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1.
Objective This study evaluated the efficacy of noninvasive continuous positive pressure (CPAP) ventilation in infants with severe upper airway obstruction and compared CPAP to bilevel positive airway pressure (BIPAP) ventilation.Design and setting Prospective, randomized, controlled study in the pulmonary pediatric department of a university hospital.Patients Ten infants (median age 9.5 months, range 3—18) with laryngomalacia (n=5), tracheomalacia (n=3), tracheal hypoplasia (n=1), and Pierre Robin syndrome (n=1)Interventions Breathing pattern and respiratory effort were measured by esophageal and transdiaphragmatic pressure monitoring during spontaneous breathing, with or without CPAP and BIPAP ventilation.Measurements and results Median respiratory rate decreased from 45 breaths/min (range 24–84) during spontaneous breathing to 29 (range 18–60) during CPAP ventilation. All indices of respiratory effort decreased significantly during CPAP ventilation compared to unassisted spontaneous breathing (median, range): esophageal pressure swing from 28 to 10 cmH2O (13–76 to 7–28), esophageal pressure time product from 695 to 143 cmH2O/s per minute (264–1417 to 98–469), diaphragmatic pressure time product from 845 to 195 cmH2O/s per minute (264–1417 to 159–1183) During BIPAP ventilation a similar decrease in respiratory effort was observed but with patient-ventilator asynchrony in all patients.Conclusions This short-term study shows that noninvasive CPAP and BIPAP ventilation are associated with a significant and comparable decrease in respiratory effort in infants with upper airway obstruction. However, BIPAP ventilation was associated with patient-ventilator asynchrony.  相似文献
2.
平静呼吸状态下MSCT评价上气道狭窄   总被引:3,自引:0,他引:3       下载免费PDF全文
目的 观察平静呼吸状态下应用多层螺旋CT判定阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者上气道狭窄的价值.方法 应用16层螺旋CT对63例OSAHS患者分别行吸气、呼气、平静呼吸状态下的上气道扫描,对比分析不同呼吸时相下软腭的状态及腭后区、舌后区咽腔最狭窄处的大小,并与多导睡眠监测结果进行相关性分析.结果 14例患者在不同呼吸时相中均有出现悬雍垂远端上翘、软腭上抬及运动伪影等情况,其中呼气时相出现的机会较多.平静呼吸时相的腭后区最小面积最小,三种不同呼吸时相间差异有统计学意义(F=4.602,P<0.05),其中吸气时相的腭后区最小面积与平静呼吸、呼气时相的差异有统计学意义,呼气时相与平静呼吸时相组间差异无统计学意义;舌后区最小面积于不同呼吸时相间差异无统计学意义.呼气时相和平静呼吸的腭后区最小面积均与LSaO_2呈正相关,r值分别为0.300和0.511(P<0.05).结论 当患者不能配合或者呼气时相出现不利于测量的因素时,平静呼吸状态下的上气道MSCT扫描是评价上气道狭窄的较好方法.  相似文献
3.
目的观察气囊漏气试验预测拔管后发生严重上气道梗阻的临床价值。方法收治764例病人中有171例气管插管患者入组,根据气囊漏气试验的情况分为阴性组和阳性组,拔除气管插管后观察两组喘鸣发生与气管插管情况。结果 171例患者中气囊漏气试验阴性组144例,阳性组27例,拔除气管插管后,阴性组有12例患者需再次插管,再插管率2.8%;而阳性组有8例需再次气管插管,再插管率29.6%,两组间比较差异显著(χ2=16.58,P<0.01)。结论气囊漏气试验是一项简单方便筛查拔管后可能上气道梗阻的方法,如为阴性其因严重上气道梗阻再插管可能性很小;如为阳性则要注意可能发生拔管后上气道梗阻。  相似文献
4.
Purpose  To evaluate, in adults, the diagnostic accuracy of the cuff-leak test for the diagnosis of upper airway obstruction secondary to laryngeal edema and for reintubation secondary to upper airway obstruction. Methods  Systematic review without language restrictions based on electronic databases and manual review of the literature up to December 2008. When appropriate, a random-effects meta-analysis and meta-regression (Moses’ method) were performed. Results  Upper airway obstruction was the outcome in nine studies with an overall incidence of 6.9%. There was significant heterogeneity among studies. The pooled sensitivity was 0.56 (95% confidence interval: 0.48–0.63), the specificity was 0.92 (95% CI: 0.90–0.93), the positive likelihood ratio was 5.90 (95% CI: 4.00–8.69), the negative likelihood ratio was 0.48 (95% CI: 0.33–0.72), and the diagnostic odds ratio was 18.78 (95% CI: 7.36–47.92). The area under the curve of the summary receiver-operator characteristic (SROC) was 0.92 (95% CI: 0.89–0.94). Only three studies have evaluated the accuracy of the cuff-leak test for reintubation secondary to upper airway obstruction. Overall incidence was 7%. The pooled sensitivity was 0.63 (95% CI: 0.38–0.84), the specificity was 0.86 (95% CI: 0.81–0.90), the positive likelihood ratio was 4.04 (95% CI: 2.21–7.40), the negative likelihood ratio was 0.46 (95% CI: 0.26–0.82), and the diagnostic odds ratio was 10.37 (95% CI: 3.70–29.13). Conclusions  A positive cuff-leak test (absence of leak) should alert the clinician of a high risk of upper airway obstruction.  相似文献
5.
儿童慢性上气道咳嗽综合征病因及诊断方法探讨   总被引:1,自引:0,他引:1  
目的探讨儿童慢性上气道咳嗽综合征(UACS)的病因及诊断方法。方法对135例诊断为UACS患儿的病因、临床特点及对治疗反应进行分析。结果135例UACS患儿中3例失访,132例慢性上气道咳嗽综合征患儿病因明确(97.78%),其中慢性鼻炎67例(49.63%),鼻窦炎42例(31.11%),变应性鼻炎22例(16.30%),腺样体肥大7例(5.19%),解剖结构异常所致鼻炎1例(0.74%)。主要临床特点是咳嗽135例(100%),抠鼻孔102例(75.56%),清喉94例(69.63%)、流涕89例(65.93%),鼻塞或打鼾78例(57.78%),打喷嚏71例(52.59%)、咽痒68例(50.37%)、咽部感分泌物下流或异物感63例(46.67%),张口呼吸45例(33.33%)。治疗12周症状基本消失128例(94.81%),显效3例(2.22%),总有效率97.04%(131/135)。结论儿童UACS最常见的三个病因是慢性鼻炎、鼻窦炎及变应性鼻炎,咳嗽是其主要症状,通过详细询问咳嗽特点及其伴随症状,尤其是鼻部症状、检查鼻咽部,97.78%都能明确诊断,经特异积极治疗,绝大部分疗效好。  相似文献
6.
上气道多层CT和测压法对OSAHS阻塞定位的比较研究   总被引:1,自引:0,他引:1       下载免费PDF全文
目的评价MSCT测量和上气道压力测定判定阻塞性睡眠呼吸暂停低通气综合征(OSAHS)病人上气道阻塞部位的诊断符合率及优缺点。方法对29例OSAHS病人分别在清醒时应用16层螺旋CT扫描测量上气道最小轴面积以及睡眠中上气道测压方法确定咽腔阻塞部位。结果腭后区及舌后区为主的阻塞两种方法符合率均为22/29。两种方法确定腭后区为主的阻塞分别占25/29(CT测量)和22/29(上气道测压);CT测量发现3例腭、舌后区咽腔双重狭窄,未发现单纯舌后区狭窄病例;上气道测压判定全部病例均为腭、舌后区咽腔双重阻塞,但不同病例腭、舌后区阻塞频度不同,多为腭后区阻塞为主,舌根平面阻塞为主4例。结论上气道测压与CT测量均可较好评价腭后区阻塞,对发现舌后区的阻塞差异较大,有待进一步研究。两种方法各有优缺点,二者结合可提高诊断率。  相似文献
7.
Abstract. The ability to detect resistances added to the tracheostomy tubes of E.N.T. patients was improved by allowing the pressure changes to be transmitted to the upper airways (by deflating the tracheostomy tube cuff). This suggests that the upper airways are sensitive detectors of added airway resistance and that this sensitivity masks impaired thoracic mechanisms of detection. Patients with chronic obstructive airways disease were able to detect added resistances less well than those with minimal airway disease. Patients with cervical cord transections from spinal level C3 to C6 were able to detect threshold resistive loads normally. It is concluded that receptors in the chest wall and diaphragm are not essential for the normal sensation of threshold resistive loads.  相似文献
8.
A 22-month-old girl with the syndrome of hypoventilation, pulmonary hypertension, cor pulmonale and pulmonary edema due to adenoidal hypertrophy is described. Adenoidectomy resulted in relief of all symptoms and signs within 24 h. Hemodynamic study using pulmonary artery catheter showed that the pulmonary artery pressure returned to normal 48 h after relief of the obstruction. The normal left ventricular end-diastolic pressure, measured throughout the period of obstruction, in the presence of severe pulmonary edema, could suggest a non-cardiogenic low pressure pulmonary edema. However, the highly negative pleural pressure which existed during upper airway obstruction indicated an elevation of transmural left ventricular end diastolic pressure (compared to pulmonary wedge pressure) and thus, suggested that the pulmonary edema in this syndrome is secondary to both — right and left heart failure.  相似文献
9.
Acute upper airway obstruction is a potentially life-threatening event. The most common causes include foreign body inhalation, thermal injury, inflammation, angioedema and trauma. Airway obstruction caused by submucosal extension of subcutaneous emphysema has only been previously reported once. We report the case of a patient who suffered a respiratory arrest as a result of hypopharyngeal and laryngeal swelling associated with massive subcutaneous emphysema.  相似文献
10.
Epiglottitis should be suspected in the adolescent with throat pain and dysphagia out of proportion to pharyngeal inflammation. Endolateral neck radiographs or indirect laryngoscopy will confirm the diagnosis. Blood and throat or epiglottic cultures always should be obtained. Therapy consists of airway stabilization and antibiotic administration. Although epiglottitis in adolescents is often less acute and less severe than in younger children, it may be life-threatening.  相似文献
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