电子喉镜在咽喉部异物诊断和治疗的临床应用

目的：探讨电子喉镜在咽喉部异物诊断和治疗的应用。方法回顾性分析咽喉部异物6713例，其中传统方式诊断咽喉部异物3331例，并成功治疗2898例，电子喉镜诊断咽喉部异物1475例，并成功治疗1473例。统计异物在咽喉各部位概率及尖锐异物和非尖锐异物的诊断率。比较电子喉镜和传统方式治疗咽喉各部位异物的成功率。结果电子喉镜相比传统方式可以显著提高咽喉部尖锐异物的诊断率，差异有统计学意义（P＜0．05），对非尖锐异物诊断率稍有提高，差异无统计学意义（P＞0．05）。咽喉部尖锐异物的诊断率均显著高于非尖锐异物（P＜0．05）。传统方式下咽喉部异物成功取出比例为87．00％，电子喉镜下咽喉部异物成功取出比例为99．86％。结论电子喉镜诊断和治疗咽喉部异物比传统方式有明显优势，具有照明充分、定位准确、操作精确的特点，是治疗咽喉部异物方便、快捷、有效的方法。     

Effect of inhalation anesthetics on antipyrine pharmacokinetics of mice

The effects of the volatile anesthetics, enflurane, isoflurane and halothane, on the pharmacokinetics of antipyrine were examined in mice. The administration of 0.75% isoflurane or 1.0% enflurane in air resulted in a 173 and a 206% increase, respectively, in antipyrine plasma half-life and a 29.1 and a 41.2% decrease in antipyrine total body clearance. There was also an almost 2-fold increase in the volume of distribution of antipyrine. Halothane, at 0.5% in air, had no significant effect upon antipyrine plasma half-life or its volume of distribution. There was no significant change in antipyrine total body clearance and volume of distribution 4 hr after exposure to the volatile agents, but there was a small increase in half-life. The exposures to the volatile anesthetics were also carried out in an atmosphere of 8% oxygen. Antipyrine plasma half-life was increased significantly by 48% in mice breathing 8% oxygen, compared to mice breathing air. Isoflurane in 8% oxygen increased the plasma half-life of antipyrine by 296% compared to mice breathing 8% oxygen. This increase was greater than the effect of isoflurane seen in mice breathing air. Mice breathing halothane in 8% oxygen exhibited a 21% increase in antipyrine plasma half-life and mice breathing enflurane in 8% oxygen, a 117% increase in antipyrine plasma half-life, although the changes were not markedly different from those seen in mice breathing air. Enflurane and isoflurane produced a significant increase in the volume of distribution for antipyrine in the mice breathing 8% oxygen. Total body clearance of antipyrine was decreased markedly in mice breathing isoflurane and enflurane but showed a lesser decrease in mice breathing halothane in 8% oxygen. In vitro in mouse microsomes, halothane, enflurane and isoflurane were all inhibitors of aminopyrine metabolism. Possible mechanisms for these results are discussed.     

小儿气管异物的误诊原因并总结小儿气管异物的应急处理措施

目的观察探讨小儿气管异物的误诊原因并总结小儿气管异物的应急处理措施,总结其临床诊断和处理经验。方法选取我院2010年5月至2012年5月术前误诊为小儿气管异物的患儿11例,对其临床诊断及处理资料进行回顾性分析。结果11例患儿误诊为淋巴瘤有1例,食管异物有1例,支气管囊肿有2例,支气管炎有2例,肺炎有5例;经常规治疗无效后,再经X线胸片或胸部螺旋CT、病理血液检验、支气管镜诊断为小儿气管异物,采取紧急气管镜检查加异物取出术处理,11例患儿术后并无1例出现并发症,皆治愈出院。结论小儿气管异物与多种支气管及肺部疾病临床表现相似,容易发生误诊,应在·临床诊断中,注意避免各项误诊原因,提高对小儿气管异物的认识和各项辅助检查的辨别,对疑似小儿气管异物的惠儿应尽早行气管镜下异物取出术处理,保证小儿生命安全,具有重要的临床意义。     

探讨数字X线机在小儿气道透X线异物诊断中的应用

目的探讨数字X线机在小儿气道透X线异物诊断中的应用价值。方法采用西门子数字胃肠机连续摄片对22例小儿气管支气管透X线异物进行诊断,全部病例经支气管镜检查对照。结果22例患儿中,数字X线机诊断小儿气管支气管透X线异物17例,其中气管异物2例,右侧支气管异物11例,左侧支气管异物4例。与支气管镜,诊断符合20例（90.9%）,误漏诊2例（9.1%）。结论数字X线机诊断小儿气管透X线异物较普通X线透视和摄片有显著优越性。     

螺旋CT和X线在气道异物诊断中的应用价值分析

目的观察比较螺旋CT和普通X线用于气道异物诊断的检出率,探讨不同影像学方法用于气道异物的诊断价值。方法选择56例气道异物患者,均先后行普通X线和螺旋CT检查,对其临床资料及检出率进行比较及统计学分析,观察组间是否存在显著性差异。结果 X线检查检出率为73.21%(41/56),螺旋CT检查检出率达到100%(56/56),螺旋CT检出率明显高于普通X线,差异具有统计学意义(P<0.01)。结论螺旋CT检查可直接显示透明或半透明的气道异物,诊断准确率较高,对于无法及时明确异物吸入史的患者,应作为首选诊断方法使用。     

3种麻醉方式在小儿食管异物取出术中的效果

目的探讨小儿食管异物取出术的麻醉方式。方法选择年龄10个月～6岁、ASAⅠ～Ⅱ级的患儿34例,随机分为三组:A组11例,采用氯胺酮麻醉;B组13例,采用丙泊酚复合芬太尼静脉麻醉,保留自主呼吸,不作气管插管;C组10例,采用气管插管下丙泊酚复合芬太尼静脉麻醉。结果A组成功率为64%;B组、C组成功率为100%,其中B组38%SPO2≤90%。结论气管插管下丙泊酚复合芬太尼静脉麻醉应用于小儿食管异物取出术安全有效。     

螺旋CT与胸部X线检查诊断小儿气管异物的临床价值对比研究

目的探讨并比较螺旋CT与胸部X线检查诊断小儿气管异物临床价值。方法回顾性我院2009年1月至2011年5月经临床纤维支气管镜确诊为气管异物患儿135例螺旋CT及胸部X线影像学资料,比较患儿两种影像学检查方式临床诊断符合率。结果螺旋CT组患者中诊断与纤维支气管镜符合135例,临床诊断符合率为100.0%,其中直接提示气管异物126例,占总数93.3%,间接提示气管异物9例,占总数6.7%;胸部X线组患者中诊断与纤维支气管镜符合112例,临床诊断符合率为83.0%,其中直接提示气管异物41例,占总数30.4%,间接提示气管异物71例,占总数52.6%;螺旋CT组患者小儿支气管异物临床诊断符合率明显高于胸部X线组,组间比较差异有统计学意义(P<0.05)。结论与胸部X线相比,螺旋CT诊断小儿气管异物临床符合率高,可作为首选影像学诊断方法。     

支气管镜诊治气管及支气管异物10年回顾研究

目的探讨气管及支气管异物的临床特点及支气管镜在气管及支气管异物诊治中的作用。方法回顾性分析中南大学湘雅医院10年支气管镜诊治气管、支气管异物45例。结果年龄6～74岁,18岁以下占65．6％;有异物吸入史30例（70％）,无异物史15例（30％）;异物种类以植物类最多,占55．5％;异物容易辨认37例,存留时间最短5h,病程不明15例;82．2％经支气管镜取出异物。结论异物吸入史不明确的支气管异物容易误漏诊,支气管镜是目前诊治支气管异物的最有效手段。     

瑞芬太尼与丙泊酚及琥珀胆碱复合全身麻醉并高频喷射通气在婴幼儿气管异物取出术中的应用

目的 探讨瑞芬太尼与丙泊酚复合琥珀胆碱全身麻醉并高频喷射通气(HFJV)在婴幼儿气管异物取出术的效果及安全性.方法 30例行气管异物取出术的患儿完全随机分为研究组和对照组,每组15例.研究组静脉注射丙泊酚、瑞芬太尼和琥珀胆碱,插入支气管镜后经侧孔FHJV.对照组静脉注射氯胺酮、γ-羟丁酸钠和丙泊酚复合麻醉,保留自主呼吸,插入支气管镜后经侧孔吸纯氧或必要时HFJV.术中连续监测心电图、心率、呼吸和脉搏血氧饱和度(SpO2),比较2组患儿术中各生命体征变化及发生呛咳、屏气、呼吸暂停、支气管痉挛的次数,手术时间、苏醒时间苏醒期并发症.结果 2组患儿年龄、性别、体重、术前SpO2差异无统计学意义(P＞0.05).2组患儿的HR置镜前[研究组和对照组分别为(105±4)次/min和(110±6)次/min]较诱导前[研究组和对照组分别为(142±6)次/min和(140±4)次/min]均有明显下降(P＜0.05),其余各时点变化差异均无统计学意义(P＞0.05).研究组发生低氧血症5例、心动过缓1例;对照组发生低氧血症25例、呛咳屏气8例、喉支气管痉挛5例、心动过缓4例.对照组不良反应发生率高于研究组,差异有统计学意义(P＜0.05).研究组平均手术时间(10.9±4.1)min,苏醒时间(30.5±9.2)min;对照组平均手术时间(19.9±5.0)min,苏醒时间(60.2±15.6)min.2组手术及苏醒时间差异具有统计学意义(P＜0.05).研究组苏醒期发生恶心呕吐2例、躁动1例;对照组发生恶心呕吐7例,躁动4例,喉、支气管痉挛5例.2组患儿恶心呕吐及喉、支气管痉挛的发生率差异有统计学意义(P＜0.05).结论 在婴幼儿气管异物取出术中,采用瑞芬太尼、丙泊酚复合琥珀胆碱全身麻醉加用HFJV较传统的氯胺酮复合γ-羟丁酸钠保留自主呼吸麻醉能更好地维持患儿呼吸、循环稳定,缩短手术时间,是一种安全、有效的麻醉方法.

Abstract：

Objective To discuss the effect and safety of surgery of removing foreign body in trachea of infants by using remifentanil, propofol and succinylcholine anesthesia combined with high-frequency jet ventilation (HFJV). Methods Totally 30 infants receiving surgery of removing foreign body in trachea were divided into two groups randomly: study group (propofol, remifentanil and succinylcholine) and control group. Each group has 15 patients. Patients of study group were given intravenous injection of propofol, remifentanil and succinylcholine and eliminated spontaneous breathing. After inserting bronchoscope, HFJV through the side hole was applied. Patients of control group were given intravenous injection of Ⅳ ketamine, γ-sodium hydroxybutyrate, propofol anesthesia and spontaneous breathing was reserved. After bronchoscope insertion, patients absorbed the pure oxygen through the side hole. They were given HFJV when necessary. During the operation, electrocardiogram (ECG), heart rate (HR) , respiratory (RR) and pulse oxygen saturation(SpO2) were continuously monitored, and compared various changes of vital sign, the times of patient choking, breath holding, apnea, and bronchospasm, and operation time, recovery time and complications during the recovery period. Results The adverse reaction and complications during the recovery period of study group were significantly lower than those in control group(P ＜0.05). Moreover, surgery and recovery time were significantly shorter than those in control group(P＜0.05). Conclusion During the surgery of removing foreign body in trachea of infants, the propofol, remifentanil and succinylcholine anesthesia combined with HFJV is superior to the traditional anesthesia in terms of keeping spontaneous breathing in maintaining stable respiration and circulation and reducing operation time.     

呼吸道异物420例临床分析

目的探讨呼吸道异物的诊断和治疗方法。方法回顾分析了1983年10月至2008年4月我科治疗的420例呼吸道异物的处理过程。结果3岁以下婴幼儿365例,约占87％;误诊27例,约占6．43％;420例（99．05％）在全麻或表麻下经直接喉镜、气管镜成功取出,2例死亡、2例脑轻瘫。结论全麻下支气管镜检及异物取出术安全,手术成功率高。对气管异物、支气管异物术前正确快速判断,术中需做好应变准备,减少并发症和降低病死率。     

儿童气管支气管异物120例诊治分析

目的 总结儿童气管、支气管异物的临床诊断与治疗方法.方法 回顾性分析经直达喉镜、硬质气管镜确诊的120例儿童气管支气管异物的临床表现、影像学改变及异物取出方法.结果 120例气管支气管异物中,109例患儿有异物吸入史;120例患儿有侵入综合征;气管拍击音在气管异物中的出现率为66.7%(26/39);59例患儿X线胸部透视下呼气时可见纵隔向健侧摆动,均被气管镜确诊有异物;经CT诊断的气管支气管异物准确率为86.2%(25/29);均行喉镜、支气管镜检查加异物取出术而得以确诊和治疗,119例异物被成功取出,1例转胸外科治疗.结论 异物吸入史、侵入综合征、气管拍击音和X线检查中的纵隔摆动是诊断气管支气管异物的重要证据,胸部CT诊断气管支气管异物准确率较高,直达喉镜气管镜检查是确诊气管支气管异物重要方法;直达喉镜、硬质气管镜下气管异物取出术是治疗气管支气管异物的有效方法.     

彩色多普勒超声浅表探头对食管上段（颈段）异物的诊断价值与技巧探查

目的探讨彩色多普勒超声浅表探头在食管上段异物的诊断价值及临床应用。方法回顾分析经超声浅表探头诊断食管上段异物32例患者超声所见,分析其声像图特点,并与胃镜、X线检查结果比较。结果根据病史、临床表现,结合声像图改变,超声诊断正确30例,漏诊1例,误诊1例,准确率为94%。结论彩色多普勒超声浅表探头检查对食管上段（颈段）异物诊断有其特征性,与胃镜及X线检查比较有着同等诊断价值,值得推广应用,而且作应急的辅助诊断方法,超声具有无创伤性,无射线辐射并能实时、动态观察异物并对异物的大小、定位以及异物的摘取治疗方法有着十分重要的指导价值。     

Accurate measurement of blood alcohol concentration with isothermal rebreathing

The importance of interaction of exhaled air with the airway surface was evaluated by comparing the effects of different breathing maneuvers and inhaled air temperature on the relationship between breath alcohol concentration (BRAC) and blood alcohol concentration (BAC). Breath alcohol was measured with an infrared absorption unit. Blood and simulator liquid alcohol concentrations were measured by gas chromatography. Breath samples were measured after both low and high exhaled volumes and after rebreathing. Breathing maneuvers were performed after either hyperventilation, breathhold or normal breathing. Inspired air temperature was varied between 0 degree C and 40 degrees C. The rebreathing method for sampling alveolar alcohol samples was evaluated with a new isothermal rebreather that was designed to provide a substantial amount of heat to the rebreathed air in order to heat the airway surfaces. Using a single breath test, the indicated BAC values vary from 14% above the actual BAC to as low as 55% below the actual BAC. Hyperventilation caused a significant decrease in BRAC and breathhold caused a significant increase in BRAC. When isothermal rebreathing is applied to such tests, the breath test results were always within +/- 10% of the true BAC, even with an altered breathing pattern. Isothermal rebreathing provided an accurate sample of alveolar air that was not affected by altered breathing pattern or air temperature.     

前房角异物临床分析34例

目的总结前房角异物的诊断与治疗体会,以提高对本病的诊疗水平,减少漏诊。方法对各类前房角异物34例应用前房角镜、影像学及B超检查,明确诊断后,采用显微镜下手术取出。结果34例均行手术予以取出,经抗炎治疗后前部葡萄膜炎消退。3例因虹膜根部与伤口粘连而引起瞳孔变形,未见其他并发症,术后视力增加者28例(82.35%),不变5例,下降者1例。结论对前房角异物的诊断应采用多种方法检查,以减少漏诊,及时手术取出是提高视力,减少并发症的有效方法。     

儿童气管、支气管非金属异物的影像学诊断

目的 探讨气管、支气管非金属异物的影像学表现，提高对该病的早期诊断率。方法 回顾性分析了60例气管、支气管非金属异物的临床与影像学征象。结果 本组60例中，右侧支气管异物32例，左侧支气管异物22例，主气管异物6例。常见的影像学表现为阻塞性肺气肿51例，纵隔摆动48例。结论 病史及影像学表现是诊断气管、支气管非金属异物的主要手段。     

前房角异物26例临床诊治分析

目的总结前房角异物患者的诊治体会,提高诊治水平,减少漏诊。方法对各类前房角异物26例患者应用前房角镜、影像学和B超检查,明确诊断后,采用显微镜下手术取出。结果26例均行手术取出,经抗炎治疗后前部葡萄膜炎消退。4例因虹膜根部与伤口粘连而引起瞳孔变形,未见其他并发症,术后视力增加21例（80.77%）,不变4例,下降1例。结论对前房角异物的诊断应采用多种方法检查,减少漏诊,并及时手术取出是提高视力,减少并发症的有效方法。     

64层MSCT在小儿支气管异物诊断中的应用价值

目的探讨64层螺旋CT（MSCT）三维图像后处理技术在小儿支气管异物诊断中的应用价值。方法回顾性分析本院14例支气管异物患儿64层MSCT的影像学资料,所有病例经MSCT横断位扫描,并行多平面重建（MPR）、曲面重建（CPR）、容积重现（VR）和CT仿真内镜（CTVE）三维图像后处理。结果14例支气管异物患儿,异物为米粒4例,花生衣1例,开心果2例,瓜子仁2例,果冻2例,葡萄干1例,不明异物2例。异物发生部位在右主支气管开口处5例,右主支气管5例,右下支气管1例,左主支气管3例。64层MSCT三维图像后处理技术能够准确地显示异物的位置、形态及大小,有异物所引起的支气管的狭窄和异物阻塞产生的间接征象。结论64层MSCT三维图像后处理技术能准确、直观地显示支气管异物。对小儿呼吸道异物的诊断和鉴别诊断具有非常重要的价值。     

螺旋CT三维重建技术在小儿气道异物中的应用价值

目的分析应用螺旋CT三维重建技术对小儿气道异物的诊断价值。方法选取笔者所在医院收治的45例小儿气道异物患者,对其行螺旋CT薄层扫描,同时采用多平面重建、最小密度投影、容积再现、仿真内窥镜等技术进行三维重建,探讨上述三维重建技术对小儿气道异物的显示率。结果 MPR、MinIP、VE能100%的显示出段以上气管、支气管,能够部分显示出亚段以下支气管;VR显示段以上支气管的概率大约为95%;MPR能部分显示外组织;MPR、MinIP能够将异物部位、大小、形状以及其与支气管黏膜的关系直接显示出来;VR能将局部气道的充盈缺损,甚至是起到的连续性中断表现出来;VE能够将支气管腔内占位表现出来;MPR能将肺内的并发症显示出来。结论采用螺旋CT三维重建技术进行小儿气道异物的诊断,提高了诊断的准确率,值得在临床上推广应用。     

阴性支气管异物误诊和漏诊分析

目的　分析阴性支气管异物误诊和漏诊原因。方法　回顾分析 5 a间证实误诊和漏诊阴性支气管异物 35例。结果　造成误诊和漏诊的原因有 :病史不详、接诊医师对本病认识或警惕性不够、X线检查方法不当或诊断经验不足、未及时行支气管镜检。结论　病史及临床表现对诊断有重要意义 ,X线检查是诊断的主要手段 ,必要时应及时行支气管镜检查。