喉罩通气在小儿纤维支气管镜诊疗中的应用

目的:探讨喉罩通气麻醉应用于小儿纤维支气管镜诊疗的安全性和可行性。方法:选择行纤维支气管镜诊疗的小儿18例,男13例,女5例,年龄0.5岁～6岁,丙泊酚和舒芬太尼静脉麻醉诱导和维持,术中监测无创血压(NIBP)、心电图(EKG)、心率(HR)、脉搏氧饱和度(SpO2)和呼气末二氧化碳分压(PETCO2),根据患儿体重分别置入相应大小的喉罩,观测置入喉罩前(T0)、置入喉罩后1min(T1)、3min(T2)和5min(T3)的HR、MAP的变化,记录术中呛咳、体动、返流和误吸等不良反应。结果:置入喉罩前(T0)与置入喉罩后1min(T1)、3min(T2)和5min(T3)的HR、MAP的变化差异无显著性(P>0.05),18例患儿术中无1例出现呛咳、体动、返流和误吸等不良反应,SpO2维持在95%～100%。结论:喉罩通气全麻用于小儿纤维支气管镜的诊疗具有操作简单、安全性高、能有效维持呼吸道通畅、保证有效通气、血流动力学平稳,对呼吸循环影响小的优点。     

光纤式CO_2激光导光束

目的　报道新近研制的CO2 激光卤化银多晶光纤 [AgClxBr(1 -x) ,0≤x≤ 1]。方法　光纤原料采用高真空熔炼、氯气气氛下区域融熔和高真空石英安瓿内单晶生长等特殊工艺提纯 ,光纤用热挤压法成型。结果　制成的直径为 1 0mm光纤 ,其传输CO2 激光的损耗为 0 3～ 0 5dB m ,长度为 1 6 4m、输出CO2 激光功率 >2 0W。用光纤制成光纤式CO2 激光传输系统 (光纤式CO2 激光手术刀 )。结论　光纤导光束长度为 1 3～ 1 8m ,输出功率 10～ 15W ,配有普通型和内腔专用型两种结构的输出端头。弯曲半径大于 5cm ,光纤传输效率没有变化。弯曲半径增加到 3cm ,传输效率下降 10 %。     

纤维支气管镜下大剂量腔内放疗治疗癌性支气管阻塞

目的　应用后装设备在纤维支气管镜引导下将192Ir导入支气管内进行腔内放疗,治疗癌性支气管阻塞。方法　常规纤维支气管镜检后,将施源器导管经活检孔导入病变部位,接后装机进行放疗,每次6～8Gy,每周1次,连续3周为1疗程。疗程结束后第1、4周复查。结果　胸部X线检查示:CR15例(23.08%),PR28例(43.08%),MR12例(18.46%),总有效率(CR+PR+MR)为84.62%。纤支镜检查示:CR25例(38.46%),PR28例(43.08%),MR9例(13.85%),总有效率为95.38%。结论　该方法对肺癌引起的支气管阻塞具有良好的再通效果,作用快,疗效好,副作用少。     

Difficult airway management in the neonate: a simple method of intubating through a laryngeal mask airway

Tracheal intubation through a laryngeal mask airway is one option for securing an airway in the patient with a difficult airway. A variety of techniques and equipment have been used to stabilize the position of the tracheal tube while removing the laryngeal mask airway. We have shown that if a fibreoptic bronchoscope is used to place an tracheal tube through a laryngeal mask in neonates, additional equipment is not needed to remove the laryngeal mask airway without endangering tracheal tube placement. This is possible even in small neonates.     

The relevance of clinical and radiological measurements in predicting difficulties in fibreoptic orotracheal intubation in adults

Resistance to the passage of the tracheal tube has been reported to occur in up to 36% of patients subjected to orotracheal fibreoptic intubation. In this prospective study we assessed five radiological measurements of the upper airway in an attempt to find anatomical causes of obstruction to passage of the tube. Forty-nine patients undergoing fibreoptic orotracheal intubation under general anaesthesia were studied. Pre-operatively, the Mallampati grade and the thyromental distance were assessed. The plain films, CT scans or MR images of the cervical spine were used for measurement of the position of the vocal cords, the length of the epiglottis and the size of the tongue. The resistance to the passage of the tube was graded as none, mild, moderate or severe. The length of the epiglottis and the size of the tongue, but not the position of the vocal cords, had positive correlations with the severity of impingement. The pre-operative bedside tests did not correlate with difficulties in fibreoptic intubation.     

Fiberoptic evaluation of peripheral airways of two patients with acute respiratory failure during mechanical ventilation

Key words  bronchiolectasis - fiberoptic bronchoscopy - mechanical ventilation     

A new triaxial fiberoptic soft tissue retractor

The triaxial configuration of this fiberoptic instrument allows for operation through a small incision site and expansion within the wound. It also has a self-retaining aspect.     

Diagnostic value of brush biopsy in suspected bronchial carcinoma with the use of the flexible fibre bronchoscope

In a 12-month period, brush biopsy through a fibreoptic bronchoscope was performed on 125 consecutive patients who were clinically or radiographically suspected of lung cancer. Of the patients, 62 appeared to have lung cancer. Cytological analysis of the brush-biopsy specimens was positive in 69%. A total of 58% had positive biopsy, and 58% had cancer cells in the bronchial secretion aspirated during the bronchoscopy. Thirty-five per cent had positive mediastinoscopy. When the methods of examination were combined, the diagnosis could be established in 90% of the patients. The study shows that brush biopsy and cytological analysis, in combination with the other methods of examination, increase the diagnostic sensitivity in bronchoscopically visible tumours. In bronchoscopically invisible tumours, brush cytological analysis, together with the study of bronchial secretion and fine-needle puncture, is the most effective diagnostic method. The diagnostic possibilities can presumably bronchoscopy.     

气管镜介入治疗对良性气道狭窄患者的疗效及狭窄程度、气促评分的影响

目的探讨气管镜介入治疗对良性气道狭窄患者的疗效及狭窄程度、气促评分的影响。方法选取2016年5月～2018年10月我院及广东医科大学附属中山医院收治的良性气道狭窄患者30例,根据良性气道狭窄病因不同分为三组,分别为瘢痕组(13例)、肉芽肿组(12例)、良性肿瘤组(5例)。所有患者均进行气管镜介入治疗。比较三组患者疗效、气道狭窄程度、气促评分、肺功能。结果瘢痕组、良性肿瘤组的总有效率分别为84.6%、80.0%均高于肉芽肿组(75.0%)(P0.05);瘢痕组气道狭窄程度(1.4±0.5)%小于肉芽肿组(12.2±0.3)%、良性肿瘤组(14.9±0.6)%(P0.05),肉芽肿组、良性肿瘤组气道狭窄程度相比,无明显差异(P0.05),瘢痕组气促评分(1.1±0.4)分大于肉芽肿组(0.5±0.1)分、良性肿瘤组(0.3±0.1)分(P0.05);瘢痕组、良性肿瘤组FEV1[(2.0±0.6)%、(1.9±0.6)%]、Vcmax[(2.7±0.5)L、(2.5±0.5)L]大于肉芽肿组[(1.7±0.3)%、(2.3±0.2)L](P0.05),瘢痕组、良性肿瘤组FVC[(2.2±0.2)%、(2.4±0.4)%]小于肉芽肿组(2.7±0.3)%(P0.05)。结论良性气道狭窄治疗中,气管镜介入治疗疗效确切,值得应用。