协和医学杂志

2011, v.2(04) 331-337

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我国气道管理现状调查
Preliminary Survey on Airway Management in China

易杰;黄宇光;罗爱伦;
YI Jie,HUANG Yu-guang,LUO Ai-lun Department of Anesthesiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China

摘要(Abstract):

目的针对我国气道管理的现状进行问卷调查,为改进和完善我国气道管理提供参考。方法采用邮寄调查问卷的方法,对全国27个省市自治区78家医院进行调查。调查问卷包括被调查者基本情况,对各种气道工具的熟知和使用程度,对临床几种气道情景的处理以及科室气道管理等4个部分。以教学和非教学医院为分组变量,采用校正χ2检验进行分析比较。结果调查问卷有效回收率为60.7%。所有麻醉医师最熟悉且能熟练使用的是Macintosh喉镜片、标准镜柄、口咽通气道和塑形管芯。教学医院麻醉医师对视频喉镜Glidescope、可视管芯、插管型喉罩及纤维支气管镜的了解和熟练使用与非教学医院比较差异有显著统计学意义(P<0.01)。对其他气道工具,包括紧急气道工具的了解和使用教学与非教学医院差异较大。对有明确插管困难的患者,近半数麻醉医师(46.9%)选择纤维支气管镜下清醒插管;79.2%的麻醉医师遇到意外插管困难时能在维持通气时尝试其他方法;遇到不能通气不能插管时,首选喉罩改善通气和环甲膜穿刺建立气道的麻醉医师分别为47.6%和52.4%;怀疑有插管困难,绝大多数麻醉医师(92.6%)会先尝试麻醉后直接喉镜插管。教学医院在建立简便气道处理流程、专业团队建设和培训上比非教学医院好(P<0.01)。结论被调查的麻醉医师对气道管理工具的认识和使用差异较大,但对气道处理流程的遵循较好。麻醉科室在气道管理方面仍有需改善之处。
Objective To perform a preliminary survey on airway management in China.Methods The postal questionnaires were sent to anesthesiologists in 78 hospitals of 27 provinces/municipalities/autonomous regions.The questionnaire contained four parts which included the general information of respondents,the knowledge and usage of various airway tools,the practical patterns to different clinical airway scenarios,and the administrative management of the anesthesiology department.Chi-square analysis was performed for categorical variable(teaching hospital or non-teaching hospital).Results The response rate was 60.7%.Direct laryngoscope using Macintosh blade with standard handle,oral airway,and malleable stylet were the most familiar airway tools for all the respondents.Anesthesiologists in teaching hospitals had better knowledge and more frequent usage of Glidescope,seeing stylet,intubating laryngeal mask airway,and fiberoptical bronchoscope than those in non-teaching hospitals(P<0.01).There were large variations between teaching and non-teaching hospitals in the knowledge and usage for other airway tools including emergency tools.Nearly half of respondents(46.9%) preferred to choose awake fiberopitcal intubation as their first choices for definite difficult intubation patients.When encountering unexpected difficult intubation,79.2% of anesthesiologists would attempt alternative tools to intubate only if they could maintain the airway.For patients who were unable to be intubated or ventilated,47.6% of the responders preferred to improve ventilation using larngeal mask airway as first choice while 52.4% preferred to establish an emergency airway via cricothyrotomy.For suspected difficult intubation,most respondents(92.6%) would attempt to paralyze patient and intubate with direct laryngoscopy.Teaching hospitals were better than non-teaching hospitals in terms of establishing simple airway management algorithm,subspecialty development,and staff training(P<0.01).Conclusions Although the knowledge and usage of airway tools differ among anesthesiologists in China,most of them well follow the airway management algorithm in different airway scenarios.However,the administrative management of the anesthesiology department requires further improvement.

关键词(KeyWords): 气道管理;问卷调查
airway management;questionnaire survey

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作者(Author): 易杰;黄宇光;罗爱伦;
YI Jie,HUANG Yu-guang,LUO Ai-lun Department of Anesthesiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China

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