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支气管成形术治疗主支气管内膜结核致全肺不张

目的 总结支气管成形术治疗经长期内科治疗无效的主支气管内膜结核致全肺不张患者的临床经验。 方法 华中科技大学同济医学院附属同济医院对3例（男1例，女2例；年龄22~27岁）术前诊断为主支气管内膜结核而行长期内科治疗无效致全肺不张患者采用支气管成形术治疗，其中行单纯主支气管成形术1例，同期行左肺上叶袖式切除术1例，行右肺上、中叶袖式切除术1例。 结果 3例患者全部手术顺利，吻合口通畅，余肺扩张良好，无吻合口瘘发生，术后采用复治抗结核治疗方案继续治疗。3例患者分别随访17个月、14个月和11个月，结核无复发，并恢复正常生活和工作。 结论 支气管成形术对内科治疗无效的主支气管内膜结核导致全肺不张患者是一种有效的治疗方式，预后良好。

肺叶切除术后余肺不张的病因与防治

目的 为了减少肺叶切除术后余肺不张的发生,探讨其病因与防治方法.方法 对33例肺叶切除术后余肺不张的患者应用纤维支气管镜检查.结果 33例患者均出现气管下端隆凸区粘膜环形充血、水肿,其中4例局部出现粘膜坏死、脱落.术侧主支气管腔充满分泌物,积极行纤维支气管镜吸痰,肺即刻复张,无肺水肿、肺部感染等并发症.结论 气管隆凸区粘膜的损伤导致局部粘膜纤毛运动丧失和咳嗽反射减弱,是造成支气管腔分泌物潴留,引起肺不张的主要原因.气管导管采用大容量低压套囊可有效地防止气管粘膜损伤.纤维支气管镜吸痰是治疗术后肺不张最有效的方法.

Type-B Ultrasonography Diagnosis of Atelectasis

【摘要】 目的 探讨B型超声对肺不张的诊断价值。 方法 对2007年5月-2009年5月收治的67例肺不张患者的CT诊断与B型超声诊断进行对照、分析、总结。 结果 B型超声诊断一侧肺不张和肺叶肺不张与CT诊断符合率为94.64%，肺段型肺不张诊断符合率为54.55%。 结论 B型超声诊断可作为肺不张筛查的首选诊断方法。【Abstract】 ObjectiveT o study the diagnostic value of atelectasis by type-B ultrasonography. Methods Data of 67 cases of patients with atelectasis diagnosed by type-B ultrasonography and CT were compared, analyzed, and summarized between May 2007 and May 2009. Results The diagnosis coincidence rate which was got by comparing ultrasonography diagnosis of the one side atelectasis and pulmonary lobectomy atelectasis with CT diagnosis was 94.64%, and that of pulmonary segmental atelectasis was 54.55%. Conclusion Type-B ultrasonography can be used as the preferred screening atelectasis diagnosis.

Value of Positron Emission Tomography - computed Tomographic Simulator Treated with Intensity Modulated Radiotherapy in Patients with Non-small Cell Lung Cancer Complicated with Atelectasis

目的:探讨PET-CT模拟定位对非小细胞肺癌合并肺不张适形调强放疗靶区确定的临床价值。方法:对经影像学和病理证实伴有肺不张的非小细胞肺癌12例患者,进行PET-CT模拟定位。根据PET-CT扫描显像结果,分别以GTV CT和GTVPET-CT勾画原发病灶,对用治疗计划系统计算出的两组数值加以比较。结果:GTVCT平均为141 cm3(99～185 cm3),GTVPET-CT平均为113 cm3(60～165 cm3),两者差异有显著性(t=5.497,Plt;0.001)。12例患者原发病灶体积的GTVPET-CT均较GTV CT有不同程度的缩小,平均缩小体积28 cm3(19%)。结论:PET-CT模拟定位,对非小细胞肺癌合并肺不张患者放疗靶区的精确定位具有重要的临床意义。

Comparative Study of Recruitment Maneuver in Mechanically Ventilated Patients after Fibrobronchoscopy

ObjectiveTo investigate the effect of recruitment maneuver (RM) following fibrobronchoscopy in invasively mechanically ventilated (IMV) patients with excessive airway secretions or foreign body aspiration. MethodsFrom September 2012 to July 2014, 200 eligible patients were randomly assigned to intervention group (n=100) and control group (n=100) . Airway clearance by fibrobronchoscopy was conducted in both the two groups, but RM was subsequently performed only in the intervention group. Outcome measurements included oxygenation index, partial pressure of carbon dioxide (PaCO2), heart rate (HR), air way resistance (Raw) and dynamic lung compliance (Cdyn) before and 2 hours after treatment, and duration of IMV and Intensive Care Unit (ICU) stay were also analyzed. ResultsAfter treatment with fibrobronchoscopy, oxygenation index [intervention vs. control: (291.14±38.49) vs. (241.39± 35.62) mm Hg (1 mm Hg=0.133 kPa)], PaCO2 [(41.65±7.73) vs. (38.87±7.97) mm Hg] and Cdyn [(48.94±11.21) vs. (39.59±10.98) mL/cm H2O (1 cm H2O=0.098 kPa) ] were significantly increased, while HR [(95.41±20.59) , vs. (106.47±19.11) beats/min] and Raw [(17.87±8.32) vs. (23.98±7.88) cm H2O/(L·s)] were significantly decreased in both groups (P ＜ 0.01) . Duration of IMV and ICU stay in the intervention group were (15.72±6.42) and (19.85±8.12) days respectively, while in the control group were (20.49±7.21) and (27.87±10.33) days. Compared with the control group, patients in the intervention group had lower Raw, duration of IMV and ICU stay, and higher Cdyn, oxygenation index, and PaCO2 (P ＜ 0.01) , but no significant difference was found in HR (P ＞ 0.05) . ConclusionIn mechanically ventilated patients with excessive airway secretion or foreign body aspiration, recruitment maneuver following fibrobronchoscopy is of great clinical importance, due to the decrease of the duration of mechanical ventilation and ICU stay by re-inflating the collapsing alveoli, improving pulmonary ventilation and gas exchange, lung compliance and diffusion capacity.

Electronic Bronchoscope Lavage Lung Segment for Traumatic Atelectasis Caused By Rib Fractures

目的探讨肋骨骨折导致的创伤性肺不张治疗中应用电子支气管镜肺段灌洗治疗的效果 方法回顾性分析新疆医科大学第六附属医院2009年10月至2013年4月肋骨骨折导致创伤性肺不张73例行电子支气管镜肺段灌洗治疗患者的临床资料，其中男52例、女21例，年龄29～83（36± 5）岁。按治疗方式将患者分为两组：灌洗组（37例）行电子支气管镜肺段灌洗，对照组（36例）采用肺不张的常规治疗。比较两组临床效果。 结果灌洗组呼吸频率及心率减慢，动脉血氧饱和度升至95%以上，肺复张明显好于对照组，差异有统计学意义（P < 0.05）。 结论电子支气管镜肺段灌洗治疗肋骨骨折导致的创伤性肺不张直视下诊断明确，起效快，创伤小，疗效确切。

床旁肺部超声评估对心脏术后早期肺实变和肺不张的诊断准确性研究Accuracy of bedside lung ultrasonography in diagnosis of pulmonary consolidation and atelectasis in postoperative cardiac surgery patients

目的 探讨床旁肺部超声对心脏术后早期肺实变和肺不张的诊断准确性。 方法 选取 2014 年 9 月至 2015 年 8 月四川大学华西医院心脏大血管外科行心脏大血管手术（包括冠状动脉旁路移植术、瓣膜置换术等）后 1 周之内出现呼吸衰竭的 49 例患者，其中男 24 例、女 25 例，年龄（54.4±13.2）岁。收集患者术后床旁肺部超声及胸部 CT 检查结果，进行对照、分析、总结。 结果 在肺实变和肺不张的诊断中，胸部 CT 诊断 47 例（95.9%）患者为阳性，肺部超声评估方案（BLUE方案）诊断 45 例（91.8%）患者为阳性，床旁肺部超声与胸部 CT 诊断一致率为 95.9%。 结论 床旁肺部超声可作为筛查肺实变和肺不张的方法。

SLIPATM 喉罩全身麻醉期间误吸致肺不张一例

Research progress on the identification of central lung cancer and atelectasis using multimodal imaging

Central lung cancer is a common disease in clinic which usually occurs above the segmental bronchus. It is commonly accompanied by bronchial stenosis or obstruction, which can easily lead to atelectasis. Accurately distinguishing lung cancer from atelectasis is important for tumor staging, delineating the radiotherapy target area, and evaluating treatment efficacy. This article reviews domestic and foreign literatures on how to define the boundary between central lung cancer and atelectasis based on multimodal images, aiming to summarize the experiences and propose the prospects.