中文摘要：

目的：探讨自制气道转换导管在重症监护病房（ICU）困难气管插管患者拔管中的应用。方法将62例困难气管插管拔管试验失败的患者按随机原则分为传统组和观察组，每组31例。传统组进行常规拔管，观察组置入自制气道转化导管辅助拔管。比较两组患者拔管12 h后心率、血压、呼吸频率（RR）、脉搏血氧饱和度（SpO2）的变化，以及拔管后的重新置管率、一次置管成功率和置管时间，并观察两组拔管后耐受度和并发症发生情况。结果传统组患者拔管后心率、血压和RR较拔管前显著增加（均P＜0.05），SpO2显著下降（P＜0.05），而观察组拔管后上述指标变化不明显，基本波动在正常范围。拔管12 h后传统组重新置管率较观察组明显增加（25.81%比6.45%），差异有统计学意义（P＜0.05）。观察组的重新置管时间明显短于传统组（s：27＆#177;14比49＆#177;28，P＜0.01），一次置管成功率显著高于传统组（90.32%比54.84%，P＜0.01）。观察组患者的耐受率显著优于传统组（77.4%比61.3%，P＜0.05），传统组患者出现声门水肿，行环甲膜紧急穿刺1例，气道黏膜出血2例，呛咳2例，而观察组所有患者均无并发症发生。结论和传统拔管方法比较，自制气道转换导管可增加拔管成功率，降低重新置管率，缩短置管时间，且患者耐受良好，无严重并发症发生，是ICU困难气管插管患者安全、有效的拔管策略之一。

英文摘要：

Objective To discuss the clinical application of homemade airway exchange catheter on the extubation of patients with difficult tracheal intubation in intensive care unit（ICU）. Methods Sixty-two patients with difficult tracheal intubation who failed their initial extubation trial were randomly divided into conventional group （31 cases）and observation group（31 cases）. The patients in the conventional group received routine extubation process,while the patients in the observation group were extubated under the guidance over a homemade airway exchange catheter. The changes in heart rate（HR）,blood pressure,respiratory rate（RR）and pulse blood oxygen saturation（SpO2）were compared at 12 hours after extubation,so as the re-intubation rate,intubation success rate at first attempt and re-intubation time in two groups,and the tolerance and complications after extubation were observed. Results After extubation,the HR,blood pressure and RR were increased significantly（all P＆lt;0.05）, and the SpO2 was much lower in conventional group（P＆lt;0.05）,while those parameters were changed little and basically in the normal ranges in the observation group. At 12 hours after extubation,the re-intubation rate was much lower（6.45%vs. 25.81%,P＆lt;0.05）in the observation group,with shorter re-intubation time（seconds：27＆#177;14 vs. 49＆#177;28,P＆lt;0.01）,higher intubation success rate at first attempt（90.32%vs. 54.84%,P＆lt;0.01）and better tolerance （77.4% vs. 61.3%,P＆lt;0.05）compared with those in the conventional group. There was no severe complication in the observation group,and there were 1 cases of glottic edema with cricothyroid membrane puncture,2 cases of broncheal mucous membrane bleeding and 2 cases of bucking in the conventional group. Conclusion Compared with conventional extubation process,the extubation over homemade airway exchange catheter can increase the rate of extubation,reduce re-intubation rate and the re-intubation time,with favorable tolerance and no occu