Ramsey Cyrus A, Dhaliwal Sukhdeep S
Fairfax Oral and Maxillofacial Surgery, Fairfax, VA 22030, USA.
Atlas Oral Maxillofac Surg Clin North Am. 2010 Mar;18(1):61-8. doi: 10.1016/j.cxom.2009.11.004.
Direct laryngoscopy remains the technique of choice for placing an endotracheal tube (ETT). However, alternative techniques are needed for the difficult airway or unsuccessful intubation. Retrograde intubation may be used in adult or pediatric patients, whether awake, sedated, or obtunded. Contraindications include nonpalpable neck landmarks, pretracheal mass, severe flexion deformities of the neck, tracheal stenosis, coagulopathies, and infections. Submental intubation allows simultaneous access to the dental occlusion and nasal pyramid without the morbidity associated with tracheostomy. Contraindications include patients who require long periods of assisted ventilation and a severe traumatic wound on the floor of mouth. Complications include localized infection and sepsis, poor wound healing or scarring, and postoperative salivary fistula.
直接喉镜检查仍然是放置气管内导管（ETT）的首选技术。然而，对于困难气道或插管失败的情况，需要其他替代技术。逆行插管可用于成人或儿童患者，无论其是清醒、镇静还是昏迷状态。禁忌证包括颈部标志无法触及、气管前肿物、颈部严重屈曲畸形、气管狭窄、凝血功能障碍和感染。颏下插管可同时观察牙咬合和鼻锥体，且无气管造口术相关的并发症。禁忌证包括需要长期辅助通气的患者以及口底严重创伤的患者。并发症包括局部感染和脓毒症、伤口愈合不良或瘢痕形成以及术后唾液瘘。
