治疗支气管哮喘的常用药物

众所周知,支气管哮喘是由多种炎性细胞参与的气道慢性炎症,临床上表现为反复发作性的气流受限、气道粘液产生增加和咳嗽等。通常用药物治疗来预防和控制哮喘的症状,以减少哮喘发作的频率和减轻重症哮喘的严重程度,消除可逆性气道阻塞。目前往往使用以下几种类型的药物来治...     

气管腺样囊性癌二例报告

气管腺样囊性癌是一种罕见的气管恶性肿瘤,文献上仅有个案报告。本文报告两例气管腺样囊性癌。 例1,女性,41岁,于1967年4月24日因咯血1年、吸气性呼吸困难和气喘6月入院,曾诊断为慢性气管炎与支气管性哮喘。支气管镜检查与气管照片发现     

支气管哮喘的硝苯啶治疗

硝苯啶(Niedipine,商品名心痛定),为较强的钙通道阻滞剂。早先主要用于心绞痛、高血压的治疗。近年来,随着对支气管哮喘病理生理学研究的深化,发现Ca~(2 )与气道可逆性阻塞有密切关系,因而提出了应用硝苯啶治疗哮喘。经初步实验和临床观察表明,该药对支气管哮喘有一定的临床应用价值。一、硝苯啶的平喘机理哮喘是一种可逆性气道阻塞性疾病。气道阻塞的形成是由于支气管痉挛、粘膜充血、水肿以及粘液腺     

慢性阻塞性肺疾病的治疗进展

慢性阻塞性肺疾病 (ＣＯＰＤ)是具有气流阻塞特征的慢性支气管炎和 (或 )肺气肿。气流阻塞呈进行性发展 ,但部分有可逆性 ,可伴有气道高反应性。某些支气管哮喘患者在疾病长期发展过程中发展为不可逆性气流阻塞 ,或合并了慢性支气管炎和肺气肿 ,也属于ＣＯＰＤ。已知病因或具有特异病理表现并有气流阻塞的疾病 ,如囊性纤维化、弥漫性泛细支气管炎或闭塞性细支气管炎等不包括在内。无气流阻塞的单纯性支气管炎或肺气肿也不属于ＣＯＰＤ。支气管哮喘患者如长期抽烟则更易发展为ＣＯＰＤ。具有明显气流阻塞、最大呼气流速降低、肺用力排气延缓…     

支气管腺样囊性癌的 CT 表现5例报道

目的：探讨支气管腺样囊性癌的 CT 表现。方法回顾性分析5例经手术病理证实的支气管腺样囊性癌的CT 征象。结果5例病灶均位于支气管,主支气管4例（其中右侧3例,左侧1例）,右肺下叶支气管1例。1例伴有右肺门淋巴结转移。病灶主要表现为向支气管腔内、外生长的不规则软组织肿块,并以向腔外生长为主,支气管壁增厚呈移行性改变,均未见钙化灶。平扫肿块密度尚均匀,增强后呈轻、中度不均匀强化。结论支气管腺样囊性癌的 CT 表现具有一定特点,了解其表现有利于术前正确诊断。     

支气管原发腺样囊性癌2例

支气管原发腺样囊性癌是一种少见的低度恶性肿瘤,因其症状不典型易被漏诊或被误诊为慢性支气管炎、支气管哮喘等疾病。我院治疗2例,报告如下。例1,男性,55岁。咳嗽、胸痛1月入院。CT示右上肺叶占位性病变,纤维支气管镜活检,诊断为腺样囊性癌。行右全肺切除术,术中见肿块位于右上叶支气管开口处,大小约2.0 cm×2.0 cm×3.0 cm,并侵及主支气管。术后病理诊断为:腺样囊性癌,支气管断端阴性,淋巴结无转移。术后随访6年健在。例2,女性,46岁,咳嗽、咳血20天入院。CT示左肺占位性病变伴纵膈淋巴结转移。纤维支气管镜检查示:左主气管内菜花样肿物,左主支气管腔狭窄,活检示腺样囊性癌。因病情较晚,行放     

气管、支气管腺样囊性癌经电子支气管镜介入与治疗20例临床分析

目的探讨气管、支气管腺样囊性癌支气管镜下的形态特点以及支气管镜腔内介入治疗.方法回顾性分析20例气管、支气管腺样囊性癌的电子支气管镜检查、支气管镜腔内介入治疗资料及随访.结果 20例气管、支气管腺样囊性癌发生于气管,主支气管16例(80%),主要位于气管下段及上段,镜下形态表现为乳突样新生物17例(85.5%).经支气管镜腔内介入治疗6例,随访1 d～61个月,3例未复发;1例带瘤生存;1例手术;1例死亡.结论气管、支气管腺样囊性癌在支气管镜下形态有一定独特性,手术是首选治疗方法,通过支气管镜腔内介入治疗能对一部分患者进行姑息性治疗.     

支气管哮喘与咳嗽

支气管哮喘是以可逆性气道阻塞和气道高反应性为特点的疾病,是引起慢性咳嗽最常见的病因之一。几乎所有哮喘患者均有咳嗽。尤其值得注意的是,在一部分存在气道高反应性的患者尤其儿童患者中,咳嗽特别是夜间干咳是哮喘的惟一表现,少有甚至无喘息、哮鸣音等表现,称咳嗽变     

长期误诊小儿支气管腺样囊性癌1例

长期误诊小儿支气管腺样囊性癌１例张爱平，辛英才，杨锋内蒙古包钢职工医院（０１４０１０）腺样囊性癌是一种少见的多发生于涎腺组织的低度恶性肿瘤，很少发生在气管或支气管。本病发展慢、病程长，不少病人长期按哮喘或结核治疗。我科于１９９３年收治１例，现报告如下...     

巨大气管腺样囊性癌伴结节性甲状腺肿一例报道

气管腺样囊性癌（ACC）是一种起源于气管黏液腺上皮的恶性肿瘤,临床上少见,好发于气管和主支气管,常以咯血、干咳、胸痛等为首发症状,容易误诊为哮喘.对于气管ACC,早期发现和正确治疗非常关键.     

Tracheal stenting for primary tracheal mucosa-associated lymphoid tissue lymphoma

Primary tracheal mucosa-associated lymphoid tissue (MALT) lymphoma is extremely rare. We report a 49-year-old female patient with the complaint of dyspnea. Fiberoptic bronchoscopy showed polypoid, variable-sized and irregular nodules causing narrowing of the tracheal lumen from the proximal trachea to the left main bronchus. Because of severe stenosis in the airway and the severity of symptoms, this case was unresectable. The patient was then treated successfully with placement of an endobronchial stent through bronchofibroscopy. After the placement of the stent, bronchoscopic biopsy was performed. Pathological analysis confirms a diagnosis of MALT-associated malignant lymphoma. We performed systemic chemotherapy on the patient. The temporary stent was removed after the reduction of the stenosis. This is the first case in which tracheal MALT lymphoma was treated successfully following tracheal stent insertion guided by bronchofibroscopy. Temporary tracheal stenting can be a favorable choice for a patient with tracheal stenosis caused by primary tracheal MALT lymphoma.     

A case of bronchial squamous cell carcinoma in situ detected by sputum cytology

A 64-year-old man underwent a medical checkup in May 1996 and was evaluated as class V using sputum cytology. Chest X-ray examination, bronchoscopy and chest computed tomography (CT) demonstrated no abnormalities. Thereafter, the patient was followed up with chest X-ray, bronchoscopy and chest CT at 3-month intervals. In December 1996, chest CT showed an increased density at the mediastinal side of the left upper bronchus, B1+2. There were no findings on bronchoscopy, but subsequent exfoliative cytology demonstrated keratinized malignant cells in samples obtained from left upper bronchus, B1+2. Although, it was difficult to identify localization of the tumor, left upper lobectomy was performed and the diagnosis of squamous cell carcinoma in situ was finally made. Here, we report on the course of this patient and discuss the diagnostic usefulness of sputum cytology as well as the pathogenesis of lung squamous cell carcinoma.     

Adenoid cystic carcinoma (cylindroma) of the trachea masquerading as asthma.

A 40-year-old woman was admitted with upper airway obstruction; chest roentgenogram with tomograms, laryngoscopy, and bronchoscopy verified the presence of a subglottic tumor. Spirometry disclosed a maximum inspiratory flow rate more reduced than in the maximum expiratory flow rate, suggestive of upper airway obstruction. The pathologic conditions were consistent with cystic adenoid carcinoma (cylindroma) of the trachea. The patient underwent tracheostomy and total laryngectomy with an uneventful recovery. No evidence of local extension or distant metastases were evident at time of surgery.     

多层螺旋CT在婴幼儿气道透X线异物急症中的临床应用价值

目的:探讨儿童支气管异物的多层螺旋CT诊断价值.方法:对33例儿童气道异物进行三维重建,8例同时进行低毫安(ma)量的胸部CT扫描,回顾分析其影像学表现.结果:气管内5例,左主支气管13例,右主支气管8例;中间主支气管3例,左、右下支气管异物各2例.以花生米、瓜子类为主.CT征象包括:异物直接显示,阻塞性肺气肿.结论:多层螺旋CT能清晰显示气管支气管树,能直接而准确定位异物为支气管异物提供一种新的更准确的术前诊断途径.     

Tracheal schwannoma as a mimic of bronchial asthma

Primary tracheal tumours are rare and less frequently observed than bronchial tumours. Primary neurogenic tumours of the trachea as schwannomas or neurilemmomas are extremely uncommon. We report a tracheal schwannoma in a female patient who presented with breathlessness and wheeze, and she was being treated for asthma. Flexible bronchoscopy revealed a large pedunculated tracheal mass and biopsy confirmed schwannoma. She was treated with laser ablation with partial reduction of the tumour. Subsequently, she was lost to follow-up, although resection of the tumour with tracheal reconstruction was planned.     

气管、大支气管结核的影像学诊断

对35例成人气管、大支气管结核进行了临床分析。本组病例以青年女性居多。多数患者胸片有或多或少或新或旧的结核灶或支气管播散灶。35例均有不同程度的管腔狭窄,病变范围较长,支气管多部位受累。左侧多于右侧。管腔高度狭窄至阻塞者22例,其中狭窄伴有变形者12例。管腔内缘显示光滑或呈轻度锯齿或波浪状改变。狭窄周围无明显包块。只有依靠支气管体层或造影摄影才能显示直接征象。笔者还分析了误诊原因,讨论了诊断与鉴别诊断。     

应用螺旋CT诊断不典型气管异物病例的价值探讨

目的探讨螺旋CT在不典型小儿支气管异物中的诊断价值。方法对11例没有明确异物吸入史,长期误诊为“支气管哮喘”和“支气管炎”的患儿进行支气管螺旋CT的冠扫和轴扫诊断,并与气管镜检查结果相比较。结果11例患儿螺旋CT显示右侧支气管异物4例,左侧支气管异物6例,主气管异物1例。11例患儿在全麻下行支气管镜检查及异物取出术,其中右侧支气管花生米异物2例,西瓜子2例,左侧支气管西瓜子异物5例,葵瓜子1例,主气管异物1例完整西瓜子一枚。与螺旋CT结果一致。结论小儿支气管异物在螺旋CT扫描上有较为特征性表现,对不明原因的反复咳喘和呼吸道感染的患儿可首选支气管CT检查,排除有无气管异物。     

双腔支气管导管型号与左主支气管内径相关性分析

目的探讨左侧双腔支气管导管(DLT)型号与左主支气管内径的相关性。方法随机抽取胸外科手术需行左侧DLT插管的成年病人100例，所有病人术前均行胸部螺旋CT扫描，利用三维图像重建技术测定病人隆突水平与左主支气管纵轴垂直平面的左主支气管内径值，根据左主支气管内径值插入左DLT，以纤维支气管镜定位或引导插管、采用“气泡溢出法”和“主支气管套囊压力测定法”判断DLT型号的合适性和插管的准确性。结果合适的左DLT型号与左主支气管内径有相关性．相关系数为0．7346。结论临床上，可根据左主支气管内径测量值指导选择左DLT。     

双腔支气管导管型号与左主支气管内径相关性分析

目的 探讨左侧双腔支气管导管(DLT)型号与左主支气管内径的相关性。方法 随机抽取胸外科手术需行左侧DLT插管的成年病人100例,所有病人术前均行胸部螺旋CT扫描,利用三维图像重建技术测定病人隆突水平与左主支气管纵轴垂直平面的左主支气管内径值,根据左主支气管内径值插入左DLT,以纤维支气管镜定位或引导插管、采用“气泡溢出法”和“主支气管套囊压力测定法”判断DLT型号的合适性和插管的准确性。结果 合适的左DLT型号与左主支气管内径有相关性,相关系数为0.7346。结论 临床上,可根据左主支气管内径测量值指导选择左DLT。     

Track your trach: Removal of a fractured tracheostomy tube using a flexible fibreoptic bronchoscope in a patient with severe head injury

Tracheostomy is a common airway procedure for life support in critically ill patients with head injuries. This procedure is safe but also associated with early and late complications. Tube fracture and dislodgement into the tracheobronchial tree leading to airway obstruction is a rare but life-threatening complication after prolonged tracheostomy tube placement. There are very few published reports of tracheostomy tube fracture and dislodgement into tracheobronchial tree in a neurologically injured patient. We report a case of a fractured tracheostomy tube which got impacted in the left main bronchus, in a 41-year-old male patient who had been on prolonged tracheostomy tube after craniotomy and evacuation of subdural hematoma. The distal part of the tracheostomy tube fractured and impacted in the left main bronchus. Fibreoptic bronchoscopy was performed through the oral cavity to extract it, and the anaesthetic management during the period is discussed.