两种不同胸腔引流管治疗脓胸的临床研究

目的在改良胸腔套管针引导下,胸腔内置入可冲洗引流管治疗脓胸,并与双腔球囊导尿管相对照,评价其疗效及安全性。方法46例脓胸患者随机分为两组。在引流管侧释放套管针引导下,A组：胸腔内置入双腔球囊导尿管治疗脓胸。B组：胸腔内置入可冲洗胸腔引流管治疗脓胸。结果3周后A组有效15人（65％）,B组19人（83％）,两组间疗效有统计学差异（P〈0．05）。A组：引流管堵塞5例,包裹性脓胸6例,B组分别1例和2例（P〈0．05）。结论应用引流管侧释放套管针,胸腔内置入可冲洗胸腔引流管治疗脓胸是一种更加安全、有效和同样简单的新方法。     

经胸壁插管、气道粘堵治疗巨大张力性肺脓肿的临床观察

我科采用经胸壁、气道双路介入治疗巨大张力性肺脓肿,取得较好疗效。现报道如下。对象与方法1.对象:36例肺脓肿患者按住院顺序分为两组。A组在内科常规抗菌和对症支持疗法基础上,采用经胸壁、气道双路介入治疗肺脓肿;B组采用内科常规抗菌和对症支持疗法。见表1。表1两组临床资料比较组别(例例数)年(岁龄)男/女脓(肿cm直)径原性发肺癌食癌管肺核继结发肺性肿囊其它A组1861.7±13.011/715.3±3.3852111B组1858.6±14.212/616.9±3.69431012.方法(1)器械:中心静脉导管一套,生物蛋白胶专用导管,医用生物蛋白胶[1]。(2)中心静脉导管置入术:CT…     

Forgarty导管球囊充液定位气胸肺漏气支气管

目的探讨Forgarty双腔球囊导管球囊充液定位肺漏气支气管的方法,并评价其效果及安全性。方法 17例气胸患者,在纤支镜直视下,经纤支镜工作道插入Forgarty导管,采用球囊充液方法定位肺漏气支气管。结果 17例气胸患者平均13 min顺利置入球囊导管,完成球囊充液,定位和粘堵术。球囊内充液1毫升3例,1.5 ml 4例,2 ml 10例。生物蛋白胶封堵肺漏气支气管1次成功10例,2次5例和3次2例。结论 Forgarty导管球囊充液定位肺漏气支气管的方法简单、快捷,无明显不良反应,具有较好的安全性。     

介入治疗先天性心脏病118例近期疗效评价

目的：评价应用国产封堵器治疗动脉导管未闭（PDA）、房间隔缺损（ASD）室间隔缺损（VSD）的近期疗效及安全性。方法：118例先天性心脏病患者（PDA24例，ASD48例，VSD46例）均在X线透视及经胸超声心动图监视下经导管置入封堵器治疗PDA、ASD和VSD。结果：全组封堵成功率98．3％，所有封堵成功的患者均于术后24h、7d、1月和3月行经胸超声心动图检查，均无残余分流。结论：经导管置入封堵器是治疗PDA、ASD和VSD的一种操作简便、成功率高、疗效可靠的介入方法。     

内镜下放置螺旋型鼻空肠管方法的探讨

目的探讨胃镜下置空肠管方法的效果和可行性。方法将93例患者随机分成A、B、C三组,A组采用导丝置管法,B组患者采用经胃镜导管推入法,C组患者采用内镜工作通道异物钳夹导管缝合线法,并比较三组置管成功率、平均置管时间。结果 A组、C组患者置管成功率明显高于B组（P〈0.05）,而C组置管成功率明显高于A组（P〈0.01）。A组、C组患者平均置管时间明显低于B组（P〈0.05）,而C组平均置管时间明显低于A组（P〈0.01）。结论经内镜工作通道异物钳夹导管缝合线法安全可靠,成功率高,可以作为肠内营养支持治疗鼻空肠管置入的首选方法。     

球囊探查加选择性支气管封堵术与凝血酶胸膜腔粘连术治疗难治性气胸的疗效比较

目的比较球囊探查加选择性支气管封堵术与凝血酶胸膜腔粘连术治疗难治性气胸的疗效。方法选取该院呼吸内科2006-01~2016-04经胸腔穿刺及胸腔置管引流术、负压吸引等措施7~14 d后自发性气胸仍未愈合的难治性气胸患者71例,接受球囊探查加选择性支气管封堵术26例,凝血酶胸膜腔粘连术45例(两法重合4例),比较两种方法疗效及不良反应。结果球囊探查加封堵术组成功率为69.2%(18/26),凝血酶胸膜腔粘连术组成功率为48.9%(22/45);球囊探查加封堵术组有效率为84.6%(22/26),凝血酶胸膜腔粘连术组有效率为71.1%(32/45)。球囊探查加选择性支气管封堵术组疗效优于凝血酶胸膜腔粘连术组,差异具有统计学意义(P0.05)。结论两种方法治疗难治性气胸均安全、有效,尤其适用于全身情况差、肺功能明显减退以及不愿接受手术者,但球囊探查加选择性支气管封堵术疗效优于凝血酶胸膜腔粘连术。     

选择性支气管封堵术治疗18例难治性气胸的临床体会

目的 探讨球囊探查加选择性支气管封堵术治疗难治性气胸的疗效、安全性及并发症.方法 选取我院2013年8月至2015年8月期间18例难治性气胸患者,进行球囊探查加选择性支气管封堵术治疗.在常规电子支气管镜检查基础上采用双腔球囊导管对脏层胸膜瘘口所属的引流支气管进行探查定位,然后经双腔导管确认的目标支气管注入不同剂量的自身全血加凝血酶,观察是否成功封堵及相关并发症.结果 16例成功定位引流支气管,2例无法探查到引流支气管.对16例球囊探查成功者顺利施行自体血封堵术,首次封堵成功13例,其中3例于72 h内复发,对该3例行第2次封堵后2例成功,另1例封堵失败患者转入胸外科行手术治疗.封堵术最终成功并顺利拔出胸腔引流管12例,失败4例.在失败的4例中l例患者签字带管出院(跟踪随访半月,胸腔引流瓶内未见气泡逸出,复查胸片提示肺复张,遂拔出胸腔引流管);另外3例未探查到引流支气管,其中2例转入胸外科行手术治疗.结论 球囊探查加选择性支气管封堵术是治疗难治性气胸安全、有效、可行的介入治疗方法.     

球囊扩张与临时性金属支架置入治疗良性气道狭窄的疗效分析

目的观察和分析经支气管镜球囊扩张与临时性金属支架置入治疗良性气道狭窄的疗效。方法将30例良性气道狭窄的患者随机分为两组,球囊扩张组(A组,n=15例)和临时性金属支架置入组(B组,n=15例),疗程均为2个月,随访共6个月,观察两组治疗前后气促评分、狭窄段管腔直径等指标的变化。结果观察6个月末时,两组患者的狭窄段管腔直径均较治疗前增加,差异有统计学意义,气促指数均较治疗前降低,差异有统计学意义;临时性金属支架置入组与球囊扩张组相比,气促评分显著降低,狭窄段管腔直径显著升高,差异均有统计学意义,同时临时性金属支架置入组再狭窄发生率低于球囊扩张组。结论临时性金属支架置入治疗良性气道狭窄疗效优于球囊扩张,且术后再狭窄率较低。     

房间隔缺损封堵术后合并心房颤动的房间隔穿刺及导管消融

目的先天性房间隔缺损（简称房缺）患者介入封堵术后合并的心房颤动（简称房颤）导管消融存在一定挑战,本研究拟评价这类患者房间隔穿刺及导管消融的安全性及疗效。方法共入选16例[年龄（56±12）岁,10例男性]房缺封堵术后接受导管消融的房颤患者,其中阵发性房颤10例,持续性房颤6例。房间隔封堵器之外无穿刺空间者直接穿刺封堵器,在球囊扩张辅助下建立左房入路后单导管完成所有操作。阵发性房颤消融策略为环肺静脉电隔离;持续性房颤消融策略为环肺静脉电隔离联合心房线性消融并实现传导阻滞。结果 16例患者中,房间隔穿刺成功率100%,11例（A组）直接穿刺房间隔成功,5例（B组）穿刺封堵器并经球囊扩张后长鞘可顺利通过。与A组比较,B组房间隔穿刺操作时间[（38±8）min vs（5±3）min]、总透视时间[（54±15）min vs（31±11）min）]以及总手术时间[（224±36）min vs（165±35）min）]显著延长,P均〈0.05。除B组中1例持续性房颤患者未实现二尖瓣峡部传导阻滞之外,所有患者实现既定手术终点,无严重围术期并发症发生,术后3个月复查经胸超声未见房间隔水平左向右分流。平均随访（16±6）个月,12例（75%）患者维持稳定窦性心律。结论房缺封堵术后合并的房颤经导管消融安全,有效。球囊扩张辅助下可直接穿刺房间隔封堵器获得左房入路。     

介入技术和外科手术同期"复合"治疗先天性心脏病的临床研究

目的结合介入器械和外科手术,实施“复合（Hybrid）”技术对先天性心脏病实施治疗。方法2005年3-10月,20例先天性心脏病患者接受了术中Hybrid技术治疗。球囊扩张组包括3例室间隔完整型肺动脉闭锁的新生儿和4例婴儿重度肺动脉瓣狭窄。缺损封堵组13例,包括10例房间隔缺损和3例多发室间隔缺损。正中或右侧腋下小切口进胸,在超声引导下经右室流出道置入球囊扩张管扩张肺动脉瓣或经右心房置入封堵器。2例多发室间隔缺损于体外循环下经三尖瓣置入封堵器。合并的其他心脏病变同期常规外科矫正,术式包括部分性肺静脉异位引流矫正、动脉导管结扎、冠状动脉旁路移植术等。术后心脏超声随访。结果患者全部顺利出院。1例婴儿重度肺动脉瓣狭窄术后2个月接受常规右室流出道成形术,1例多发肌部室间隔缺损因无法置入封堵器而转为常规术式。其余患者均顺利实施Hybrid术式。随访期内未发现介入器材相关的并发症。结论“复合”Hybrid技术可以避免体外循环,减少手术创伤,对于提高先天性心脏病的疗效具有重要的意受．     

应用引流管侧释放套管针胸腔内置入双腔球囊导尿管治疗气胸29例临床观察

目的 观察改良胸腔套管针胸腔内置入双腔球囊导尿管治疗气胸的疗效和安全性.方法 29例自发性气胸患者,应用引流管侧释放套管针,经胸壁胸腔内置入可冲洗胸腔引流管治疗气胸.结果 2周后有效率90%(23/29),无明显不良反应.结论 应用引流管侧释放套管针,胸腔内置入双腔球囊导尿管治疗气胸是一种简单、安全、价廉和有效的方法.     

Swan-Ganz飘浮导管监测血流动力学指标在心肺复苏中指导价值

目的探讨利用Swan-Ganz飘浮导管监测胸外按压时血液流动力指标来指导胸外按压的幅度及频率、呼吸频率及呼吸末正压的调整的研究价值。方法选取我院从2014年7月至2015年7月68例进入急诊抢救室进行心肺复苏的患者,随机分为A、B两组,A组为治疗组,B组为观察组,每组各34例。A、B两组患者在Swan-Ganz飘浮导管置入前,均采用2010指南标准进行心肺复苏术,包括气管插管、除颤、药物的使用并详细记录,A组患者在胸外按压的同时进行Swan-Ganz Swan-Ganz飘浮导管置入,B组为观察组。对比治疗后两组患者心肺复苏的成功率和24 h存活率差异是否有统计学意义。结果 A组心肺复苏成功率为82.35%,B组心肺复苏成功率为64.71%,两组数据比较,差异具有统计学意义(P0.05);A组患者24 h的存活率为91.18%,而B组患者在24 h的存活率仅为79.42%,两组比较差异具有统计学意义(P0.05)。结论利用Swan-Ganz飘浮导管监测血流动力指标来指导胸外按压的幅度及频率、呼吸频率及呼吸末正压的调整以形成有效的右心室峰压及胸腔负压,达到理想的冠状动脉灌注压和心输出量以保证心肌细胞及脑细胞的血液供应,建立个体化的复苏模式从而提高心肺复苏的成功率及24 h的存活率;同时,这一成果将极大的推进心肺复苏技术的进一步发展,增强胸外按压对血流动力学影响的认识。     

Knotting of intracardiac flow-directed balloon catheter: A non-surgical technique for removal

A knot occurred in a flow-directed balloon tipped (Swan-Ganz) catheter inserted through the right internal jugulary vein. Knot was undone using right Judkins catheter introduced via left jugulary vein approach. By passing through the loop of knot, right Judkins catheter was used to stabilize the knotted segment and knot was unknotted by gently pulling the Swan-Ganz Catheter.     

Knotting of intracardiac flow-directed balloon catheter: A non-surgical technique for removal

A knot occurred in a flow-directed balloon tipped (Swan-Ganz) catheter inserted through the right internal jugulary vein. Knot was undone using right Judkins catheter introduced via left jugulary vein approach. By passing through the loop of knot, right Judkins catheter was used to stabilize the knotted segment and knot was unknotted by gently pulling the Swan-Ganz Catheter.     

A case of type 2 diabetes mellitus complicated with left iliopsoas abscess caused by a left femoral vein catheter during treatment for right pyothorax and right subphrenic abscess

A 78-year-old man was receiving regular treatment for diabetes and dementia at our hospital. Diabetes was diagnosed about 10 years previously, at which time the patient's HbA(1)c level had been maintained at 6% by diet therapy and an oral hypoglycemic agent. In July, 2008, he was admitted with fever and hospitalized for pneumonia, which improved with antibiotic treatment and chest drainage. However, pyothorax developed, and in October, 2008 he was admitted again with fever and inflammation. A chest computed tomography (CT) scan revealed a right subphrenic abscess, which improved with antibiotic treatment. He was readmitted for fever and lumbago in November, 2008, and an abdominal CT scan showed a left iliopsoas abscess that did not improve with antibiotic treatment, and had increased in size. Due to infection from the central vein catheter in the left femoral vein inserted at the end of October, the catheter was withdrawn at the end of November. There was a rapid reduction of the left iliopsoas abscess, his inflammation and lumbago symptoms reduced, and he was discharged in January 2009. In cases of dementia in elderly with diabetes, a catheter from a femoral vein is frequently used to prevent complications. However, this method has been known to result in infection at the site of the catheter, and to cause fever. The circumstances of this case strongly support the removal of such a catheter in elderly patients at the first indication of persistent infection.     

中心静脉导管行胸腔闭式引流治疗气胸的临床观察

目的比较中心静脉导管与粗硅胶引流管行胸腔闭式引流治疗气胸的疗效和并发症。方法我科收治的116例气胸患者随机分为研究组（58例）和对照组（58例）,研究组采用中心静脉导管行胸腔闭式引流,对照组采用粗硅胶引流管行胸腔闭式引流,观察两组的治疗效果和并发症。结果研究组和对照组相比,治疗效果接近,差异无统计学意义。但在某些并发症上,研究组较对照组明显减少,差异有统计学意义。结论采用中心静脉导管行胸腔闭式引流治疗气胸创伤小、操作简单、引流效果可靠、并发症少,值得临床推广。     

Selective left endobronchial suctioning in the intubated patient

Suctioning of secretions from the left endobronchial tree is frequently necessary but often difficult in intubated patients. We examined the effectiveness of a catheter designed expressly for this purpose. Special curved tip (Bronchitrac-L) suction catheters were fitted with thin, radiopaque tubing to facilitate x-ray visualization. Eight-one attempts at left endobronchial placement were made on 74 stable adult intensive care unit patients. The suction catheter was inserted into the oral endotracheal tube or tracheostomy tube just prior to an x-ray filming of the chest. In 15 of 66 patients, the tip of the oral endotracheal tube was too distal (less than 2 cm above the carina) to allow proper functioning of the catheter. Patients with a properly positioned oral endotracheal tube were analyzed separately and showed 56 percent of the catheters went to the left bronchus. When the head was turned to the left prior to placement, successful left bronchus placement occurred in 65 percent. When the catheter was placed through a tracheostomy tube, 100 percent went into the left bronchus (n = 15). There were no catheter-induced complications in this study. The curved tip catheter is an effective means of suctioning the left bronchial tree in patients with tracheostomy tubes. Its reliability in patients with oral endotracheal tubes is reduced but more effective than current methods.     

中心静脉导管胸腔引流治疗自发性气胸的临床分析

目的比较中心静脉导管与粗硅胶管行闭式引流治疗自发性气胸的疗效及并发症。方法25例自发性气胸患者行中心静脉导管闭式引流,28例行粗硅胶管闭式引流,观察疗效及并发症。结果中心静脉导管与粗硅胶管行胸腔闭式引流治疗自发性气胸疗效相近,无显著性差异;但粗硅胶管行胸腔闭式引流治疗并发症多。结论中心静脉导管行闭式引流治疗自发性气胸是一种痛苦小,并发症少,操作简单,舒适耐受的方法。     

Short-term central venous catheter complications in patients with sickle cell disease who undergo apheresis

Patients with sickle cell disease (SCD) are prone to develop thrombosis and infection due to their inflammatory and immune deficiency state. These patients require red cell exchange therapy for treatment or prevention of hemoglobin S associated complications. Owing to vascular access problems, adult patients need central venous catheterization (CVC) for exchange procedures. Procedure related complications have been reported for long-term CVCs in pediatric patients. However, short-term CVC complications in adult patients are not clear. This report represents the results of documented complications of short-term CVCs in patients with SCD who undergo apheresis. A total of 142 non-tunneled catheters with average median diameter of 9 F (range 8–16 F) were implanted for apheresis. The catheters were mainly inserted through the right internal jugular vein (66.2 %). Total days of catheter were 412. Results were reported as a complication rate and event according to 1,000 catheter days and compared to a control group including 37 healthy stem cell donors. In the patient group, 1 (1 %) hematoma and 1 (1 %) infection were observed for internal jugular vein catheterization (3.7 hemorrhages and 3.7 infections according to 1,000 catheter days), whereas four (8.9 %) cases of thrombosis and 1 (2.2 %) infection (27 and 6.9 according to 1,000 catheter days) developed in femoral vein. There was a significant difference in terms of thrombosis (P = 0.009). In the control group, only individual developed thrombosis in internal jugular vein. Short-term CVC inserted through to the internal jugular vein seems to be safer than femoral vein in patients with SCD.