双腔管肺通气时判定选择性单肺通气的声学监测方法

气管内插管最常见的并发症是置入一侧支气管（单肺插管）（OLI）。对此，目前尚无有效的早期监测方法。在本研究中我们探讨使用声学分析的方法来判定单肺插管。11例需要使用双腔气管导管的胸外科手术患者纳入研究。麻醉诱导后及确认双腔气管导管位置正确后，于手术前记录每侧肺的通气数据。使用3个压电扩音器来记录肺呼吸音，其中每侧胸壁各一个，第3个置于右前臂用于记录背景噪音。采集到的声音经过滤后，计算信号的能量包，并将呼吸及其间歇分为小片段。根据单肺能量信号的比率，呼吸被分成以下三类：双侧通气、选择性的右肺通气以及选择性的左肺通气。右肺通气时11例患者中有10例可以通过此项技术确认，在左肺通气时确认率达到100％。研究提示声学监测能有效地监测选择性单肺通气，并可用于早期诊断OLI。     

肺复张策略伍用人工鼻预防气管插管全麻后肺部并发症

目的：观察肺复张策略操作伍用人工鼻（温－湿交换过滤器）对气管插管全身麻醉后患者肺部并发症预防效果。方法选择在本院择期手术,需行气管插管全身复合麻醉,排除原有严重心、肝、肺、内分泌合并症的患者140例,按手术通知单序号随机分为两组（n=70）。Ⅰ组气管插管成功后呼吸机机控呼吸,常规管理患者呼吸道,术毕清醒后拔除气管导管;Ⅱ组气管插管成功后,严格按照肺复张策略操作并在呼吸回路中接用人工鼻,其他管理同Ⅰ组。观察术后6天患者出现肺部并发症的情况,并作统计学处理。结果Ⅰ组病人全身麻醉后出现肺部并发症7例,Ⅱ组病人全身麻醉后出现肺部并发症2例,Ⅰ组明显高于Ⅱ组。结论肺复张策略伍用人工鼻对预防气管插管全身麻醉后肺部并发症有确切的效果,可以推广应用。     

全麻下经双腔气管插管行大容量肺灌洗治疗肺泡蛋白沉积症

患者女,29岁,因活动后气短8年多,心慌、紫绀4年多,加重6个月余入院。该病人因进行性气短7年多,加重伴盗汗第1次入院,给予抗感染、抗结核等治疗无效,诊断为双肺弥漫性间质病变待查,呼吸衰竭（I型）。后经纤维支气管镜检病理证实为肺泡蛋白沉积症,经呼吸机辅助呼吸,气管切开,纤支镜灌洗3次后好转,出院时血气:PaO2 82mm     

无创正压通气在慢性阻塞性肺疾病合并肺性脑病的疗效分析

目的:评价无创双水平正压通气在慢性阻塞性肺疾病急性加重期合并肺性脑病治疗中的临床疗效.方法:选择60例慢性阻塞性肺疾病急性加重期合并肺性脑病患者,对照组21例,治疗组39例,治疗组中包括有有创呼吸机指证而拒绝插管患者1 2例;对照组进行常规治疗,治疗组在常规治疗基础上采用无创正压机械通气治疗,观察治疗前后血气指标.结果:两组治疗前后血气指标变化有显著性差异(P＜0.05).结论:采用无创呼吸机治疗慢性阻塞性肺疾病急性加重期并肺性脑病患者临床效果显著,特别是有有创呼吸机指证而拒绝插管患者也有一定效果.     

气管导管外使用Foley管在成人单肺通气中的临床观察

单肺通气(OLV)主要通过双腔管或支气管阻塞管技术来实现。双腔管的外径粗而有效管腔小,对位困难、气道压力高,可供选择的型号较少[1]。支气管阻塞管价格昂贵,术中导管易移位[2]。Foley管是用于体腔引流的一种导管,临床没有使用Foley管在单腔气管导管外进行肺隔离的报道。本研究拟评价OLV时应用Foley管在单腔气管导管外气道管理的效果,为OLV提供一种新的方法。资料与方法     

胸部外伤致闭合性气管断裂伤患者的护理

目的 探讨气管断裂伤围术期的护理方法.方法 对15例气管断裂伤患者术前积极抢救,保持呼吸道通畅;术后初期加强呼吸道管理与吸痰护理,恢复期加强鼻饲护理、心理护理与肺功能训练.结果 15例患者中8例呼吸机辅助呼吸3 d,7例呼吸机辅助呼吸2 d.平均住院16.2 d,痊愈出院.术后随访6个月,均无吻合口瘘发生,胸部X线摄片示肺扩张良好.结论 对气管断裂伤患者,术前以抢救生命为主,术后应强调气道管理和肺功能训练.     

双肺移植术后并发气管内大出血

2004年8月我院为1例肺淋巴管平滑肌瘤病合并双肺感染患者进行了体外循环下序贯式双侧单肺移植手术，术后患者存活29d，最后因气管内大出血死亡。现报道如下。     

胸部外伤致闭合性气管断裂伤患者的护理

目的探讨气管断裂伤围术期的护理方法。方法对15例气管断裂伤患者术前积极抢救。保持呼吸道通畅;术后初期加强呼吸道管理与吸痰护理,恢复期加强鼻饲护理、心理护理与肺功能训练。结果15例患者中8例呼吸机辅助呼吸3d,7例呼吸机辅助呼吸2d。平均住院16．2d,痊愈出院。术后随访6个月,均无吻合口瘘发生,胸部X线摄片示肺扩张良好。结论对气管断裂伤患者,术前以抢救生命为主,术后应强调气道管理和肺功能训练。     

肺移植术后急性左心衰竭患者的肺康复护理

对2例肺动脉高压、3例肺纤维化患者行肺移植手术,术后出现不同程度的急性左心衰竭,给予镇痛镇静、呼吸机辅助通气、血管活性药物、容量控制和预防感染等治疗并辅以肺康复护理。5例患者机械通气时间11~40(25.6±12.3)d,住院时间40~99(69.4±25.3)d,均恢复良好,康复出院,随访至今生活质量良好。提出肺康复护理要点,包括构建肺移植ICU专业小组、患者健康教育和心理护理、上下肢运动、序贯式呼吸功能训练、营养支持等综合性肺康复方案。     

肺移植患者急性肾损伤的术后监护

目的总结肺移植并发急性肾损伤患者的术后护理经验。方法对8例成人肺移植术后发生急性肾损伤的患者,行肾脏替代疗法,同时给予抗感染、营养支持治疗;2例多器官功能衰竭患者行循环支持和呼吸机辅助呼吸。结果治疗后,2例肾病患者肾功能恢复至原有水平;6例SCr值恢复正常;住院时间10~32d痊愈出院。结论肺移植术后急性肾损伤患者早期行肾脏替代治疗,做好血流动力学及微循环的监测与护理,可有效改善患者预后。     

Horseshoe lung with left lung hypoplasia.

Horseshoe lung is an uncommon congenital malformation in which the bases of the right and the left lungs are fused to each other by a narrow isthmus posterior to the cardiac apex. So far 22 cases have been described: most of these were associated with right lung hypoplasia and the scimitar syndrome. A horseshoe lung anomaly with left lung hypoplasia is described.     

Technetium-fibrinogen lung scanning in canine lung contusion

To detect experimentally induced acute lung contusion in anesthetized dogs, serial radionuclide images of the lung were recorded following intravenous infusion of 99mTc-labelled human fibrinogen (Tc-HF). The accumulation of Tc-HF in canine lungs was serially quantitated for up to 20 hours after lung contusion. A contusion (#1) was produced in one lung, Tc-HF was injected IV after 15 minutes, and 75 minutes later a contralateral lung contusion (#2) was produced in a series of 14 dogs. At autopsy the excised lungs were scanned, sectioned, and counted for radioactivity. Radiolabelled fibrinogen accumulated within 2-4 minutes of contusion #2 and remained stable over the next 20 hours in 14 dogs; contusion #1 was barely visible in four dogs. Lung Tc-HF activity in the central region of contusion #2 remained sixfold higher than in normal lung tissue. These data suggest that following lung contusion, fibrinogen deposition occurs rapidly and remains stable over a 20-hour interval of observation.     

Septic lung and shock lung in man.

Two series of patients were studied by serial measurements of blood gas exchange and pulmonarmonary dysfunction and to evaluate the dangers of respiratory failure in post traumatic patients. There were 27 patients who had sustained profound hemorrhagic shock and massive blood replacement averaging 9.7 liters and 38 patients who suffered general peritonitis or other forms of fulminating nonthoracic sepsis. All were supported by endotrachael intubation and volume controlled ventilators. The overall mortality for the post shock patients without sepsis was 12% while in the septic patients it was 35%. The maximal pulmonary arteriovenous shunt encountered in the post hemorrhagic shock patients at 36 hours averaged 20 plus or minus 8% and was accompanied by high cardiac indices (average 5.1 plus or minus 1.3 L/M-2/min) but no significant rise of pulmonary arterial pressure or peak inspiratory pressure (PIP). Severe pulmonary dysfunction subsequently occurred only in those patients who later became septic. The studies on the septic patients were divided according to the magnitude of the cardiac indices (the high indices averaged 4.8 plus or minus 1.6L/M-2/min) and thelow indices averaged 1.9 plus or minus 1.0 L/M-2/min. In the former, the average maximal shunt of 30 plus or minus 6% was sustained for 4 or more days, accompanied by an elevation of PIP to 36 plus or minus 6 cm H2O and by Pa pressure of 28 plus or minus 5 mm Hg. The patients in low output septic shock usually had an associated bronchopneumonia and had an average venous admixture of 34 plus or minus 8% and PIP values of 41 plus or minus 8 cm H2O. The mean Pa pressure in this group was 29 plus or minus 6 mm Hg.     

Living-donor lobar lung transplantation for infectious lung diseases

The rate of infection among lung transplant recipients is several times higher than that among recipients of other organs and is most likely related to the exposure of the allograft to the external environment. Meticulous peri-operative management is mandatory in performing living-donor lobar lung transplantation for patients with infectious lung diseases. All 5 patients with end-stage infectious lung diseases are currently alive for 17-104 months after receiving living-donor lobar lung transplantation at Okayama University Hospital.     

Videothoracoscopy-assisted surgical lung biopsy for interstitial lung diseases

Objectives

Surgical lung biopsy (SLB) by videothoracoscopy for diffuse interstitial lung diseases is recommended for detailed diagnosis. Because substantial mortality and morbidity are associated with this procedure, its safety and diagnostic yield should be validated.

Methods

Sixty-four patients with diffuse interstitial lung disease who received SLB by videothoracoscopy between 2007 and 2013 were retrospectively analyzed for mortality, surgical complication, and diagnosis. Criteria for the procedure included patients <70-year old, who had at least 60 % vital capacity and at least 40 % diffusion capacity. Patients with radiologically definite usual interstitial pneumonia were not eligible.

Results

One conversion from the 3-port approach to thoracotomy due to bleeding occurred. Mean operation and anesthesia times were 63 and 133 min, respectively. The mean hospital stay was 6 days. Only 10 patients (16 %) received prophylactic steroid and/or elastase inhibitor administration. Neither deaths nor acute exacerbations of interstitial pneumonia occurred within 60 days after surgery. Pneumothorax occurred in four cases (6 %) after discharge, which was associated with lower % vital capacity and intraoperative steroid administration. Prolonged air leak and postoperative pneumonia were observed in 2 and 1 patients, respectively. Postoperative diagnosis was obtained in all patients. A group of connective tissue disease-related interstitial pneumonia (n = 15) and chronic hypersensitivity pneumonitis (n = 18) were the major diagnoses. Discordance between pre- and postoperative diagnoses was observed among usual interstitial pneumonia, non-specific interstitial pneumonia, and chronic hypersensitivity pneumonia.

Conclusions

Surgical lung biopsy for diffuse interstitial lung diseases is safe under appropriate inclusion criteria and provides definite diagnosis.