脉冲振荡法支气管激发试验诊断支气管哮喘

目的：探讨脉冲振荡法在支气管激发试验诊断支气管哮喘中的应用价值。方法：采用常规肺通气功能及脉冲振荡法测呼吸道阻力（IOS）,比较2种测定方法在哮喘组和健康对照组吸入支气管激发剂前、后的肺功能及呼吸阻抗等指标的变化。结果：哮喘组吸入支气管激发剂后呼吸总阻抗（Z5）、总气道阻力（R5）、中心气道阻力（R20）、共振频率（Fres）较激发前及对照组显著增加（P〈0.01）,哮喘组IOS测定指标中Z5、R5、R20、Fres与FEV1呈负相关关系,X5与FEV1呈正相关关系。结论：脉冲振荡法在支气管激发试验诊断支气管哮喘中具有较高的临床应用价值。     

Successful eight-year survival of unresectable lung adenocarcinoma with bronchial artery infusion chemotherapy: A case report

A case report of eight year complete remission post bronchial artery infusion (BAI) chemotherapy (Pimetrazine and cisplatin) for unresectable lung adenocarcinoma.     

Heart,tracheo-bronchial and thoracic spine trauma. Succesful multidisciplinary management: a challenging thoracic politrauma

We reported the case of a 36 years old woman involved in a car accident and admitted to the Emergency Room with critical conditions. A CT scan showed hemopericardium, pneumomediastinum and D2 unstable vertebral fracture; then a sternotomy was promptly performed. After admittance to Intensive Care Unit a bronchoscopy showed a tear of the posterior wall of the trachea and the complete disruption of the left main bronchus with a 2 cm gap beetwen two consecutive cartilage rings. D2 fracture would have required stabilization, but pronation of the patient was contraindicated by the bronchial rupture. On the nineth day the vertebral fracture was stabilized, thus allowing a lateral decubitus and a left thoracotomy. The bronchial laceration was wrapped all around with a pedicled pericardial flap and a bronchial stent was placed inside the gap with a pediatric bronchoscope. Postoperative course was uneventful and the patient was transferred to the Physical Rehabilitation Unit after 23 d. The successful outcome of this case is the result of multidisciplinary management where every decision was shared by each specialist. From the surgical point of view survival is uncommon in such severe association of lesions. The use of pericardium wrap together with a bronchial stent represents an innovative solution to treat a complicated bronchial disruption.     

支气管中心性肉芽肿1例

患者男,68岁.发热、气促、全身酸痛1周入院,体检双肺底可及少许湿啰音.抗感染治疗后,症状减轻.CT示:右肺下叶后基底段见大小约2.5 cm× 2.3 cm软组织密度结节影,CT值为25 HU,边界清楚,呈长毛刺及浅分叶征,与胸膜相邻面较光整,邻近胸膜增厚,未见胸膜凹陷征(图1),增强后病灶均匀轻度强化(CT值为43 HU),纵隔内未见肿大淋巴结(图2).     

A retrospective study of the patients with positive ImmunoCard Mycoplasma test on an outpatient clinic basis

The simplified ImmunoCard Mycoplasma test for rapidly detecting Mycoplasma pneumoniae-specific IgM antibodies has been widely used. We examined the usefulness of this test for outpatient practices as well as for the association with bronchial asthma. Among 196 patients whose ImmunoCard showed positive, we targeted 57 cases in which we were able to perform this test multiple times. We evaluated the degree of inflammatory response in the laboratory findings at the time of the test, the period until negative seroconversion for antibodies, and the course of their pulmonary function findings. The number of days from the onset of pyrexia until the test was a median of 10 (range 2–70) days, wherein the inflammatory response did not have a significant effect on that number of days. In 35 cases in which we observed the seroconversion to negative for antibodies, the period of the positive phase was 180 (21–421) days, wherein it was significantly longer for smokers. We observed exacerbation in the majority of the asthma patients, and some of the non-asthmatic patients showed either asthma or asthma-like clinical conditions. For ImmunoCard-positive individuals, it is desirable to ascertain the history of respiratory infection retrospectively to about half a year, although this test is known to suffer from lack of both of sensitivity and specificity. Additionally, it is necessary for ImmunoCard-positive patients to pay attention to the exacerbation of asthma and the development of asthma thereafter.     

噻托溴胺治疗成人哮喘的效果观察

目的观察噻托溴铵干粉吸人剂治疗成人哮喘的临床效果及安全性。方法采用随机对照研究方法,将34例筛选合格的未控制哮喘患者随机分为吸入噻托溴铵组（17例）及吸入福莫特罗组（17例）,两组均在联合吸人糖皮质激素的基础上进行,观察两组患者治疗前后肺功能指标、症状控制情况及生命质量。结果治疗8周后,吸入噻托溴铵组及吸入福英特罗组最大流速峰值分别为（359±12）、（346±11）L／min,均显著高于治疗前[（273±5）、（275±9）L／min,P均〈0．05];第1秒用力呼气流量分别为（2．80±0．28）、（2．69±0．34）L,均较治疗前显著改善[分别为（2．30±0．28）、（2．25±0．34）L,P均〈0．05]。两组的哮喘症状均减轻,万托林气雾剂的用量显著减少,分别为（0．96±0．34）喷／d与（4．11±1．03）喷／d,（0．88±0．44）喷／d与（4．43±0．87）喷／d（t值分别为3．05、3．23,P均〈0．05）;两组的生命质量评分均较治疗前显著改善（P均〈0．05）,但上述疗效指标两组间比较差异无统计学意义（P均〉0．05）。结论在吸人糖皮质激素的基础上加用噻托溴铵,可改善未控制哮喘患者的症状和肺功能,其疗效等同于加用福莫特罗。     

食管支气管源性囊肿1例

患者男,36岁。数小时前饮酒后出现胸部胀满不适,尔后出现胸闷,胸痛,持续不缓解。CT检查:后下纵隔见一4 cm×6cm软组织密度影,其内可见散在高密度影。CT值范围为14~62 Hu,向邻近一侧肺野突出,食管受压移位。MRI检查:后纵隔心脏水平见类圆形占位,T1WI病变呈等,低信号。T2WI病变呈     

晚发老年性哮喘31例临床分析

目的　总结晚发老年性哮喘临床诊治特点。方法　分析 31例患者临床资料。结果　晚发老年支气管哮喘多有吸烟史、慢性支气管炎、慢性鼻炎史 ,合并症多 ,误诊率高 ,缓解期短 ,发作频繁 ,呼吸道感染为常见诱因 ,临床表现不典型 ,缓解期肺功能、胸片多不能恢复正常 ;治疗以吸入疗法为主 ,兼顾合并症 ,氧疗、家庭成员和护理人员健康教育尤为重要。结论　晚发老年支气管哮喘诊治有其特殊性。     

332例支纤镜刷片细胞学准确性分析

为探讨支纤镜刷片细胞学诊断准确性，复阅332例细胞学支纤镜刷片涂片，142例有临床或病理证实为支气管肺癌病例。细胞学检出癌细胞106例，未检出癌细胞225例，其中1例细胞学高度怀疑小细胞未分化癌，手术病理证实为结核。支纤镜刷片细胞学诊断敏感性为74.7％，特异性为99．5％，假阳性率为0．5％，假阴性率为25．4％。同时对细胞学误诊原因进行了分析。     

支气管哮喘与变应性鼻炎的相关研究

变应性鼻炎与支气管哮喘二者常同时存在,前者先于后者发生,是哮喘的一个危险因素。多方面研究证明二者之间存在密切联系。现通过阐述二者的多方面联系,提高临床医生对这两种疾病的认识,加强对变应性鼻炎的重视及早期防治,以免发展为支气管哮喘。     

小儿支气管哮喘与肺炎支原体感染关系的临床研究

目的探讨小儿支气管哮喘与肺炎支原体(MP)感染的关系。方法儿童哮喘专科门诊及住院哮喘发作期患儿193例(哮喘组)及同期就诊的呼吸道感染患儿213例(对照组),采用MP被动冷凝集法检测血清肺炎支原体抗体(MP-Ab)。结果哮喘组MP-Ab阳性93例,阳性率48.2%;对照组阳性53例,阳性率25.8%,两组比较差异显著(P<0.01)。结论MP感染与儿童哮喘关系密切,MP导致呼吸道慢性炎症,进而改变呼吸道高反应性是最根本的机制。对哮喘发作期的患儿要考虑MP感染可能,应常规行MP-Ab检查。     

经纤支镜诊治气管、支气管结核16例体会

目的：观察气管、支气管结核的临床、X线特征及纤支镜下的诊断和治疗效果。方法：回顾总结分析了16例气管、支气管结核临床、X线特征及经纤支镜诊断和治疗的方法。结果：(1)支气管黏膜充血水肿或出血8例；(2)支气管黏膜弥漫分布干酪结节4例；(3)腔内肿物或外压性狭窄4例。结论：纤支镜下刷检和活检对气管、支气管结核的诊断有重要价值；全身抗痨加纤支镜下用药治疗有效。     

院内外规范化健康教育对支气管哮喘患者疗效的影响

目的了解院内外规范化健康教育对哮喘患者疗效的影响。方法将80例被确诊为哮喘的住院患者随机分为观察组和对照组。观察组按照我科“哮喘患者健康教育规范”对其进行哮喘知识专门宣教及电话随访，并建立随访档案。对照组采用传统的健康教育方式。1年后对两组患者采用自行设计的问卷检测健康教育达标率；采用全院统一的门急诊患者满意度调查表调查护理工作满意度；并统计1年内哮喘复发住院2次以上患者数评价院内外规范化健康教育效果。结果观察组的健康教育达标率和护理工作满意度均显著高于对照组，对照组哮喘复发2次住院率明显高于观察组。结论院内外规范化健康教育对哮喘患者疗效的影响是非常显著的，能有效减轻和控制哮喘发作，提高患者的生活质量。     

肺癌患者中肺炎支原体感染的研究

本文对４３例肺癌患者的肺炎支原体抗体检测结果显示：肺癌患者炎支原体抗体阳性率明显高于正常对照组（Ｐ〈０．００５），提出由于肺癌患者免疫功能降低，易发生肺炎支原体感染，故对于肺癌患者应注意肺炎支原体感染的监测，争取早期诊断以利治疗。     

Bronchial electrocardiography to determine left or right main bronchial placement of an endotracheal suction catheter tip

Objective To assess the utility of a blue lined angle tiped and electrode tipped catheter, to guide left and right main bronchus cannulation.Design A prospective studySetting An 11-bed general intensive care unit in a 900-bed teaching hospital.Patients 50 intubated intensive care patients, in sinus rhythm with normal P and QRS mean frontal axis, who required endobronchial suctioning for routine respiratory management.Interventions Endobronchial electrocardiography was used to position a blue lined angle tiped and electrode tiped suction catheter into the right and left main bronchi.Results Selective cannulation of the left main bronchi was determined by observing a biphasic or inverted P wave in 42 patients, or biphasic or inverted QRS complex in 31 patients. In 8 patients in whom no changes in the ECG were found, bronchoscopic placement of an ECG electrode into the left main bronchus demonstrated a biphasic or inverted P wave in 8 patients and a biphasic QRS complex in 3 patients, confirming the failure to cannulate the left main bronchus in these 8 patients.Conclusions Using a blue lined, angle tipped and electrode tipped catheter for endotracheal suctioning, endobronchial electrocardiography may be a simple method to signal left or right main bronchus cannulation.     

纤支镜对41例支气管结核的诊断意义

目的：探索气管-支气管结核的临床特征，分析纤维支气管镜（FB）对支气管结核的检出率及镜下特征，探讨其诊断价值。方法：分析41例经纤维支气管镜确诊的气管-支气管结核的纤维支气管镜下表现、临床症状、胸部X线及实验室检查情况。结果：纤支镜检查显示：Ⅰ型11例，占26．83％；Ⅱ型8例，占19．51％；Ⅲ型17例，占41．46％；Ⅳ型5例，占12．20％。镜下所见管腔内各种类型病变互有重迭，其病变表现具有一定特征。31例镜检前后进行痰菌涂片检查2～6次／例，仅6例阳性。41例经FB刷片行抗酸杆菌检查，有12例阳性（阳性率29．3％）。41例行活组织检查证实为结核36例（87．80％）。结论：气管-支气管结核缺乏特异性临床表现，胸部X线表现正常并不能排除支气管结核，确诊主要依靠纤支镜下活检病理、刷检涂片及痰结核菌检查。对不明原因低热和呼吸道症状经积极抗炎治疗无效者，应怀疑支气管结核及早行纤支镜检查。     

401例支气管肺癌供血动脉分析

总结了401例支气管肺癌血管造影资料,分析了肺癌的供血动脉来源,支气管动脉直经、走行方向、开口方位和开口高度、并提出了作肺癌动脉插管化疗时除支气管动脉外,还应寻找其他供血动脉。支气管动脉宜在胸5～6椎体高度自右侧壁、右前壁、前壁、左前壁、左侧壁及后壁顺时钟方向寻找。     

支气管动脉药物灌注治疗中晚期肺癌(附70例报告)

目的：选择性支气管动脉药物灌注治疗不能手术之中晚期肺癌并观察其疗效。材料与方法：利用药物灌注前后的胸部平片及支气管动脉造影所取得的影像资料，分析其疗效并就如何加以提高进行讨论。结果：本组70例，经药物灌注治疗共121次，总有效61例，占87.1％。有效病例肿块缩小，临床症状得到不同程度改善。结论：此法为不能手术的中晚期肺癌治疗之首选。且简单安全易行，近期疗效确实，无明显并发症。     

缓解支气管哮喘急性发作的护理

支气管哮喘是急诊的常见病,我国患病率为1％～4％。其发病机制错综复杂,容易反复发作,难以根治,在积极预防及治疗哮喘病发作的工作中,护理起着重要作用。我院2007年12月～2009年12月收治的支气管哮喘患者79例,现将护理体会报告如下。     

进展期食管癌的支气管动脉灌注治疗（附22例报告）

目的：观察食管癌患者支气管;动脉食管支的血管造影解剖并探讨支气管动脉灌注（BAI）治疗进展期食管癌的疗效。方法：对20例食管癌患者进行了支气管动脉造影（BAG）和BAI,2例胸下段食管癌患者分别作了食管固有动脉（PEA）和胃左动脉（LGA）造影及化疗。结果：总的有效率（CR＋PR＋MR）为81．8％,CR＋PR率68．2％,结果：两侧BAG对于显示支气管动脉食管支是甚为重要的,BAI是治疗不能手术的进展期胸中,中上或中下段食管癌患者的一个较为有效的方法。