纤维支气管镜检查四种麻醉方法效果观察

为探讨纤维支气管镜（纤支镜）检查时下呼吸道粘膜表面麻醉最佳的方法，我们对四种麻醉方法的效果进行了对比观察。     

支气管镜检查及介入治疗术前局部麻醉方法的临床研究

支气管镜检查及介入治疗作为诊断和治疗肺、支气管疾病的重要手段,已被广泛应用。该检查能否顺利进行,很大程度上取决于麻醉效果。良好的术前局部麻醉有助于提高患者对支气管镜检查的接受程度,同时对于能否顺利达到预定的检查和治疗目的起着至关重要的作用。我中心于2007年3月～2007年5月对284例共291例次行支气管镜检查及介入治疗的患者采用复合局部麻醉,取得了较满意的效果。     

双项麻醉在纤维支气管镜检查中的应用研究

麻醉是纤维支气管镜(BF)检查成功与否的关键。若麻醉不充分,操作时病人出现剧烈咳嗽、憋气、发绀等症状,特别是短颈、肥胖、咽喉部高度敏感者,上述症状更加明显,有时会出现低氧血症、休克等并发症,严重者可死亡。近年来,我们对BF的局部麻醉方法进行了研究,提出了气管滴入法与超声雾化吸入法交替并用的双项麻醉法,经过302例的应用观察,取得了较好的效果。     

电子支气管镜检查前气道麻醉护理体会

在电子支气管镜的应用当中,经常会有患者因为不能耐受检查的痛苦,甚至强行拔管导致检查失败,因此术前的气道麻醉效果为能否顺利完成检查奠定了良好基础。为减轻患者的痛苦,提高检查的成功率,我们对麻醉护理方法进行了一些改进,取得了良好的效果,现报告如下。     

右美托咪啶对硬膜外麻醉患者镇静效果观察

目的:观察右美托咪啶对硬膜外麻醉患者的镇静效果。方法:选择硬膜外麻醉80例,随机分为观察组和对照组各40例。麻醉成功后,观察组给予右美托咪啶0.5μg/kg泵注10min,继以0.5μg/(kg.h)持续泵注;对照组给予咪达唑仑0.05mg/kg泵注10min,继以0.05mg/(kg.h)持续泵注。记录两组给药前(T0)、切皮即刻(T1)、手术开始后15min(T2)、30min(T3)、45min(T4)及术毕(T5)时警觉/镇静(OAA/S)评分及不良反应发生情况。结果:两组不同时间节点OAA/S评分差异不显著(P>0.05);两组T1～T4时间节点的OAA/S评分,均显著低于T0时OAA/S评分(P<0.05)。观察组呼吸抑制、多语及躁动发生率显著低于对照组(P<0.05),心动过缓发生率显著高于对照组(P<0.05),低血压发生率两组差异不显著(P>0.05)。结论:右美托咪啶镇静时不抑制呼吸,无多语及躁动发生,但可引起心率减慢,因此合并窦性心动过缓、心脏传导阻滞患者应慎用。     

辅助镇静麻醉药物在区域麻醉中的合理应用

区域麻醉镇静是指通过应用镇静药、麻醉性镇痛药和全身麻醉药及相关技术,消除或减轻患者在接受区域麻醉操作或手术过程中的疼痛、紧张、焦虑等主观痛苦及不适感,从而增强患者对于区域麻醉操作和手术的耐受性和满意度.该文阐述了辅助镇静麻醉药在区域麻醉中的合理应用.     

右美托咪啶对椎管内麻醉高龄患者镇静效果观察

目的:观察右美托咪啶对椎管内麻醉高龄患者的镇静效果。方法:选择行椎管内麻醉择期手术60例,从开始麻醉操作至手术结束时静脉输注小剂量右美托咪啶,观察记录入室时(T0)、给完负荷量后(T1)、麻醉操作时(T2)、术中30min(T3)、手术毕(T4)时收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SO2)水平,警觉/镇静(OAA/S)评分,以及不良反应发生情况。结果:T1～T4时间节点SBP、DBP和SO2水平均略有升高,但与T0比较,差异不显著(P>0.05);HR水平显著低于T0时水平(P<0.05),T1～T4各时间节HR水平差异不显著(P>0.05)。T1～T4时的OAA/S评分均显著低于T0时水平(P<0.05)。结论:右美托咪啶具有良好的镇静、镇痛作用,是高龄患者椎管内麻醉时理想的辅助镇静药。     

丙泊酚麻醉下静脉注射多巴胺对脑电监测指标及镇静评分的影响

目的 探讨丙泊酚麻醉下静脉注射多巴胺对脑电监测指标[双频谱指数(BIS)、熵指数]及镇静评分(OAA/S)的影响.方法 选择9例ASA Ⅰ-Ⅱ级全麻下手术患者,给予丙泊酚镇静麻醉,当OAA/S=2时,维持此时血浆/效应室浓度(Cp/Ce)不变,静脉单次注射多巴胺3～5mg,记录注射前1min、注射后第1～5min内BI...     

纤维支气管镜检查两种麻醉方法的效果观察

2003～2005年在我科行纤维支气管镜（简称纤支镜）检查的240名患者，随机平均分为2组，分别采用压缩雾化吸入麻醉和直接经鼻滴药实施术前麻醉。实践证明采用百瑞压缩雾化吸入麻醉比经鼻直接滴注麻醉效果好，报道如下。     

不同麻醉方法对患者术后认知功能障碍的影响

目的：观察分析麻醉方法的不同对患者术后认知功能障碍的影响,总结其临床意义。方法：选取2009-04～2011-04本院86例手术患者,随机分为观察组A和观察组B,各43例,观察组A采取全身麻醉,观察组B采取全麻复合硬膜外麻醉,分别进行简易智能状态检查法（MMSE）行神经心理学的测试,观察对比两组麻醉效果及术后6 h、1 d、3 d、5 d的中心静脉压（MAP）、SPO2、HR、BP、PETCO2及MMSE评分,进行统计学分析。结果：两组术后6 h的MMSE评分对比麻醉前存在显著性差异（P〈0.05）,具有统计学意义;术后1、3、5 d的术后认知功能障碍的发病率存在显著差异（P〈0.05）,具有统计学意义。结论：麻醉方法的不同对患者术后认知功能障碍存在一定的影响,全麻复合硬膜外麻醉术后认知功能障碍较低,尤其适用于老年手术患者,具有重要的临床应用意义。     

咯血患者胸部影像学与纤维支气管镜检查对比分析

目的探讨胸部影像学与纤维支气管镜（FB）检查在咯血患者诊断中的作用。方法回顾性分析458例咯血患者的临床资料,对胸部影像学、FB所见,镜下活检并刷检的病理诊断等进行对比分析。结果458例咯血患者胸部影像学发现异常422例,阳性率92.1%,经FB病因诊断426例,阳性率93.0%。FB诊断主要病因：肺癌165例（36.0%）、炎症157例（34.3%）、结核76例（16.6%）。胸部影像学检查对FB检查的符合率为89.1%。结论在胸部影像学的基础上,FB检查对明确咯血部位及病因诊断具有重要的临床价值。     

The diagnostic yield of bronchoscopy

The endoscopic examination of the tracheobronchial tree is most helpful in the diagnosis and staging of bronchial carcinoma. Tumors that are endoscopically visible may be confirmed in more than 95% of the cases. In localized peripheral tumors, the diagnostic yield of bronchoscopy is significantly lower; for peripheral metastases, only about 10%. In diffuse interstitial pulmonary diseases other than malignancies, some infections, and histiocytosis X, bronchoscopy including transbronchial biopsy is less successful.     

锁骨骨折内固定术三种麻醉方法的临床经济学评价

目的 采用成本效果分析方法对锁骨骨折内固定手术患者三种麻醉方法作出临床经济学评价。方法随机将144例患者分为3组,Ⅰ组臂丛加颈浅丛神经联合阻滞,Ⅱ组臂丛神经阻滞,Ⅲ组颈浅丛神经阻滞。分别计算出三种麻醉方法的成本和效果,作出成本效果比较。结果单病例成本而言,单纯颈浅丛神经阻滞成本最低,锁骨骨折位于锁骨外2／3时单纯臂丛神经阻滞平均成本最低,锁骨骨折位于锁骨内1／3时单纯颈浅丛神经阻滞平均最低。结论从临床经济学角度来看,锁骨骨折位于锁骨外2／3时首选单纯臂丛神经阻滞,锁骨骨折位于锁骨内1／3时首选单纯颈浅丛神经阻滞。     

不同镇痛方式对下肢骨折手术患者应激反应及焦虑状况的影响

Objective To observe the effect of different analgesic methods including patient controlled epidural analgesia (PCEA) and patient controlled intravenous analgesia (PCIA) on stress response and anxiety in surgical patients with lower limb fracture. Methods A total of 120 surgical patients with lower limb fractures were employed and divided randomly into Groups PCEA, PCIA and C (40per group). All patients were anaesthetized by using combined spinal-epidural anesthesia. After operation, PCEA and PCIA were applied in the patients of Groups PCEA and PCIA, respectively. No analgesic method was employed in the Group C. The dynamic indices including mean blood press (MAP) and heart rate (HR), blood serum cortisol (COR) and blood sugar (BS) were measured at different time points,ie, T0 ( pre-anesthesia), T1 ( the end of the operation), T2 (24 hours after operation) and T3 (48 hours after operation). The visual analogue pain score was conducted at time points of T1, T2 and T3. The measurement of anxiety score was done at pre-operation and at days 1 and 7 after operation. Results There were no significant changes in HR and MAP of Groups PCEA and PCIA (P＞0.05, compared with T0) at every time point after operation. Whereas, HR and MAP of Group C were increased at time points of T1 and T2 (P ＜ 0.05, compared with T0 ), with statistical difference compared with Groups PCEA and PCIA at the same time points (P ＜ 0.05 ). VAS in Group PCEA was lower than that in Group PCIA at time points of T2 and T3 ( P ＜ 0.05). Meanwhile, VAS in Groups PCEA and PCIA was lower than that in Group C (P＜0. 05). COR and BS in Group PCEA were significant lower than those in group PCIA at time points of T2 and T3 (P ＜ 0. 05 ). Meanwhile, COR and BS in Groups PCEA and PCIA was lower than that in Group C (P＜0.05 or ＜0.01 ). Moreover, the changes were more significant in Group PCIA than that in Group PCEA (P ＜ 0. 05 ). The anxiety score in Groups PCEA and PCIA was lower than that in Group C (P ＜ 0.05). Conclusions Two analgesic methods of PCEA and PCIA can provide safe and effective postoperative analgesia and attenuate the stress response and anxiety in surgical patients with lower limb fracture. Meanwhile, PCEA takes more advantages than PCIA.     

核素显像法估测不同条件下甲状腺模型体积计算方法的探讨

目的 探讨在核素平面显像条件下,Allen法和椭球体法对估测不同体积、不同放射性活度甲状腺模型体积的影响.方法 向甲状腺气球模型内注入不同体积和不同放射性活度的99Tcm O4- 溶液,并置入有机玻璃制成的颈部模型中,内充稻米模拟甲状腺颈部软组织吸收,进行核素平面显像.用Allen法和椭球体法在不同本底扣除水平下计算甲状腺模型体积,并将其与实际体积相比较,计算误差.结果 在99TcmO4-溶液为7.4和18.5MBq条件下,当甲状腺模型体积为20～30 ml时,用Allen 法,本底扣除20％,测量值误差最小,其相对误差均值为10.04％,误差范围为-19.23％～11.25％;当模型体积为40～80 ml时,用椭球体法,本底扣除20％,测量值误差最小,其相对误差均值为13.06％,误差范围为-21.41％ ～39.45％;当模型体积为90～110 ml时,用Allen法,本底扣除20％,测量值误差最小,其相对误差均值为8.12％,误差范围为- 11.05％～ 6.66％.在37.0和74.0 MBq条件下,当甲状腺模型体积为20～30 ml时,用Allen法,本底扣除20％,测量值误差最小,其相对误差均值为5.30％,误差范围为-1.25％～-11.73％;当模型体积为40～80 ml时,用椭球体法,本底扣除20％,测量值误差最小,其相对误差均值为11.74％,误差范围为- 30.36％～9.23％;当体积为90～ 110 ml 时,用Allen法,本底扣除15％,测量值误差最小,其相对误差均值为7.21％,误差范围为- 13.76％～1.46％.结论 用核素平面显像估测甲状腺模型体积时,体积大于90 ml或小于40 ml时用Allen 法,本底扣除20％时(体积大于90 ml、活度为37.0和74.0 MBq时本底扣除15％),测得的体积误差较小;体积在40～ 80 ml时,利用椭球体法,本底扣除20％,测得的体积误差较小.     

不同镇痛方式对下肢骨折手术患者应激反应及焦虑状况的影响

目的 观察术后硬膜外自控镇痛(patient-controlled epidural analgesia,PCEA)与静脉自控镇痛(patient controlled intravenous analgesia,PCIA)对下肢骨折手术患者应激反应及焦虑状况的影响.方法 选择行下肢骨折手术患者120例[美国麻醉师协会(ASA)分级Ⅱ～Ⅲ级],用随机数字表法分为PCEA组、PCIA组和对照组(C组),每组40例.所有患者均施行蛛网膜下腔阻滞和硬膜外联合麻醉.分别于麻醉前(T0)、术毕(T1)、术后24 h(T2)、术后48 h(T3)各时相点测定血流动力学指标和血浆皮质醇(COR)、血糖(BS).在T1、T2、T3对两组患者进行视觉模拟疼痛评分(VAS).在术前、术后1 d、术后7 d行焦虑评分.结果 PCEA组和PCIA组心率、平均动脉压(MAP)在术后各时相点均无明显变化,与T0比较差异无统计学意义(P＞0.05);C组术后T1、T2时相点心率(HR)、MAP均升高,与T0比较差异有统计学意义(P＜0.05),与同时相点PCEA组和PCIA组比较差异有统计学意义(P＜0.05).T2、T3 PCEA组VAS低于PCIA组(P＜0.05),两组又低于C组(P＜0.05).PCEA组和PCIA组在T1和T3 COR及BS与T0比较明显降低并低于C组(P＜0.05或0.01),PCEA组又低于PCIA组(P均＜0.05).术后焦虑评分PCEA组和PCIA组均低于C组(P＜0.05).结论 PCEA和PCIA均能提供安全有效的术后镇痛,减轻手术后应激反应和焦虑状况,但PCEA优于PCIA.     

热线风速仪监测小儿七氟烷麻醉诱导期呼吸力学的变化

目的本研究通过使用热线风速仪观察小儿七氟烷吸入麻醉诱导不同时期上呼吸道呼吸力学的变化,以期将七氟烷对呼吸的抑制程度和控制通气加深麻醉的效果进行量化描述。方法选择无呼吸系统及神经系统疾病的全麻小儿20例（4.3±1.5y,17.95±5.12kg）,静脉注射氯胺酮1mg/kg,吸入氧气2L/min＋7%七氟烷麻醉诱导,应用恒温热线风速仪分别采集四个时间段呼吸力学数据：静注氯胺酮1分钟后（T1）;开始吸入7%七氟烷时（T2）;吸入7%七氟烷3分钟后（T3）;控制通气2分钟后（T4）。结果①T2较T1吸气相和呼气相最大流速、平均流速、平均流量、平均动压、呼吸频率均增加（P〈0.05或P〈0.01）,而吸气时间、呼气时间均缩短（P〈0.05或P〈0.01）。②T3较T1吸气相和呼气相最大流速、平均流速、平均流量、平均动压及呼吸频率均减小（P〈0.01）;T3较T2吸气时间和呼气时间明显延长（P〈0.01）,平均吸气速度与最大吸气速度之比、平均呼气速度与最大呼气速度之比均减小（P〈0.01）。③T4较T1吸气相和呼气相最大流速、平均流速、平均流量、平均动压及呼吸频率均进一步减小（P〈0.01）,平均吸气速度与最大吸气速度之比、平均呼气速度与最大呼气速度之比均减小（P〈0.01）。结论小儿7%七氟烷麻醉诱导随着持续吸入时间的增加,各项呼吸力学指标出现相应的变化,证明其对呼吸的影响是由兴奋到抑制程度逐渐加深之过程,麻醉诱导中经过控制通气吸入七氟烷加深麻醉效果明显。     

Three-dimensional human airway segmentation methods for clinical virtual bronchoscopy

RATIONALE AND OBJECTIVES: The segmentation of airways from CT images is a critical first step for numerous virtual bronchoscopic (VB) applications. Automatic or semiautomatic methods are necessary, since manual segmentation is prohibitively time consuming. The methods must be robust and operate within a reasonable time frame to be useful for clinical VB use. The authors developed an integrated airway segmentation system and demonstrated its effectiveness on a series of human images. MATERIALS AND METHODS: The authors' airway segmentation system draws on two segmentation algorithms: (a) an adaptive region-growing algorithm and (b) a new hybrid algorithm that uses both region growing and mathematical morphology. Images from an ongoing VB study were segmented by means of both the adaptive region-growing and the new hybrid methods. The segmentation volume, branch number estimate, and segmentation quality were determined for each case. RESULTS: The results demonstrate the need for an integrated segmentation system, since no single method is superior for all clinically relevant cases. The region-growing algorithm is the fastest and provides acceptable segmentations for most VB applications, but the hybrid method provides superior airway edge localization, making it better suited for quantitative applications. In addition, the authors show that prefiltering the image data before airway segmentation increases the robustness of both region-growing and hybrid methods. CONCLUSION: The combination of these two algorithms with the prefiltering options allowed the successful segmentation of all test images. The times required for all segmentations were acceptable, and the results were suitable for the authors' VB application needs.     

Diagnostic value of bronchoscopy, CT and transbronchial biopsies in diffuse pulmonary lymphangiomatosis: case report and review of the literature

The authors present the case of a 48-year-old man with diffuse pulmonary lymphangiomatosis. This rare lymphatic disorder is characterized by proliferation of anastomosing lymphatic vessels varying in size. Clinical presentation and imaging findings are highly suggestive. Bronchoscopic examination of this patient showed, for the first time to our knowledge, vesicles disseminated throughout the bronchial tree. Histopathological examinations are necessary to differentiate lymphangiomatosis from lymphangiectasis. The diagnosis can be made by transbronchial biopsy without performing open lung biopsy which was, until now, considered necessary for diagnosis.