呼吸末PETCO2及纤维支气管镜在双腔管中的应用

目的 评价用纤维支气管镜（FOB）检查定位及呼吸末CO2分压（PETCO2）监测在双腔管中的可行性。方法 选择期行开胸手术、术中需单肺通气患者66例，ASⅠ—Ⅲ级。麻醉期间监测无创血压、心电图、脉搏血氧饱和度（SpO2）、呼吸末CO2分压、通气参数等。通气参数设为：潮气量6～8mi／kg、呼吸频率12～14bpm、维持PETCO2在34～45mmHg之间，记录SpO2和气道压峰值（paw）。DLT导管型号及左右的选择根据患者身高、体重、病变部位及术式而决定。全麻诱导后喉镜暴露声门插入DLT，接麻醉机手控通气。分别用听诊定位法及纤维支气管镜FOB检查定位和调整导管位置；通气过程中监测PETCO2，判断平、侧卧位DLT对位情况，记录结果。结果 66例患者听诊法发现25例（37．9％）DLT位置不当，调整深浅度后14例对位满意，9例完全错位者5例重新插管，6例对位满意，存在部分肺隔离不全者3例（4．5％）。呼吸末C0，监测发现22例功能对位满意，34例（51．5％）DLT位置不当，侧卧位时，听诊法发现7例（10．6％）DLT位置不当，调整后仍有2例（3.0％）有肺隔离不全。使用纤维支气管镜检查定位和调整导管位置；呼吸末CO2监测发现2例（3．3％）DLT住置不当。术中单肺通气时，根据连续监测通气侧的呼吸末CO2变化发现4例因手术牵拉所致的DLT移位，3例解除牵拉后DLT移位解除，1例经重新调整位置后才解除。结论 呼吸末CO2监测可作为临床上判断DLT对住是否满意和连续监测DLT对住情况的一种可行的方法。特别是和FOB定位的情况下，为临床上一个较好的方法。     

咪唑安定和芬太尼在老年患者纤维支气管镜检查中的应用

目的观察咪唑安定和芬太尼在老年患者纤维支气管镜检查中的应用效果及安全性评价。方法将210例接受纤维支镜检查的老年患者随机分成试验组（A组）和对照组（B组）,同时选择同期106例青年患者作为对照（c组）,A、C两组在局部麻醉的基础上加用咪唑安定和芬太尼进行麻醉,B组单纯应用局部麻醉,分别观察3组各时点的平均动脉压、心率、呼吸频率及脉氧饱和度。对A、C两组患者按Ramsay法进行镇静分级评估,记录A、C两组的麻醉诱导时间和麻醉时间。调查3组患者对检查过程的遗忘程度、不良反应以及再次检查的接受程度。结果A组麻醉时间高于C组（P〈0．01）。A、C两组遗忘比率分别为97．2％（103／106）和95.3％（101／106）,镇静分级评估A组以3级为主占68．9％（73／106）,C组以2级为主占66．0％（70／106）,而B组镇静程度全部为0级,无遗忘。A、C两组在检查过程中平均动脉压稍下降,但平稳,而B组显著升高,波动大。B组心率入声门时比A、C两组显著加快（P〈0．01）。A、C两组在检查过程中的不良发应、中断检查及再次检查接受程度与B组比较差异有统计学意义（P〈0．01）。结论老年患者在纤维支气管镜检查联合应用咪唑安定和芬太尼麻醉安全有效。     

小儿肺不张的纤维支气管镜检查结果分析

目的 探讨小儿肺不张发生的原因。方法 对81例肺不张患儿行纤维支气管镜检查。经肉眼观察、支气管分泌物、肺泡灌洗液细胞学检查。结果 炎症：52例（包括2例痰栓），占64．2％，居首位；支气管异物24例，占296％。居第二位；支气管软化管口狭窄4例，占4.7％；来见明显异常1例，占1．3％。结论 在小儿引起肺不张的原因以炎症为主，异物次之。     

纤维支气管镜检查诊断肺不张108例分析（摘要）

我科近几年来对120例肺不张患者行纤支镜检查,对其中资料完整,诊断明确的108例进行分析。 1 一般资料 108例中男67例,女41例,年龄18～79岁,40岁以上92例占85.2％。 2 X线表现 均摄胸正侧位X线平片,部份病人加照胸CT片,病例选择根据X线胸片:一侧肺不张,一叶或两叶肺不张,肺段不张及肺亚段不张(盘状肺不张),以肺叶为单位进行统计。     

老年人纤维支气管镜检查919例结果分析（摘要）

本文分析了919例老年人纤维支气管镜检查结果,占用期检查的33.2％。诊断为肺癌392例(42.7％),慢性炎症371例(40.4％),急性炎症116例(12.6％),支气管粘膜正常17例(1.9％),结核15例(1.6％),支气管内异物6例(0.6％),曲菌病2例(0.2％),肺癌检出率高于同期非老年组,肺不张127例中,肺癌29例(62.2％)。19例术后肺不张经纤支镜治疗后肺复张17例(89.5％),14例严重肺部感染     

纤维支气管镜检查诊断单纯性支气管结核

目的探讨纤维支气管镜（FB）检查对单纯性支气管结核（SBTB）的诊断价值。方法对68例SBTB患者进行FB检查，据镜下所见直接取材、刷片和冲洗液标本送细菌学检查（找抗酸杆菌），活组织标本送病理学检查；对刷片和冲洗液抗酸杆菌阴性者，术后痰找抗酸杆菌连续3次。结果镜下表现为支气管黏膜充血水肿、增厚粗糙及肉芽肿分别为58．8％、32．4％、16．2％，支气管出血及干酪样物分别为26．5％、35．3％；病变部位上叶支气管及主支气管为好发部位，分别为39．7％、22．0％；确诊率为88．2％，其中刷片和冲洗液阳性率为58．8％，活检阳性率为29.4％。结论FB检查对诊断SBTB有重要临床价值。     

纤维支气管镜在急症中的应用

纤维支气管镜(纤支镜)已广泛用于肺部疾病的诊断、治疗和研究,对轻、中度病人简而易行,但对危重病人会增加病人的危险性,不敢轻易涉足于此,近年来随着操作技术的提高,设备日趋完善以及病人的需要,有些心肺功能相当差的老年病人,甚至已进入呼吸衰竭,在作好充分供氧,心电监护抢救准备,小心灵活的运用这一技术,可以解决一些过去难以处理的危重急症。我院的操作经验,无1例手术中或术后两周内死于此检查。     

异丙酚用于纤维支气管镜检查226例临床分析

目的回顾性分析64例妊娠合并子宫肌瘤的临床资料。方法选取1995年1月至2006年1月在我院妇产科住院分娩并被确诊为妊娠合并子宫肌瘤的患者64例,从肿瘤的发现时间及方法、B超诊断、分娩方式、肿瘤状况及随诊情况等临床资料给予分析。结果妊娠合并子宫肌瘤主要在孕晚期发现确诊(45/64)、B超诊断(48/64)剖宫产加子宫肌瘤切除术(54/64),产后42d复查情况好。结论妊娠合并子宫肌瘤的孕妇,应定期作B超检查了解不宫肌瘤的情况,并作为高危妊娠进行监护,对于符合手术的患者,应在监护下给予处理。     

纤维支气管镜在临床治疗中的应用

纤维支气管镜(纤支镜)于60年代发明之后至今已广泛应用于临床检查上,对呼吸系统疾病的诊断方而取得了很大的进展。此外,纤支镜在临床上的治疗方面已取得可喜的成绩,简述如下: 1 摘取异物 气管镜的发明、发展及改进与早年为设法取出气管内异物密切相关联,既往认为金属镜是摘取气管支气管内异物的唯一最佳器械,自从60年代末期纤维支气管镜问世以来,由于它可弯曲、质“软”、损伤小的优点已应用于摘取异物,异物种类     

163例肺不张患者纤维支气管镜检查结果分析

目的 探讨纤维支气管镜检查在肺不张的病因诊断中的价值.方法 我院2003年5月～2009年6月收治163例放射影像学诊断为肺不张的患者,行纤维支气管镜检查明确病因.结果 163例肺不张患者中,以右肺中叶发生肺不张的比率最高,发生62例,占38%,右下肺次之,发生43例占26.38%;病因肿瘤97例,占59.95%,为首位;炎症34例,占 20.8%,次之;结核26例占15.9%.支气管肺癌好发的部位在右中叶及右下叶,占33.5%,炎症多发生于右中叶支气管,占所发生炎症的62.5%,结核好发部位在右上叶及右中叶支气管.结论 纤维支气管镜检查对明确诊断肺不张的病因及部位至关重要,同时还能有效治疗某些肺部的炎症性阻塞性疾病及取出气管异物.     

布托啡诺复合丙泊酚在无痛胃镜检查中的应用

目的探讨布托啡诺联合丙泊酚在无痛胃镜检查中的麻醉效果。方法将90例胃镜检查患者随机分为2组,每组45例。观察组患者采用布托啡诺联合丙泊酚,对照组患者采用芬太尼联合丙泊酚。观察患者在麻醉之前、检查中以及意识清醒时的心率、血压和血氧饱和度的变化,将呼吸抑制情况和麻醉效果进行比较分析。结果2组患者用药后心率、血压和血氧饱和度均下降,P〉0．05,无统计学意义;丙泊酚总量和呼吸抑制2组比较,P〈0．05,具有统计学意义。结论布托啡诺联合丙泊酚在无痛胃镜检中麻醉的时间长、呼吸抑制低,值得临床推广。     

小剂量长托宁在无痛肠镜中的应用

目的探讨在无痛肠镜检查麻醉前给予小剂量长托宁(盐酸戊乙奎醚)治疗的应用价值。方法我院2012年7月至2013年1月接受无痛肠镜检查患者90例,将其随机分为3组,每组30例,分别于麻醉前给予小剂量长托宁静注(小剂量组)、常规剂量长托宁静注(常规剂量组)及阿托品静脉注射(阿托品组),观察3组患者的下镜顺利程度、检查前后心率和平均动脉压及术后不良反应情况。结果 3组患者的总下镜顺利率和血氧饱和度比较未见明显差异,小剂量组在检查前后心率及平均动脉压方面作用明显优于常规剂量组及阿托品组,且小剂量组术后不良反应发生率明显低于常规剂量组及阿托品组。结论无痛肠镜检查麻醉前给予小剂量长托宁可明显提高检查效果,且可降低术后不良反应发生率。     

Phenomenon of painless knee in recurrent patellar dislocation in children

Introduction

Cartilage lesion with patellar malalignment may be correlated with pain. Situations in which patients with recurrent patellar dislocation are painless between episodes of luxation can be approached with considerable curiosity. We evaluated the distribution of substance-P and S-100 protein expression in soft tissue of the knee in children with recurrent patellar dislocation, in order to evaluate the distribution of nociceptors and determine tissue origins of this situation.

Material and methods

Samples were collected from the medial and lateral synovial membrane, medial and lateral patellar retinaculum, Hoffa''s body, patellar ligament, and quadriceps’ aponeurosis in 10 children during the Blauth procedure and 10 adults with idiopathic osteoarthritis during total joint alloplasty. The density of nociceptive fibres was compared in the children and adults using S-100 and substance-P monoclonal antibodies.

Results

Statistical differences between groups were demonstrated for S-100 expression in synovial membrane of the medial knee compartment (p < 0.05) and for substance-P expression in the medial patellar retinaculum (p < 0.05) and synovial membrane of the lateral (p < 0.05) and medial (p < 0.05) knee compartment in favour of children.

Conclusions

Lack of pain sensations in patients with recurrent patellar dislocation may be associated with non-increased expression of nerve endings in Hoffa''s body. Increased expression of either S-100 protein or substance-P in synovial membrane and the medial retinaculum did not induce pain development in the knee joints of that group of patients.     

新型健康管理模式在老年综合评估中的应用研究

目的：分析老年综合评估在构建老年新型健康管理模式中的应用价值。方法：将2014年至2015年社区老年中心、养老院、宜昌市中心医院老年病科、综合内科的300例老年患者平均分为研究组和对照组,对对照组患者实施常规健康管理,对研究组患者进行老年综合评估,并根据评估结果制定新型健康管理模式对患者实施健康管理。结果：实施健康管理前两组患者的生活质量综合评定问卷(Generic Quality of Life Inventory-74,GQOLI-74)评分、日常生活能力量表(Activity of Daily Living Scale,ADL)评分比较均无显著性差异(P>0.05),实施健康管理后研究组患者的GQOLI-74问卷评分、ADL量表评分均较对照组患者高(P<0.05),其家属对健康管理工作的满意度为91.3%,与对照组患者家属的83.3%比较存在明显差异(P<0.05)。结论：以老年综合评估为核心,构建老年新型健康管理模式对老年人实施健康管理,可有效改善老年人的生活质量。     

Pancreaticoduodenectomy of pancreatic ductal adenocarcinoma in the elderly

PURPOSE: Pancreatic ductal adenocarcinoma has the highest incidence between the ages of 60 and 70 years. As the elderly population has been increasing in the last several decades, the proportion of patients older than 70 years of age with resectable pancreatic cancer is expected to increase in our society. This retrospective observation was performed to evaluate surgical value of pancreaticoduodenectomy for the elderly patients with pancreatic ductal adenocarcinoma. MATERIALS AND METHODS: From January 1990 to June 2005, among the patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma, the elder patients older than 70 years of age were retrospectively reviewed. Perioperative surgical outcomes, including general clinicopathologic features, morbidity, mortality, and survival outcomes, were investigated based on available medical records. RESULTS: Seventy-seven patients underwent pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma. Among them, 11 patients (14.3%) were 70 years older. More frequent incidences of morbidity (8 out of 11 vs. 25 out of 65, p=0.049), especially delayed gastric emptying (3 out of 8 vs. 3 out of 66, p=0.035), were observed and overall length of hospital stay was also longer in the elderly (49.2 +/- 13.9 days vs. 36.1 +/- 13.2, p=0.012). However, no significant differences in mortality rate and survival outcomes were noted when comparing with those of the younger patients (p > 0.05). CONCLUSION: We agree with the opinion that age factor can not be absolute contraindication for pancreaticoduodenectomy, however, appropriate preoperative evaluations, proper patient selection considering life expectancy, advanced surgical techniques and detailed perioperative management are mandatory to guarantee the safety of pancreaticoduodenectomy performed in the elderly with pancreatic ductal adenocarcinoma.     

Breast cancer in the elderly: a histological assessment

Aims:  To understand the correlation between the expression status of different biological markers in breast cancers in the elderly.
Methods and results:  Three hundred and ninety-seven cases were evaluated for expression of hormone receptors [oestrogen receptors (ER) α and β, progesterone receptor (PR)], basal markers [p63, cytokeratin (CK) 5/6 and CK14] and others (HER2/neu, synaptophysin and chromogranin). The expression rates were 60, 29, 25, 6, 14, 8, 28, 17 and 5%, respectively, for these markers. The expression of ER α and β, PR, synaptophysin and chromogranin at any level correlated with low nuclear or tumour grades, whereas the expression of HER2/neu, CK5/6 and CK14 at any level correlated with high nuclear grade. By using hierarchical clustering, groups of HER2, luminal and basal types were identified. In addition, a neuroendocrine group was also identified, being characterized by expression of synaptophysin, chromogranin, ER and PR, but not HER2/neu, and other basal cytokeratins. This group was associated with lower nuclear grade, and hence better prognosis.
Conclusions:  Breast cancer in the elderly shows similar molecular groupings as other breast cancers, with an additional neuroendocrine group that is associated with a favourable biological marker profile.     

Anemia in elderly Koreans

Recently, the geriatric population in Korea has grown to comprise approximately 10% of the total population, and anemia has become a significant problem among elderly patients. Many elderly patients have anemia due to nutritional deficiency, chronic inflammation, or comorbid diseases; however, in a significant fraction of the patients with anemia, the cause remains obscure. Anemia of any degree is recognized as a significant independent contributor to morbidity and mortality in elderly patients. This article summarizes the patterns of anemia in Korean geriatric patients.     

Prevalence of wheeze, bronchial hyper-responsiveness and asthma in the elderly Chinese

BACKGROUND: Asthma is a common health problem affecting patients of all ages. Because of the ease of sampling, epidemiological studies have concentrated mainly on the paediatric and general population. OBJECTIVE: This study aimed to determine the prevalence of wheeze, bronchial hyper-responsiveness and asthma amongst our elderly population and deduce any clinical and laboratory risk factors that might identify elderly asthmatics at an earlier stage. METHODS: Two thousand and thirty-two elderly Chinese aged > or = 70 years, randomly selected from a registered list of all recipients of Old Age and Disability Allowances in Hong Kong, were administered a questionnaire on lung health. Two hundred and fifty subjects were invited to attend our laboratory for skin tests and pulmonary function tests and 179 agreed. Of these, 173 (96.6%) and 176 (98.3%) had eosinophil count and serum IgE levels measured, respectively. Two definitions of asthma were used: (1) bronchial hyper-responsiveness (BHR) plus current wheeze, and (2) history of wheezing without previous diagnostic labels of emphysema or chronic bronchitis. RESULTS: Fifteen patients (out of 179: 8.4%) reported wheezing over the past 1 year. Fifty-one patients (28.5%) demonstrated BHR on spirometry or histamine challenge tests. Seven patients had both symptoms of wheezing and evidence of BHR. The prevalence of asthma using this definition is therefore 3.9% (95% CI 1.6-7.9%). Nine patients had symptoms of wheezing without previous diagnostic labels of chronic bronchitis or emphysema and, using this definition, the prevalence is 5.0% (95% CI 2.3-9.3%). Using multiple logistic regression studies, sex, social class, age, smoking habits, serum IgE levels and eosinophil counts did not predict a diagnosis of asthma using either definition. We found no association between a positive skin test and any respiratory symptoms or illnesses including asthma. CONCLUSION: Wheeze, bronchial hyper-responsiveness and asthma are prevalent amongst our elderly population. However, there were no identifiable demographic and laboratory risk factors in this study that may help us predict a diagnosis of asthma.     

Community-acquired acute bacterial meningitis in the elderly in Turkey

This investigation aimed both to delineate the current status of community-acquired acute bacterial meningitis and to produce data on the interrelationships between clinical, laboratory and therapeutic parameters in the elderly. This retrospective cohort study was conducted in 28 Turkish institutions in 159 culture-positive patients over the age of 50 years. Streptococcus pneumoniae was the most common pathogen (69.2%), followed by Listeria monocytogenes (8.8%). For this reason, antilisterial antibiotics such as ampicillin or benzylpenicillin should be added to the therapeutic regimen. Pathogen-specific mortality did not vary between S. pneumoniae and L. monocytogenes. The overall mortality was 2.5% at the third day, 12.6% at the seventh day, 20.1% at the 14th day and 21.4% at the 21st day. The risk factors for fatality were increasing age, the presence of stupor, sepsis and inappropriate antibiotic administration. Cerebrospinal fluid (CSF) leukocyte counts and CSF/blood glucose ratios were lower in patients who died. Fever did not differ between survivors and fatal cases. The mean duration of antibiotic therapy in survivors was 16.3 ± 6.4 days. One-fifth of the patients had complications, and in 5.7% of the patients sequelae persisted at follow-up.