摘要:目的：探讨纤支镜经口引导气管插管在慢阻肺合并重度呼吸衰竭救治中的临床应用价值。方法：237例慢阻肺合并重度呼吸衰竭患者,随机分为纤支镜经口引导气管插管组(纤支镜组)125例和喉镜经口引导气管插管组(喉镜组)112例,分别在纤支镜和喉镜引导下按常规进行气管插管术。结果：纤支镜组和喉镜组一次获得插管成功率分别为984%和920%(P＜005),平均插管时间分别为（613±391） min 和（926±415） min(P＜005)。纤支镜组有5例患者出现咽喉部少量出血,并发症发生率为40%;喉镜组共有12例发生并发症,并发症发生率为107%(P＜005),其中齿、舌、咽或喉部损伤6例,反射性呕吐致误吸2例,单侧肺通气1例,插入食管2例,心跳呼吸骤停1例。结论：纤支镜经口引导气管插管在慢阻肺合并重度呼吸衰竭救治中是一种简便快速、成功率高和并发症少的有效方法,值得临床推广应用。Abstract: Objective: To evaluate the efficacy of endotracheal intubation under fiberoptic bronchoscope through mouth in severe respiratory failure. Methods:Two hundreds and thirtyseven cases of severe respiratory failure were divided into two groups at random (fiberoptic bronchoscope group and laryngoscope group), 125 cases were intubated through mouth under fiberoptic bronchoscope, the others were intubated through mouth by laryngoscope. Results: The successful rates of endotracheal intubation were 98.4% and 92.0% in two groups respectively (P ＜005), the mean intubation timewere (613±391) min and (926±415) min respectively ( P ＜ 005), 4 cases in fiberoptic bronchoscope group appeared a little blood in throat, the complication rate was 32% 12 cases in the laryngoscope group had complications, the complication rate was 107%( P＜ 005). Among it, 6 cases had the injury of tooth, tongue, gullet and larynx.The cases of reflexvomiting were 2,pulmonary ventilation by single lung were 1, intubation in esophagus were 2, cardiopulmonary arrest were 1.Conclusions:Endotracheal intubation under fiberoptic bronchoscope through mouth was accurate, the fewer complications and effective for patients, and could be used widely in clinical applications.
Objective To investigate the safety and effectiveness of a self-made bronchoscopic catheter ( an improved artificial airway) in bronchoscopic interventional therapy.Methods 126 patients planning to receive bronchoscope between October 2012 and February 2013 were divided into A, B and C groups. Three groups received inhalation of 2% lidocaine 5mL for surface anesthesia, and the venous channel was build up. Then the patients in group A ( n = 45) were treated with conventional bronchoscope. The patients in group B ( n =40) were treated with painless bronchoscope ( received intravenous injection with midazolam0. 06 mg/kg and fentanyl 1μg/kg before operation) . The patients in group C ( n = 41) were treated with painless bronchoscope through improved artificial airway ( after anesthesia similar to group B, the improved artificial airway was implanted through the mouth guided by bronchoscope, then the bronchoscopy was performed through artificial airway) . Blood pressure, respiration rate, heart rate and the pulse oxygen saturation were measured by multi-parameter ECG monitor before and during the operation, and the differences were compared among three groups. Body movement, transient respiratory depression during the operation, and postoperative feelings and reactions after operation were also observed. Meanwhile, the convenience of operation by physicians was evaluated. Results The blood pressure fluctuations in group C and group A had no significant difference ( P gt;0. 05) . Heart rate of three groups was somewhat increased,but there was no significant difference between group C and group A ( P gt; 0. 05) . Body movement and postoperative pain memory in group B and group C were better than those in group A ( P lt; 0. 05) .Respiratory depression of three groups had no significant difference ( P gt; 0. 05) . The operative convenience and the comfort of physicians in group C were better than those in group A and group B ( P lt; 0. 05) .Conclusions Operation safety of bronchoscopic interventional treatment with improved artificial airway is similar to the conventional procedure, but the reaction of the intra-operation and postoperative painful memories are significantly superior to conventional bronchoscopy. The convenience of operation and comfort of physicians are much better than the conventional bronchoscopy. It can be concluded that the improved artificial airways is worthy of clinical application.
目的 探讨经脐单孔腹腔镜胆囊切除的可行性、安全性及实用性。 方法 回顾分析2010年11月－2011年2月27例行经脐单孔腹腔镜胆囊切除术患者的临床资料。其中男15例，女12例；年龄19～53岁，平均39.5岁。胆囊息肉样病变12例，病程6个月～8年；胆囊结石17例，结石数量1～9个，大小0.5～1.5 cm，均为非急性期患者，病程1个月～13年。 结果 27例手术均顺利完成，无1例中转开腹或转为传统三孔腹腔镜胆囊切除术，术中生命体征平稳。手术时间35～149 min，平均63 min；术中出血10～20 mL，平均15 mL。所有患者术后2～3 d出院。患者均获随访，随访时间6～24个月，平均13个月。术中及术后随访期间未发生任何并发症。脐部瘢痕不明显，患者满意度高。 结论 经脐单孔腹腔镜胆囊切除安全可行，具有创伤小、瘢痕不明显等优点。
目的:探讨老年人自发性气胸的临床特点、治疗及预后。方法:对本院在2005年11月至2008年4月间收治的79例老年人自发性气胸患者临床资料进行回顾性分析。结果:老年人自发性气胸大多有肺部基础疾病,临床表现缺乏特异性,本组误诊为慢性阻塞性肺病急性发作4例、左心衰2例、支气管哮喘1例。气胸类型: 张力性气胸47例(72.1%),闭合性气胸11例,交通性气胸21例。采用以肋间闭式引流的为主的治疗措施,效果好。结论:老年人自发性气胸大多有肺部基础疾病, 易误诊,气胸的类型以张力性气胸多见,治疗多需排气减压术,及早的排气减压可望缓解症状,缩短肺复张时间,减少患者住院天数, 降低死亡率,提高老年人生活质量。
目的:评价无创正压通气(NIPPV)在救治慢性阻塞性肺疾病(COPD)急性加重期并严重呼吸衰竭患者中的临床疗效。方法:对2006年1月至2008年1月入选的47例COPD急性加重期并严重呼吸衰竭患者使用双水平无创正压呼吸机面罩辅助通气, 患者均伴有不同程度的意识障碍,动态观察NIPPV治疗前和治疗后2 h、8 h、1 d及3 d动脉血气、神志、治疗后患者的转归,NIPPV的不良反应及并发症。结果:本组47例患者中,41例经NIPPV治疗2 h、8 h、1 d及3 d后与治疗前比较,PaO2明显升高Plt;0.01,PaCO2明显降低Plt;0.01,pH明显升高Plt;0.01,均脱机出院,有效率达87.23%(41/47);6例改为有创通气,其中3例经有创机械通气治疗后脱机成功,1例因上消化道出血死亡,2例自动出院.结论:双水平无创正压通气对有选择的COPD急性加重期并严重呼吸衰竭患者治疗疗效确切,它能迅速缓解病情,减少患者的气管插管和气管切开以及相应的并发症,提高生活质量。
ObjectiveThrough measuring fractional exhaled nitric oxide (FeNO) and eosinophil levels of peripheral blood in chronic obstructive pulmonary disease (COPD) patients with different phenotype of acute exacerbation frequency, to predict the therapeutic effect of glucocorticoid therapy and guide the clinical treatment of different subtypes patients with acute exacerbations of COPD.MethodsA total of 127 patients with acute exacerbation of COPD in Suining Central Hospital from February 2017 to October 2019 were recruited. They were divided four groups according to the number of acute exacerbations in the past one year and the treatment scheme, ie. a frequent acute exacerbation with glucocorticoid treatment group (34 cases), a frequent acute exacerbation with non-glucocorticoid treatment group (31 cases), a non-frequent acute exacerbation with glucocorticoid treatment group (30 cases), and a non-frequent acute exacerbation with non-glucocorticoid treatment group (32 cases). FeNO value, eosinophil ratio in peripheral blood, COPD assessment test (CAT) score, and interleukin-8 (IL-8) concentration were measured before and on the 10th day of treatment, and the differences within group and between groups before and after treatment were compared.ResultsCAT score, FeNO, eosinophil ratio and IL-8 level in the four groups were significantly improved on the 10th day after treatment (all P<0.05). The declines of FeNO value, eosinophil ratio, and IL-8 level on the 10th day of treatment compared with those before treatment in the frequent acute exacerbation with glucocorticoid treatment group and the frequent acute exacerbations with non-glucocorticoid treatment group were larger than those in the non-frequent acute exacerbation with glucocorticoid treatment group and the non-frequent acute exacerbation with non-glucocorticoid treatment group (all P<0.05). The declines of FeNO value, blood eosinophil ratio and IL-8 level in the frequent acute exacerbation with glucocorticoid treatment group were also statistically significantly larger than those in the frequent acute exacerbations with non-glucocorticoid treatment group (all P<0.05). The improvement of CAT score in the frequent acute exacerbation with glucocorticoid treatment group was greater than that in other three groups (all P<0.05). There was no significant difference in CAT score between the non-frequent acute exacerbation with glucocorticoid treatment group and the non-frequent acute exacerbation with non-glucocorticoid treatment group (P>0.05).ConclusionsThe degree of airway inflammation is more obvious in patients with frequent acute exacerbation phenotype of COPD. FeNO value can reflect the level of airway inflammation in patients with frequent acute exacerbation of COPD and evaluate the response to glucocorticoid therapy.