困难气道处理最新进展和指南解读 ASA 困难气道指南 中国医学科学院 北京协和医学院整形外科医院薛富善 ASA 困难气道的定义 受过常规训练的麻醉科医师，在进行面罩通气和 / 或气管插管操作时遇到的、使其感到困难的情况。 包括困难面罩通气、困难喉镜显露、困难气管插管和气管插管失败。Caplan RA, et al. Practice guidelines for management of the difficult airway: An updated report by the AAS Task Force on Management of the Difficult Airway. Anesthesiology 2003; 98:1269–1277. 困难气道的定义面罩通气困难 面罩不能密闭、大量气体漏出、通气阻力过大、胸廓起伏不明显、呼吸音弱或无、严重气道梗阻征象、紫绀、胃肠胀气、 SpO2 降低、呼出 CO2 低以及低氧血症造成的血液动力学变化（如高血压、心律失常）等。 喉镜显露分级Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39:1105-1111. 困难喉镜显露 困难喉镜显露是指在正确直接喉镜操作下不能看见声带的任何部分，即Ⅲ级和Ⅳ级喉镜显露。Benumof JL. Management of the difficult adult airway: With special emphasis on the awake tracheal intubation. Anesthesiology 1991; 75:1087-110. 困难喉镜显露与困难气管插管 Ⅰ 级和Ⅱ级喉镜显露一般不会导致气管插管操作困难；Ⅲ级和Ⅳ级喉镜显露则有导致气管插管操作困难的高度可能，气管导管误入食管的危险高达 50% 。Caplan RA. Practice Guidelines for Management of the Difficult Airway. A report by the American Society of Anesthesiologists Task Force on management of the difficult airway. Anesthesiology 1993;78 ： 597. 困难气管插管 受过常规训练的麻醉科医师，采用直接喉镜进行气管插管操作，试插 3 次以上方获成功；或用直接喉镜操作进行气管插管时，操作时间超过 10min 方获成功。Caplan RA, et al. Practice guidelines for management of the difficult airway: An updated report by the AAS Task Force on Management of the Difficult Airway. Anesthesiology 2003; 98:1269–1277. 困难气道的分级Caplan RA. Practice Guidelines for Management of the Difficult Airway. A report by the...
