Clinical evaluation of a multiparameter intra-arterial blood-gas sensor

Objective To evaluate the in vivo performance of a continuous, intra-arterial, multiparameter blood-gas sensor containing a thermocouple, miniaturized polarographic oxygen electrode, as well as fiberoptic pH andpCO₂ sensors.Design Prospective, multicenter study comparing pH, PaCO₂, and PaO₂ measurements from the intraarterial sensor with those obtained from a conventional, laboratory blood-gas monitor.Setting Intensive care units in three academic medical centers.Patients: Adult ICU patients (n=26) with a clinical need for a radial artery catheter and frequent monitoring of arterial blood gases for 3 days.Interventions All patientys had the multiparameter intra-arterial sensor placed through a 20-gauge catheter into the radial artery. Every 4 h, or more frequently if clinically indicated, a blood-gas sample was withdrawn from the radial artery catheter and sent to the laboratory for analysis using a conventional laboratory bloodgas analyzer. Immediately pior to withdrawal of the arterial blood, values for pH, PaCO₂, and PaO₂ from the multiparameter intra-arterial sensor were recorded.Measrements and main results The multiparameter sensor was placed into 26 patients. In 7 of the patients, premature discontinuation of monitoring was necessary because of dampening of the pressure tracing, difficulty in withdrawing blood from the arterial catheter, or bending of the extra-arterial fiberoptic channel owing to the cable being inadequately secured (mean monitoring time in these 7 patients: 40.6±25.7 h). In the other 19 patients, monitoring was continued until no longer clinically indicated. In these patients, a total or 341 data sets was collected, with the average length of monitoring being 69.9±37.9 h (range 22.0 to 57.9 h). Comparison of the sensor values with those from the bloodgas analyzer showed bias and precision values of 0.006 and 0.026 for arterial pH–1.19% and 12.54% for PaO₂, and 1.28 mmHg and 2.48 mmHg for PaCO₂, respectively. No complications were associated with the intra-arterial sensor.Conclusions Clinical performance of this intra-arterial, multiparameter blood-gas sensor demonstrated stability, consistency, and accuracy comparable to laboratory blood-gas analyzers. The present multiparameter, intravascular     

静脉维持丙泊酚全麻加口咽通气管行无痛支气管镜检查的临床应用

目的探讨一种方便、有效、安全的支气管镜麻醉方法，配合支气管镜的临床应用。方法研究组169例患者以芬太尼诱导后丙泊酚微泵静脉维持，达全麻状态下经口放置口咽通气管吸氧行无痛性纤维支气管镜。观察过程中患者的反应性症状，询问患者的痛苦记忆以及医生操作情况，并与同期256例对照组进行比较；记录研究组生命体征变化，评价该方法的安全性。结果研究组169例患者共进行236次支气管镜操作，成功率100％。与对照组比较，操作过程中体动、呛咳、屏气、呼吸困难等反应性症状均较低（P〈0．01）；患者痛苦记忆少（P〈0．01），医生操作完成到位程度高。研究组操作全过程患者无任何不适感觉，生命体征稳定。结论静脉雏持全麻加用口咽通气管吸氧行无痛支气管镜，是一种痛苦少、反应轻、操作容易、安全可行的麻醉方法，尤其适用需要多次检查治疗的患者。     

乳头溢液的超声与纤维乳管镜对比研究

目的评价超声对乳头溢液相关病变的诊断价值。方法应用高频超声对乳头溢液患者进行观察,结合手术和病理结果与纤维乳管镜检查进行对比。分析乳头溢液患者的超声声像图特征,探讨超声诊断优势和不足。结果导管内乳头状瘤的超声诊断正确率为67.86%,纤维乳管镜的诊断正确率为89.29%,导管内癌的超声诊断正确率为54.55%,纤维乳管镜的诊断正确率为90.91%。结论超声能准确地显示扩张的导管,但对导管内肿瘤的诊断正确率低于纤维乳管镜,结合纤维乳管镜能为手术提供准确的诊断。     

经纤维支气管镜激光治疗气道内良性肿瘤26例临床分析

目的研究经纤维支气管镜激光消融治疗在气道内良性肿瘤治疗中的价值.方法对26例气道内良性肿瘤患者经纤维支气管镜应用Nd:YAG激光进行消融治疗,观察患者咳嗽、气促、血气分析及气道内新生物改善情况并进行密切随访.结果经激光治疗后所有患者气道内新生物均完全清除,患者气促、咳嗽等得到明显改善,术后1周咳嗽完全缓解者21例,气促由治疗前的(3.3±0.7)级改善为(1.5±0.5)级(p＜0.001);PaO2由治疗前的(8.4±1.4)kPa上升为(11.8±1.2)kPa(P＜0.001);18例患者术后3 d内治愈出院.治疗过程中除11例出现一过性低氧血症及1例少量出血外,未见其他严重并发症.术后随访6～60个月,除1例乳头状瘤术后1 a左右复发外,其余患者气道一直保持通畅.结论经纤维支气管镜Nd:YAG激光消融治疗气道内良性肿瘤安全有效,并发症少,优先于开胸手术治疗,值得临床推广应用.     

支气管镜下介入治疗气管支气管淀粉样变性患者的护理

笔者总结经支气管镜下介入治疗原发性气管支气管淀粉样变性患者的护理。认为术前做好心理护理及各项准备工作;术中密切配合,协助患者取合适体位,取出假牙,用毛巾盖住双眼,密切观察病情变化,正确处理治疗中的不良反应确保手术顺利进行;术后观察咯血等并发症,及时发现并处理。     

Short flexible fiberoptic colonoscopy in routine office examinations

Through experience with 1,464 examinations using the short flexible fiberoptic colonscope, the author concludes it to be the preferred instrument for endoscopy of the distal bowel. He finds it superior to the rigid instrument in detection of polyps and early malignant disease of the distal descending and sigmoid colons. The flexible instrument is generally less uncomfortable for the patient and is readily accepted as a routine part of a thorough colonic and rectal examination. Read at the meeting of the American Society of Colon and Rectal Surgeons, Hollywood, Florida, May 11 to 16, 1980.     

支气管镜肺减容术对慢性阻塞性肺疾病患者肺功能及并发症的影响

目的探讨支气管镜肺减容术对慢性阻塞性肺疾病(COPD)患者肺功能及并发症的影响。方法 80例COPD患者随机分为对照组(开胸肺减容术)和观察组(支气管镜肺减容术)。比较2组临床疗效、手术前后肺功能指标以及术后并发症。结果观察组治疗总有效率显著高于对照组(P0.05)。术后2组FEV1均显著增高,RV均显著降低(P0.05)。观察组术后漏气、机械通气、肺炎、心律失常、肺水肿等并发症发生率显著低于对照组(P0.05)。结论支气管镜肺减容术能够明显改善COPD患者的肺功能,降低术后并发症的发生。     

可弯曲支气管镜诊治成人气道异物

目的探讨可弯曲支气管镜(纤维支气管镜/电子支气管镜,简称支气管镜)在成人气道异物诊断及治疗中的意义。方法回顾性分析20例经可弯曲支气管镜确诊和治疗的成人气道异物患者的临床资料。结果主要临床表现为咳嗽、咳痰、发热、呼吸困难、呼吸音减弱、吸气相干啰音;院外误诊10例,其中误诊为肺癌4例、肺炎2例、支气管哮喘1例等;19例经可弯曲支气管镜取出,1例转胸外科手术取出。结论成人气道异物临床上容易误诊,可弯曲支气管镜在成人气道异物的诊断和治疗中具有重要的意义。     

光棒及纤维支气管镜在头面部烧伤插管中的应用

目的 比较光棒和纤维支气管镜引导下气管内插管成功率、插管时间和血流动力学的影响,评价光棒和纤维支气管镜在麻醉困难插管中的应用效果,为野战麻醉提供一种可行的通气方式.方法40例头面部烧伤、炸伤,随机分光棒组(LW组)、纤维支气管镜组(FOB组).根据综合气道评估分为Ⅱ一Ⅳ级,记录入室后、诱导后、插管后3 min的平均动脉...     

环境干预对稳定纤支镜检查患者情绪的研究

目的:了解环境干预对稳定纤支镜检查患者呼吸、血压、心率、血氧饱和度、焦虑的影响。方法:将100例纤支镜检查患者随机分成实验组和对照组两组,每组各50例。对照组检查时不调整环境条件,在常态环境下进行,实验组检查时根据患者的需求调整室内温度、湿度、空间大小、装饰物、音乐等各种因子。结果:纤支镜检查前呼吸、心率、血压、血氧饱和度、焦虑程度两组比较差异无显著性意义(P>0.05);检查后血氧饱和度两组差异无统计学意义(P>0.05),但呼吸、心率、血压、焦虑程度两组比较差异有统计学意义(P<0.01)。结论:环境干预能稳定患者呼吸、血压、心率,能降低患者的焦虑水平,并增加纤支镜检查患者耐受性。