Relaxant effects of forskolin on guinea pig tracheal smooth muscle

We investigated the relaxant effects of forskolin, a diterpene derivative isolated from the roots ofColeus forskohlii, on guinea pig airway smooth muscle by measuring the isometric tension of tracheal smooth muscle in vitro and transcutaneous Po₂ during the histamine inhalation test (HIT) in vivo. Forskolin (10⁻⁹–10⁻⁵ M) caused dose-dependent relaxant effects on resting tone and on leukotriene C₄ (10⁻⁷ M)-, leukotriene D₄ (10⁻⁷ M)-, and carbachol (3 × 10⁻⁶ M)-induced contraction of tracheal smooth muscle. Moreover, with propranolol pretreatment the relaxant effect of forskolin on tracheal smooth muscle did not change, whereas with the same pretreatment the relaxant effect of isoproterenol diminished. Forskolin (10⁻⁸–10⁻⁶ M) raised tissue cyclic AMP levels dose-dependently in tracheal smooth muscle (6.7–359.9 pmol/mg protein). Forskolin (1 mg/kg) administered subcutaneously raised the respiratory threshold of (RT-histamine in the HIT. The determination of the RT-histamine by measuring tcPo₂ was possible without anesthesia. These results suggest that forskolin relaxes airway smooth muscle in guinea pigs in vitro and in vivo by raising tissue cyclic AMP levels and that its actions are independent ofβ-adrenoceptors.     

超声测量颏舌骨肌长度对女性患者困难插管预测作用的初步研究

目的 研究超声测量颏舌骨肌长度对女性困难插管的预测作用.方法 选取择期手术需行气管插管的女性患者30例,手术麻醉前使用超声测量患者颏舌骨肌长度.所有患者采用相同麻醉诱导方案及相同的插管流程.气管插管后,记录气管插管困难评分(intubation difficult scale,IDS).结果 30例患者中有3例IDS评分＞5分,认为有插管困难.以颏舌骨肌长度为检验变量,绘制ROC曲线,曲线下面积为0.852,P=0.049.以约登指数最大值3.88 cm为临界值,评估困难气管插管,敏感度、特异度、阳性预测值、阴性预测值均大于Mallampati分级,但差异无统计学意义.结论 超声下测量颏舌骨肌长度对女性患者困难插管具有一定的预测作用.     

光棒联合新型喉罩与纤维支气管镜气管插管临床效果比较

目的：比较光棒联合新型喉罩气管插管与纤维支气管镜气管插管的临床效果。方法选择100例接受光棒联合新型喉罩气管插管全身麻醉的患者100例为观察组,同期接受纤维支气管镜气管插管患者100例为对照组。观察两组不同等级气道插管情况（ Mallampati分级Ⅰ～Ⅳ级）及置管成功前后血流动力学变化,包括平均动脉压、血氧饱和度、心率、呼气末二氧化碳分压。比较两组插管时间及并发症发生情况。结果观察组Ⅳ级气道插管成功率为80.0％,显著高于对照组的36.4％,气管插管时间短于对照组,差异均有统计学意义（ P＜0.05）。气管插管置入后,观察组平均动脉压、心率、咽喉疼痛及口腔损伤的比例均低于对照组,差异有统计学意义（ P＜0.05）。两组血氧饱和度、呼气末二氧化碳分压比较差异均无统计学意义（ P＞0.05）。结论光棒联合新型喉罩气管插管成功率高,对血流动力学影响小,并发症少,值得临床推广应用。     

经股动脉插管超选择肾动脉栓塞治疗顽固性血尿（附13例报告）

目的：探讨经股动脉超选择插管动脉栓塞术治疗各种原因引起的顽固性血尿临床疗效。方法回顾性分析13例经内科药物治疗无效的顽固性血尿患者经股动脉超选择插管肾动脉或髂内动脉栓塞（或同时化疗药灌注）的临床资料。结果13例患者中5例晚期未手术膀胱癌,2例膀胱癌术后,2例经皮肾镜取石,2例晚期肾癌（后证实为1例肾结核）,1例移植肾出血,1例阴茎海绵体血管瘤伴动脉畸形出血;术后1～3 d完全或基本止血,2例无效（1例通过抗结核4d止血1例膀胱全切双肾造瘘尿道残端出血未能止血）。结论经股动脉插管行动脉栓塞术治疗各种顽固性血尿有显著疗效。     

Video laryngoscopy improves the first-attempt success in endotracheal intubation during cardiopulmonary resuscitation among novice physicians

AimTo compare the first-attempt success in endotracheal intubation (ETI) during cardiopulmonary resuscitation (CPR) using direct laryngoscopy (DL) and video laryngoscopy (VL) (GlideScope^®) among novice emergency physicians (EPs).MethodsThis study is a historically controlled clinical design. From May 2011 to April 2013 out-of-hospital cardiac arrest patients were intubated during CPR by novice EPs. CPR data was automatically recorded by pre-installed video and subsequently analysed. The primary outcome was the success rate of the first-attempt at ETI. In addition, time to successful ETI from first-attempt (T-complete), duration of chest compression interruptions, and incidence of oesophageal intubation were compared.ResultsOf 305 patients undergoing ETI, 83 were intubated by novice EPs. The success rate of first-attempt ETI in the VL group (n = 49) was higher than that in the DL group (n = 34, 91.8% vs. 55.9%; p < 0.001). The median T-complete was significantly shorter with VL than with DL (37 [29–55] vs. 62 [56–110] s; p < 0.001). Oesophageal intubation was observed only in the DL group (n = 6, 17.6%). The median duration of chest compression interruptions was greater with DL (7 [3–6] s) than with VL (0 [0–0] s). Improvements in ETI during CPR were observed in the VL group after the first 3 months, but not the DL group during regular use for 1 year.ConclusionsFor novice EPs, the VL could significantly improve the first-attempt success in ETI during CPR while the DL couldn’t improve it.     

泪道激光探通联合泪道植管术治疗泪道阻塞的疗效观察

目的：探讨泪道激光探通联合泪道植管术治疗泪道阻塞的治疗效果。方法选择2012年3月至2014年3月期间我院眼科收治的泪道阻塞患者80例(140眼)作为研究对象,根据手术方法将其分为研究组(行泪道激光探通联合泪道植管术治疗)40例(70眼)与对照组(行单纯行泪道激光探通术治疗)40例(70眼)。随访6个月,观察两组患者的临床治疗效果,以及术后并发症情况。结果研究组治疗的总有效率为95.71%,显著高于对照组的82.86%, P<0.05。两组并发症发生率对比差异无统计学意义(P>0.05)。结论泪道激光探通联合泪道植管术治疗泪道阻塞疗效确切,操作简单,并发症少,适于临床推广与应用。     

气管插管救治急性重度有机磷中毒52例临床分析

目的探讨气管插管在抢救急性重度有机磷中毒(ASOPP)患者的临床应用价值。方法回顾性分析2012年6月—2014年6月该院收治的52例行紧急气管插管后洗胃的急性重度有机磷中毒患者的临床资料,并与2010年5月—2012年5月收治的34例未实施气管插管的急性重度有机磷中毒患者临床资料进行对比观察。结果观察组52例患者中治愈47例,死亡2例,为多器官功能衰竭,自动放弃治疗3例,救治成功率为90.38%,明显高于对照组的58.82%;观察组入住重症监护室时间为(10.5±2.5)d,明显短于对照组的(15.7±3.9)d,差异具有统计学意义(P<0.05)。结论气管插管是救治急性重度有机磷中毒患者的有效措施,对于提高该类患者救治的成功率具有重要意义。     

带负压式牙刷刷牙法对气管插管患者口腔护理效果评价

目的探讨气管插管患者口腔护理的有效方法,提高护理质量,减少并发症的发生。方法采用对照研究的方式,将2013年1月至2014年6月间我院ICU收治的60例气管插管患者随机分为观察组和对照组,观察组施行负压式牙刷刷牙法,对照组施行常规口腔护理法。比较两组患者护理前后口腔细菌检测情况、口腔症状、pH值、呼吸机相关性肺炎、意外脱管、机械通气的时间以及患者的舒适度。结果观察组护理后即刻的细菌数、护理后2h、4h、6h的细菌数均少于对照组,5d牙菌斑率、口腔细菌阳性率均低于对照组,差异有统计学意义（ P＜0.05）。观察组护理后的口腔溃疡、疱疹、口臭、呼吸机相关性肺炎的发生率低于对照组,护理5 d时的口腔pH值高于对照组,机械通气时间短于对照组,差异有统计学意义（ P＜0.05）。两组的舒适度差异无统计学意义（ P＞0.05）。结论带负压式牙刷刷牙法能够有效清除气管插管患者的口腔细菌,预防感染的发生,优于传统的口腔护理方法。     

MSCT对气管憩室的诊断价值

目的探讨多排螺旋CT(MSCT)对气管憩室的诊断价值。方法选取分析68例气管憩室的临床及影像学资料。结果本组68例共发现气管憩室82个,其中59例为单发,9例为多发(≥2个),单发占86.76%,多发占13.24%,多发气管憩室中5例为2个憩室,3例为3个憩室,1例为4个憩室;本组气管憩室大小不等,其中最大直径44.00 mm,最小直径1.50 mm,平均直径为26(23~35)mm。82个气管憩室形状多样,圆形或类圆形(囊腔样)为62个,气泡样10个,烧瓶样6个,凹槽样2个,三角样2个;MSCT能显示气管憩室与气管为单一细管或多个管道相通,其中2例气管憩室合并感染,本组68例中有慢性支气管炎、肺气肿或慢性支气管炎合并肺气肿的病例共为38例,占55.88%。结论MSCT可以清晰显示气管憩室与气管的通道、气管憩室的部位、数量、形状和内容物等情况,对气管憩室的诊断有重要价值。