21. 上气道梗阻
概 述
急性上气道梗阻是指由于炎症、外伤、肿瘤、异物等原因引起的喉或气管的骤然阻塞,患者表现为急性吸气性呼吸困难,严重者可危及生命。急性上气道完全性梗阻是一种极其危急的急症,患者的呼吸气流完全中断,如不能及时予以疏通和通气,患者将于数分钟内因窒息而呼吸、心跳停止;急性上气道部分性梗阻可因患者通气功能障碍导致逐渐加重的缺氧和二氧化碳蓄积,危及心脑等生命器官功能,同样需要紧急处理。以下是上气道梗阻诊治的临床路径。
注意:虽然上气道梗阻初始的症状可能比较轻微,但通常会迅速加剧。医务人员应尽可能反复查看患者以避免完全梗阻的发生,一旦发生完全梗阻,应在1~2分钟内解除。
表21.1 气道管理方法
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T21.1_59995.jpg?sign=1739664102-KkySfFiW8cip0TeZiZHX29XHcjXhrshn-0-381f851c542d2c0ed1d63fe0148dad75)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T21.1_1_59996.jpg?sign=1739664102-26LetaJOuZmls3XQSPcRoDler3g9Xg4L-0-a693aa86b91da271e036a24ed10d54fb)
表21.2 上气道梗阻的临床特征
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T21.2_15835.jpg?sign=1739664102-EMV8hgWRcor4A5zHMNMlL5w5sOImrXsx-0-f8dbaf3323f64d8eaacde38cdcbb3087)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T21.2_1_15877.jpg?sign=1739664102-YgRQbkG5HuONZO5Tgxx7uHv6LuQtheaG-0-23a41c0a4f71ab9faf2253082d518fb4)
表21.3 上气道梗阻的原因
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T21.3_15884.jpg?sign=1739664102-1v6l8PsJVl01sdnLpAQKd8hIzDCMCmyH-0-d046cf46a084eb1568f98a1b6814439d)
表21.4 重点评估
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T21.4_59680.jpg?sign=1739664102-G13OqE7kFnlJeJPHDTtmg8v9ooCqFjKC-0-35fefaf1a3266dea8f0f4fdbdd2767b8)
表21.5 紧急检查
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T21.5_59681.jpg?sign=1739664102-I0dO8jiCUHePgxajhGkIRia7Ds2qlDFA-0-0961f37ce3319689d7afe5ff6fb4519b)
表21.6 气道梗阻患者的治疗
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T21.6_15968.jpg?sign=1739664102-FdbmAqJyMhQMWupKvWSElLCzAu22g3s3-0-b283554b9db4be4f202594ef7f514066)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T21.6_1_16009.jpg?sign=1739664102-lbOs5TOkknVeTsmS4rIcvdh0G7Z9e5mS-0-5056fb00fdd5de2d7f52f942406eac3f)