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<section data-tools="gulangu" data-label="powered by gulangu"><br /></section><p><span>来源：美敦力</span><br /></p><p><br /></p><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><br /></section></section></section><section><section powered-by="gulangu"><section><section><br /></section></section></section></section><section><section powered-by="gulangu"><section><br /></section></section></section></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><p>新型冠状病毒是“搭便车”的高手，它们乘坐 “口腔飞沫列车”与“气溶胶航班”，亦或是通过人们的接触四散开来，不放过任何一个可以乘虚而入的环节，有很强的传染性。为了抵御这位不速之客，直面患者的医护人员总是N95口罩、护目镜、防护服、防护手套……全副武装。但即便如此，还是有一些治疗操作极具感染风险，防不胜防，例如为患者进行<strong><span>“呼吸道管理”<span>。</span></span></strong></p></section></section></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><br /></section></section></section><section><section powered-by="gulangu"><section><section><br /></section></section></section></section><section><section powered-by="gulangu"><section><br /></section></section></section></section></section></section></section><section powered-by="gulangu"><section><br /></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><br /></section></section></section><section><section powered-by="gulangu"><section><p>“呼吸道管理”是一种常规的临床操作，就是我们常说的“插管”及相关护理：当氧疗和其他无创通气方式无法改善患者病情时，可以通过插入气管导管建立起人工气道，并连接至呼吸机，呼吸机才能顺利接管患者的呼吸大任。但这一平时常规的操作，却在新冠疫情下变得危险重重。</p></section></section></section></section></section></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><br /></section></section></section><section><section powered-by="gulangu"><section><p><span>因为气道作为病毒“出行”的主干道，一旦打开就会有无数病毒扩散而出，而需要近距离“直面病毒”、尤其是需要进行气道管理的医护人员成为了离危险最近的一群人，每次插管都是一次“穿越火线”，被媒体誉为插管“突击队”。</span></p></section></section></section></section></section></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><section><p><strong>01</strong></p></section><section><section><svg viewbox="0 0 1 1"></svg></section></section></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><p><span>开山辟路，穿越插管火线</span></p></section></section></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p>呼吸困难是新冠肺炎患者的典型症状之一，对于轻症患者来说，使用氧疗或无创通气是维持其血氧饱和度的有效方法。而那些呼吸衰竭的危重患者，就得通过<strong><span>插管</span></strong>建立人工气道，让<strong><span>呼吸机</span></strong>出马，开展针对性的呼吸支持治疗。连着呼吸机，接通氧气的这根透明软管就是他们的“救命稻草”。</p></section><section powered-by="gulangu"><section><p><img src="image/20200927/e432f6401aa39738de39c4bb084653b7_1.gif" /></p></section></section><section powered-by="gulangu"><p>如何顺利插管，让患者抓住这根“救命稻草”，是一项技术活。首先，需要创造插管条件，麻醉医师或护理人员会给患者注射麻醉药品。从此时开始，插管就进入了“黄金90秒”，医生需要在90秒内完成插管，否则就可能导致患者缺氧，甚至引发心脏骤停，重者致死。<span>[1]</span></p><p><br /></p><p>接下来就是找到气道的位置，医护人员打开患者口腔后，会置入一个<strong><span>喉镜</span></strong>找寻两条声带中间的一个七八毫米的小洞：<strong><span>声门</span></strong>，透明软管穿过它就能滑入气管，成功“着陆”，完成插管。</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><p><img src="image/20200927/756ae842b4d5a91cb851764789d5e799_2.jpg" /></p></section></section><section powered-by="gulangu"><p>插管示意图</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p>虽然ICU里的医护人员都是经验丰富的“老手”，但在为新冠肺炎患者找寻气道位置这个步骤上却也有些提心吊胆。面对护目镜起雾、插管视野不佳等小插曲，为了看得更清楚，他们往往会在使用喉镜插管时离患者气道更近，传染风险将大大提升。</p><p><br /></p></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section powered-by="gulangu"><p>“如果喉镜本身就自带一块小屏幕，能让他们看得更清晰，岂不是能降低风险”？</p></section></section><section><section><svg viewbox="0 0 1 1"></svg></section></section></section></section><section><section powered-by="gulangu"><section><p><img src="image/20200927/33365c904b362ce798b2cb9072c31278_3.jpg" /></p></section></section></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><p><img src="image/20200927/64e064a911552d3f131143f9cb590fd3_4.jpg" /></p></section></section></section><section><section powered-by="gulangu"><section><section><svg viewbox="0 0 1 1"></svg></section></section><section><section powered-by="gulangu"><p>“好在<strong><span>可视化喉镜</span></strong><strong><span>技术</span></strong>已实现了这一心愿，本身自带的实时传输画面屏幕让喉镜更好地成为了医生们的“眼”，不但让插管视野更好，还不必再为看清而凑得太近。”</p></section></section></section></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p>距离不仅产生美，更产生了“安全”。为医护人员争分夺秒与死神抢时间、穿越插管火线助了一臂之力。</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><section><p><img src="image/20200927/e5e14a47d8abbe2f8e278f0bc85002a3_5.png" /></p></section></section></section><section powered-by="gulangu"><p>可视化喉镜技术示意图</p><p>国械注进20172227144</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><section><p><strong>02</strong></p></section><section><section><svg viewbox="0 0 1 1"></svg></section></section></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><p><span>防微“滤”远，识破病毒险恶用心</span></p></section></section></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p>安全穿越插管火线，为患者成功装上呼吸机只是阶段性的胜利，在插管环节没能得逞的新冠病毒此时又伺机在呼吸机中“搞事情”，妄图通过患者呼出气体的时机“蒙混过关”，进入空气环境中，达到扩散传播的险恶目的。</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><p><img src="image/20200927/bc19943cda1ff148393f6dfa4e016877_6.jpg" /></p></section></section><section powered-by="gulangu"><p>呼吸治支持治疗示意图</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p>为了阻断因呼吸机造成的医护人员感染，呼吸机的吸气和呼吸端分别安排了一套“拦截系统”——<strong><span>呼吸机过滤器</span></strong>。</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p>呼吸机过滤器拦截病毒靠得不是一双“火眼金睛”，而是一种特殊的材料。这种材料不仅能隔离病毒，还带有静电，被编织成网状后放置在呼吸过滤器内，能够将试图越界的病毒精准拦截，同时还能通过静电吸附它们，直接“就地扣留”，病毒滤过率可以达到99.999%<span>[2]</span>。为患者和医护人员默默地保驾护航。</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><p><img src="image/20200927/78edc2929c695b61e9dee3861d7bb16b_7.jpg" /></p></section></section><section powered-by="gulangu"><p>呼吸过滤器示意图</p><p>国械注进20162664335</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><section><p><strong>03</strong></p></section><section><section><svg viewbox="0 0 1 1"></svg></section></section></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><p><span>豁然开朗，跃出痰液包围圈</span></p></section></section></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p>在新冠肺炎治疗中，特别是上了呼吸机的重症患者 ，多而粘稠的痰液像是一片泥沼沉积在口腔与肺部，让患者的窒息感愈发严重。因此，痰液又成为了“插管突击队”所面临的又一“拦路虎”。</p><p><br /></p><p>为了保持患者的呼吸道通畅，维持稳定的通气，医护人员需要使用<strong><span>“痰液引流技术”</span></strong>，通过“抽吸”的方式将痰液排出患者体外。</p><p><br /></p><p>传统的吸痰是“开放式”的，吸痰时必须断开呼吸机接头，将无菌吸痰管伸入患者的气管插管内吸痰。在这一过程中，痰液往往会接触到空气，或是由于患者呛咳等原因被医护人员直接接触到，造成病毒的近距离接触。根据研究发现，每次断开呼吸回路，携带病原体的悬浮颗粒可扩散到周围2米的距离，ICU医护人员感染的风险是普通病房的13倍。<span>[</span><span>3]</span></p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><p><img src="image/20200927/18e59d26aae318d16dca7c4ff6d4edfd_8.jpg" /></p></section></section><section powered-by="gulangu"><p>吸痰技术示意图</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p>有没有一种全封闭的吸痰方式能够从源头上避免病毒钻空子传染呢？</p><p><br /></p></section><section powered-by="gulangu"><p>它的名字正叫做<strong><span>封闭式吸痰技术</span></strong>。顾名思义，就是一种全程封闭，无需断开通气的吸痰方式。医护人员只需将封闭式吸痰管头端接头连接气管插管，带有薄膜防护套的中间接头接到呼吸机管路，尾端接头连接负压吸引管，“三管齐下”，患者的痰液就会顺着管路慢慢流到积水瓶内<span>[4]</span>，而不是暴露在空气中，减少了病毒的传播风险，让医护人员的安全又多了一层保障。</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><p><br /></p></section></section></section></section><section powered-by="gulangu"><p>俗话说：魔鬼都藏在细节里。但除了必须的防护服、隔离衣、护目镜、N95口罩、手套等防护之外，可视化喉镜、封闭式吸痰系统、呼吸机过滤器等组成的“守护者联盟”也扮演着同样重要的角色，让藏在细小环节蠢蠢欲动的新冠病毒终是无计可施，也帮助了前线的医护人员得以告别“插管突击队”称号。</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><p><img src="image/20200927/148e2233b89891fd82982ef9bab94a44_9.jpg" /></p></section></section><section powered-by="gulangu"><section><br /></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><p>近期随着春暖花开，湖北前线的“突击队”们正与其他医护人员一同，陆续从战役战场撤离，完成了最美逆行的任务。</p><p><br /></p><p>这个世界上并没有什么超级英雄，不过是有一分热，发一分光，萤火汇聚成星河。</p><p><br /></p><p>愿更多白衣战士都能平安归来。</p></section></section></section></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><section><p>参考文献</p></section><p><img src="image/20200927/5a6104ceefe8febdbe4164885d089ddb_10.png" /></p></section><section><section><section><svg viewbox="0 0 1 1"></svg></section></section><section><br /></section></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><p>[1]张均斌 孙庆玲. 离危险最近的人：“插管敢死队”为患者搏一线生机. 中国青年报,2020-03-02 01版.</p><p>[2]数据来源：过滤器技术要求文件</p><p>[3]HannoveHugonnetS, PittetD. Transmission of severe acute respiratory syndrome in critical care: do we need a change?[J]. AM J Respir Crit Care Med. 2004. 169(11):1177-1178</p><p>[4]蒋志华. 新冠肺炎疫情下，千万不要这样吸痰！. 华医网,2020-03-11.</p></section></section></section></section><p><br /></p>
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发表于 2020-9-27 07:05:57