Benign cartilaginous tumors of the upper airway

Benign cartilaginous neoplasms of the laryngotracheal apparatus are uncommon clinical entities. Two cases of cartilaginous lesions of the upper airway are reported. Resection with maintenance of upper airway structural integrity is the preferred treatment. Temporary tracheostomy is often necessary and can provide access for stenting of the tracheal repair.     

剑鞘气管与慢性阻塞性肺疾病的关系

研究剑鞘气管与慢性阻塞性肺疾病之间的关系。材料与方法搜集１９９６－１９９８年有剑鞘气管和ＣＯＰＤ的患者７０例。胸部轴位ＣＴ用１０ｍｍ层厚连续扫描。在主动脉弓上方１０ｍｍ层面测量气管的内冠状径和内矢状径。剑鞘形状的程度用内冠状径与内矢状径的比较来表示。     

Advantages of video endoscopy in pediatric aerodigestive tract disorders

Summary The naked eye examination of the larynx through the laryngoscope is inadequate for the examination of the minute anatomic structures and does not permit the visualization of the subglottic space or the trachea. A telescope coupled to a miniature television camera is advanced under precise visual control through the vocal cords and into the trachea. Oxygen is administered through the instrument to avoid fogging and provide diffusion oxygenation during the apneic phase. The procedure is safe, fast, and provides a simultaneous record. A vastly improved image allows the examination to be performed from the television screen. Electronic imaging has much to offer in the area of pediatric endoscopy. Video endoscopic examinations of the aerodigestive tract of 151 infants were successfully performed without any complications.     

气管切开病人高压氧治疗的护理进展

概述气管切开病人高压氧治疗的护理，从吸氧方式的选择、气道的湿化、吸痰的护理、感染的预防、气囊的管理、脱管的预防及护理进行综述。     

低剂量螺旋CT扫描及后处理对小儿气管支气管异物的诊断价值

目的:探讨低剂量螺旋CT扫描及后处理技术对气管支气管异物的诊断价值。方法:对103例气道异物患儿行螺旋CT扫描,CT扫描参数为120kV,40～80mA,层厚7mm,间距7mm,螺距3,扫描后进行层厚3mm,间隔1.5mm内插式重建,对获得的数据进行图像后处理,后处理技术包括多平面重建(MPR)、最小密度投影(MinP)、表面遮盖法重建(SSD)、CT仿真支气管内窥镜(CTVB)。与支气管内窥镜进行比较。结果:103例气管支气管异物均获得满意的后处理图像,螺旋CT及后处理技术的诊断准确性为100%,异物定位与支气管镜检相符97.1%。其中MPR(包括CPR)在显示异物本身和局限性气管、支气管阻塞最好。结论:小儿气管支气管异物可用螺旋CT低剂量扫描,但不能用单一的后处理技术,应该将轴位和多种后处理技术结合起来,综合分析。本病的直接征象是显示异物本身,而局限性支气管阻塞需结合其他征象才能确诊。     

喉气管外伤及狭窄的治疗

【目的】探讨喉外伤及狭窄的不同类型的临床治疗方法及效果。【方法】15年来收治各类喉外伤及狭窄患者38例。其中9例闭合性喉腔软组织伤,或合并软骨骨折而无移位,采用药物保守治疗,18例喉外伤颈部有开放性损伤伴有喉气管软骨损伤,或颈部无开放性损伤伴有喉气管软骨损伤,进行清创缝合,开放手术复位骨折,留置硅胶喉扩张管支撑,11例喉气管瘢痕狭窄采用瘢痕切除留置硅胶喉扩张管支撑,喉气管裂开肋软骨移植术,栅栏状喉气管成形术等方法治疗。【结果】37例患者呼吸通畅、发音满意,劳动力恢复,1例患者需终身保留气管造口。【结论】喉气管外伤应尽早明确诊断,早期治疗。喉气管外伤后瘢痕狭窄患者,根据狭窄部位和程度采取瘢痕切除留置硅胶喉扩张管支撑,栅栏状喉气管成形术及喉气管裂开肋软骨移植术,效果比较满意。     

气管切开后呼吸道管理的护理进展

介绍了气管切开后呼吸道管理的护理进展.重点阐述了气管切开的适应证,气道湿化的护理管理,吸氧、排痰的护理管理,气囊的护理管理,呼吸道感染的护理.     

黄芪多糖抗呼吸道绿脓杆菌感染的实验研究

目的:探讨黄芪多糖拮抗绿脓杆菌在呼吸道黏附,阻断感染作用及机制,从而证明黄芪多糖是补益类中药黄芪中起以上作用的主要成分。方法:复制慢性支气管炎(慢支)感染绿脓杆菌小鼠模型。从120只模型小鼠中随机选择20只进行细菌定量培养,观察感染后35 d内小鼠气管带菌情况。另100只小鼠随机再均分为5组。低、中、高剂量治疗组分别以0.26、0.78和1.56 mg黄芪多糖灌胃,阳性对照组以慢支固本冲剂1 ml灌胃,阴性对照组以1 ml蒸馏水灌胃,各组均连用10 d。从各组随机取10只小鼠,先取其气管组织作细菌定量培养,观察小鼠气管带菌数;再取其气管标本进行病理切片,用光学显微镜观察气管黏膜上皮的病理变化。将各组另10只小鼠进行活体气管和支气管原位固定,用扫描电镜观察其超微结构及绿脓杆菌黏附数。结果:1各治疗组细菌培养菌落形成单位数明显低于阴性对照组(P均<0.01),高剂量治疗组与阳性对照组差异无显著性(P>0.05)。2光镜观察:各治疗组气管黏膜的病理变化轻于阴性对照组;高剂量治疗组和阳性对照组病变基本消失。3电镜观察:治疗组纤毛损伤、黏附的绿脓杆菌数明显少于阴性对照组,与阳性对照组相似。结论:黄芪多糖对慢支病变小鼠气管黏膜上皮有修复作用,能阻断绿脓杆菌在呼吸道的黏附,从而起到抗绿脓杆菌感染的作用;黄芪多糖是补益类中药黄芪中抗细菌黏附的有效成分。     

Management of and indications for tracheostomy in care of the critically ill patient

Tracheostomy is a procedure that has evolved over many hundreds of years. In the 21st century, the majority of tracheostomies are now inserted by intensivists in the intensive care unit (ICU). Commonly performed to assist in weaning patients from mechanical ventilation, the procedure is performed using a percutaneous dilatational technique. Percutaneous tracheostomy can generally be performed safely in the ICU, although a number of contra-indications and complications do exist. Recent publications have highlighted weaknesses in the quality of care both in the immediate and longer term. Consequently, a number of organizations, based in the UK and internationally, have turned the focus in recent years to improving the quality of care delivered to these patients. Clinicians caring for patients with tracheostomies should not only be familiar with the indications, anatomy and insertion techniques, but also current guidance on routine care and the emergency management of complications.     

甲状腺癌侵犯喉和气管的外科处理

目的探讨甲状腺癌侵犯喉部和气管时的手术治疗。方法对8例甲状腺乳头状癌和滤泡状癌不同程度侵犯喉部和气管的惠者进行甲状腺切除、颈淋巴结清扫术、术中部分切除气管并用带蒂肌瓣一期修复，侵犯范围大的进行全喉切除。结果8例甲状腺癌均可全部切除，4例康复后发音和呼吸正常，3例呼吸正常但有不同程度的声嘶，1例同时喉全切除后用电子人工喉发音。8例术后均服用甲状腺素片，随访1～2年，没有复发。结论对甲状腺乳头状癌和滤泡状癌累及喉部和气管，手术范围可适当扩大，对于不超过气管直径1／3的气管缺损，可进行带蒂肌瓣一期修复，不会引起气管狭窄，喉部有较大的侵犯，可同时喉全切除术，甲状旁腺的再植可以存活，以提高患者的生活质量。