不完全气道异物梗阻最佳急救方法（无法呼吸的痛--气道异物阻塞怎么破）

不完全气道异物梗阻最佳急救方法（无法呼吸的痛--气道异物阻塞怎么破）∙ 吸气时高调声，∙ 微弱无力的咳嗽或无法咳嗽，及时识别气道异物吸入引起的呼吸道梗阻对于急救与否至关重要。最常见和特有的体征是“V”字手势，即一只手或双手抓住自己的喉咙。轻度的气道阻塞一般会有咳嗽，咳嗽间歇可能有喘息的声音，但还是有较好的气体交换。而严重的气道堵塞的症状体征则包括：∙ 用手抓喉咙或者挥舞手臂，∙ 不能说话，哭或发出声音，

周末天气晴朗，阳光明媚，小明，小刚和几个好朋友相约一起去踢足球，然后中午大家一起去吃披萨。爸爸点了小朋友们最爱的超级至尊。大家一边吃，一边讲各自学校的有趣事儿，小刚说了一个笑话，大家哄堂大笑，小明正好在嚼香肠也控制不住哈哈大笑。但是在大笑的同时吞咽食物是有难度的，结果一口香肠呛到了气管里哽住了，小明无法说话，无法呼吸，但小伙伴们以为他喘不上气是因为笑的太厉害了，直到小明用手抓住自己的喉咙 大家意识到情况不对，赶忙叫来了爸爸。幸好爸爸及时赶到用了海姆立克急救法，帮助了小明咳出了卡在气管里的香肠，小明脱离了危险。

It was a nice and sunshine weekend. Xiao Ming Xiao Gang and a few friends played football and they went to PizzaHut for lunch. Xiao Ming's Dad ordered their favorite SUPREME. They were talking about funny school stories while eating. Xiao Gang told a joke and everyone was laughing. Xiao Ming couldn't help but laugh as well just as he took a bite of his sausage. But it's hard to laugh and swallow food at the same time. The sausage got stuck into his throat. Xiao Ming couldn't speak and he couldn't breathe. His friends thought he was short of breath because he was laughing so hard. Until when Xiao Ming started to clutch his throat with thumb and fingers they knew that he was in trouble. Fortunately Xiao Ming's father was around. He rushed to Xiao Ming and performed the Heimlich maneuver. The sausage was expelled from his throat and Xiao Ming was survived.

这样的场景在生活中其实并不少见， 而且异物吸入造成的哽噎或窒息是是婴幼儿致命意外伤害的主要原因之一。当气道被食物， 玩具或其他被咽下的异物堵塞时，呼吸就受影响发生哽噎的情形。

Choking is not uncommon in daily life. It is also one of the leading causes of life-threatening incidents in infants and young children. Choking happens when airway is obstructed by food toys or any other objects that swallowed which prevent a person from breathing effectively.

及时识别气道异物吸入引起的呼吸道梗阻对于急救与否至关重要。最常见和特有的体征是“V”字手势，即一只手或双手抓住自己的喉咙。轻度的气道阻塞一般会有咳嗽，咳嗽间歇可能有喘息的声音，但还是有较好的气体交换。而严重的气道堵塞的症状体征则包括：

∙ 用手抓喉咙或者挥舞手臂，

∙ 不能说话，哭或发出声音，

∙ 微弱无力的咳嗽或无法咳嗽，

∙ 吸气时高调声，

∙ 进行性呼吸困难， 甚至于无法呼吸，

∙ 看上去很恐慌，

∙ 脸色变青。

Early recognition of choking is the key to the successful outcome. The universal choking sign is clutching the throat with the thumb and fingers. Mild airway obstruction often shows the signs of cough forcefully wheezing between cough and good air exchange. Symptoms and signs of severe airway obstruction including:

·grabs at his or her throat or waves arms

·can’t talk cry or make noise

·weak and ineffective cough or unable to cough

·hi-pitched noise while inhaling

·increased respiratory difficulty or unable to breathe

·appears panicked

·turns blue.

小明的故事中提到了海姆立克急救法，那么这是个什么急救手段呢？其实海姆立克急救法的大名是腹部冲击法，是美国心脏学会2015版的气道异物阻塞急救指南中的标准急救方法之一。原理是利用腹部冲击和挤压，驱使肺部残留空气形成快速的向上的气流，从而把堵住气管的异物冲出气道。传统的海姆立克急救法通常用于神志清醒的1岁以上的孩子和成人，一般是由他人操作，但在某些情况下也可以用作自救。

Abdominal thrusts also called Heimlich maneuver is a part of recommended emergency treatment in the 2015 American Heart Association Guidelines for choking. The quick squeeze in the middle of the abdomen expels foreign material that blocking the trachea by sending a quick powerful burst of air from the person's lungs upward to dislodge the obstruction. The traditional Heimlich maneuver is to be used on responsive adults and children over 1 year old. It's usually performed by another person but there's even a way to do it on yourself if necessary.

那么，腹部冲击法如何操作呢？美国心脏学会基础生命支持2015版指南里是这样描述的：

第一步，抢救者站在病人的背后，用两手臂环绕病人的腰部，

第二步，一手握拳，

第三步，将拳头的大拇指一侧放在病人胸廓下方和略高于脐上的腹部，

第四步，用另一手抓住握住的拳头，快速有力地向内向上冲击病人的腹部，

第五步，重复之直到异物排出或是病人失去意识为止。

对于孕妇及特别肥胖者，冲击的部位是胸部下半段中央垂直向内做胸部按压

How to perform the abdominal thrusts? It has been described in 2015 American Heart Association Basic Life Support Guideline as follows:

Step1: Stand or kneel behind the victim and wrap your arms around the victim's waist.

Step2: Make a fist with one hand.

Step3: Place the thumb side of your fist against the victims of abdomen in the midline slightly above the navel and well below the breastbone.

Step4: Grasp your fist with your other hand and press your fist into the victim's abdomen with the quick forceful upward thrust .

Step5: Repeat threats until the object is expelled from the airway or the victim becomes unresponsive .

If the victim is pregnant or obese perform chest thrusts instead of abdominals thrusts.

现在我们对腹部冲击法（海姆立克急救法）有了一定印象，接下来我们要具体看一下如果发生气道异物阻塞时，我们如何进行急救。

We understand what the Heimlich Maneuver is now. What should I do if someone is choking?

意识清醒的成人或儿童的气道阻塞急救

Choking Relief in a Conscious Adult or Child

轻度的气道阻塞：

表现：病人能够用力地大声咳嗽 说话 哭闹。

急救措施：陪伴，监护，并鼓励病人尝试用力咳嗽以排出异物

如若咳嗽无效或出现重度阻塞表现，实施海姆立克急救法， 直到异物排出。

严重的气道堵塞：

表现：“V”字手势，意识清楚，但不能说话或哭闹，呼吸微弱，咳嗽乏力，吸气高调音，或呼吸困难，脸色发青。

急救措施：实施海姆立克急救法， 直到异物排出。

如若不能缓解而且病人出现意识不清，开始心肺复苏。

Mild airway obstruction:

Signs: victim is able to cough forcefully speak or crying with god air exchange.

Actions: stay with the victim sooth and encourage the victim to continue coughing forcefully.

If obstruction continues and progresses to severe obstruction perform abdominal thrusts repeat the thrusts until choking relieved.

Severe airway obstruction:

Signs: still conscious grabs at his or her throat or waves arms but can’t talk cry or make noise weak and ineffective cough or unable to cough hi-pitched noise while inhaling increased difficulty with breathing or unable to breathe turns blue

Actions: perform abdominal thrusts immediately to relieve the obstructions repeat the thrusts until choking relieved.

If obstruction continues and the victim become unconscious start CPR immediately.

意识清醒的婴儿的气道阻塞急救

Choking Relief in a responsive infant

根据美国心脏学会基础生命支持2015版指南，对于1岁以内婴儿的婴儿的气道阻塞，是应该采用背部拍击法以及胸部冲击法，而不是海姆立克的腹部冲击法。具体操作方法如下：

第一步，将婴儿翻转面朝下呈骑跨状放在你的一侧前臂上，头部略低于胸部，同侧的手掌托住婴儿的头部和下颌，手臂可以放在同侧的大腿上。

第二步，用另一侧的掌根叩击婴儿两肩胛骨之间的区域，给予连续5次有力的背部拍击。

第三步，固定婴儿的后颈部，翻转成仰卧位躺在你的一侧前臂上，同侧手掌托住头部和颈部，使头部略低于躯干；手臂可以放在同侧的大腿上。

第四步，用另一侧手的食指和中指按压乳头连线中点下缘的胸骨，给予连续5次有力的胸部冲击， 向里向上，1秒1次。

第五步，依次重复5次背部拍击和5次胸部冲击，直到异物排出或是婴儿失去意识为止。

As recommended in 2015 American Heart Association Basic Life Support Guideline the back slaps and chest thrusts should be used for choking relief in infant. Do not use abdominal thrust. It takes the following steps to do the procedure:

Step1: Carefully position the baby face down on one forearm with the head slightly lower than the chest. Support the baby’s head and chin with same hand. Rest your forearm on your thigh. .

Step2: Using the heel of your other hand provide up to 5 forceful and distinct back slaps between the baby's shoulder blades to try to dislodge the object.

Step3: Carefully turn the baby over while keeping his face up on the forearm with the hand supporting the head and neck and head slightly lower than the trunk. Rest your forearm on your thigh.

Step4: Place two fingertips on the breastbone in the middle of his chest over the lower half of the breastbone. Deliver up to 5 quick downward chest thrusts at the rate of 1 per second.

Step5: Repeat the sequence of up to 5 back slaps and up to 5 chest thrusts until the object is forced out or the baby become unresponsive.

注意点

Caution

千万不要直接拍背，也不要用手直接去抠异物，否则会让异物落的更深 情况变得更糟。

如果病人只是呼吸道轻度梗阻，呼吸正常，用力咳嗽，气体交换良好，则暂时不需要采取措施，鼓励病人用力咳嗽来帮助呼吸道异物的排出。

急救措施实施过程中发现病人意识不清没有反应，马上开始心肺复苏。

Never to pat or slap the victim on the back or reach into the mouth to grab the object. Either of these steps could push the foreign body to farther down the airway and make the situation worse.

If there is a mild air way obstruction with normal breathe and cough forcefully do not intervene temporarily. Encourage the victim to cough forcefully which is the most effective way to dislodge a blockage.

If the victim is unresponsive during the rescue procedure immediately start cardiopulmonary resuscitation (CPR).

意识丧失时的气道梗阻急救

Choking Relief in an Unresponsive Adult Child or Infant

如果发现气道阻塞的病人意识丧失，立即拨打120急救电话，轻轻地把病人放到平地上。

轻拍重唤，即轻轻拍打其肩部，大声询问，您怎么了？或呼唤名字，同时查看有无呼吸。如果没有回应，呼吸或哭泣，开始进行心肺复苏，实施胸外心脏按压。按压和通气比例30:2，按压频率每分钟100-120次。

胸外按压所产生的冲力至少会和腹部冲击法的压力一样多，所以也会对异物的排出有帮助。

每次开放气道给予人工呼吸前都要打开口腔检查有无异物， 如果看到异物而且是容易清除的，用手指去除。 如果没看到异物，则继续予以心肺复苏。

依次重复直到异物排出并且病人意识恢复或急救人员到来。

Send someone else to call 120 ambulance and gently place the victim on the ground if you see that he is becoming unresponsive.

Tap the victim's shoulder and shout "Are you OK?" If unresponsive and no breathing begin CPR start with chest compressions. Perform the cycles of 30 chest compressions and 2 breaths at a rate of 100 to 120 compressions per minute.

The chest compressions used in CPR may create at least as much force as abdominal thrusts and they may help to expel the object.

Each time when open the airway to give breaths remember to open the victim’s mouth wide to look for the object. If the object can be seen and can be easily removed remove it with your fingers. If you do not see the object continue CPR.

Continue compressions and breaths in a ration of 30:2 until you relieve choking and the victim is responsive or ambulance arrives.

澳大利亚墨尔本大学医学院儿科博士

百汇医疗（中国）儿科医师

蒋本然