test (ULBT) with the direct laryngoscopic views obtained during tracheal intubation. Positive relationships were predicted for the MMT and ULBT with direct laryngoscopic view and between the MMT and ULBT. We assessed 50 patients' airways preoperatively by MMT and ULBT. Intraoperatively, laryngoscopic views were graded on the Cormack and Lehane scale. Descriptive statistics and correlations were computed. There was no relationship between the MMT and the ULBT and the Cormack and Lehane scale. There was a significant relationship between the ULBT and the Cormack and Lehane scale (r = 0.512; P <.001 ). The ULBT was superior to the MMT in every measure in this study: sensitivity (55% vs 11%), specificity (97% vs 75%), positive predictive value (83% vs 9%), and accuracy (90% vs 64%). The findings of this study support those of a previous study of the ULBT. Because of the ease of the ULBT and the promising results of this small study, we recommend further research with a larger, more diverse sample.

PMID: 17591297 [PubMed - indexed for MEDLINE]

2.A comparison of the upper lip bite test (a simple new technique) with modified Mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study.
Khan ZH, Kashfi A, Ebrahimkhani E.

Department of Anesthesiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. [email protected]

We explored the possibility that a simple and single test could replace the modified Mallampati score for either a difficult or an unaccomplished tracheal intubation in an impending hypoxic patient. Three hundred adult patients were enrolled in this study. They were subjected to the following assessments: 1) oropharyngeal class according to the modified Mallampati criteria; 2) the new, upper lip bite criteria-class I = lower incisors can bite the upper lip above the vermilion line, class II = lower incisors can bite the upper lip below the vermilion line, and class III = lower incisors cannot bite the upper lip; and 3) laryngeal view grading according to Cormack's criteria. The incidence of difficult intubation was 5.7%. The upper lip bite test showed significantly higher specificity and accuracy than the modified Mallampati test (P < 0.001). Comparisons of sensitivity, positive and negative predictive values, between the two tests, however, did not reveal any significant differences (P > 0.05). In conclusion, the upper lip bite test is an acceptable option for predicting difficult intubation as a simple, single test.
术前访视的时候，瞩病员用下颌牙齿触碰上嘴唇。
以此粗略判断麻醉插管的困难度

原理：借用托下颌避免舌后坠堵塞气道

chexuehua1972

没有一种气道评分方法是完全可靠的，因此要多方面综合分析，对于Mallampati分级为4级的常规清醒插本人不敢苟同，至少是在现如今有多种替代器械的情况下