慢性阻塞性肺病气管软化的发病率、形态改变以及与肺气肿、支气管扩张和支气管管壁增厚的关系

本研究的目的是明确慢性阻塞性肺病（COPD）病人气道软化的发病率及与其形态学改变之间的关系。对一组连续COPD病人的吸气相和动态呼气相多层螺旋CT（MD-CT）影像进行了回顾性分析。呼气时气道直径减小50％以上定义为气道软化。评价气道软化的分布和形态改变。     

小儿气道透X线异物X线诊断误漏诊分析

目的：旨在提高小儿气道透X线异物的X线诊断水平。方法：回顾性分析36例小儿气道透丝异物X线诊断，并与气管支气管镜结果对照，分析其误漏诊原因。结果：误漏诊共16例，其中支气管异物4例。气管异物7例，声门下异物2例，异物性局限性支气管炎3例，结论：对于小儿气道异物病的X线诊断，良好的深呼，吸气相胸片及动态透视结合诊断至关重要，并应按支气管，气管及声门下的顺序逐步诊断及鉴别诊断。     

呼气相肺部高分辨力CT扫描的临床应用研究

目的:探讨在不增加放射剂量的情况下HRCT呼气相肺容积测定,对存在小气道异常的弥散性肺疾病的临床应用价值。方法:45例研究对象行吸气末和呼气末屏气HRCT全肺扫描(层厚1.25mm,间隔20mm,骨算法)并进行冠状面图像重组,测定肺容积。结果:45例患者呼气相HRCT表现为支气管扩张、气管及支气管软化、全小叶型肺气肿、空气潴留等。呼气相HRCT对与空气潴留区相通的气道显示率达100%,冠状面重组图像对空气潴留的范围和分布所提供的诊断信息达到90%,与吸气相HRCT相比,差异均有极显著性意义(P<0.0001)。结论:在不增加患者有效的照射剂量或不降低图像质量的情况下,HRCT呼气相肺容积测定技术可以获得容积数据对显示气道病变及空气潴留区域的范围和分布有重要价值。     

三维快速场回波序列在先心病患儿 气管支气管树MRI中的应用

目的 对比分析三维快速场回波（3D-TFE）序列、三维平衡快速场回波（3D b-TFE）序列以及对比增强MR血管成像（CE-MRA）3种序列在显示气道时影像质量,探讨3D-TFE序列在先心病患儿气管支气管树成像中的应用价值。方法 连续收集2016年9月-12月间我院62例经超声心电图确诊的先心病患儿,其中男32例,女30例,年龄2~141个月,中位年龄为12.7个月。在1.5 T MR扫描设备上进行常规心脏MRI检查,常规扫描序列3D b-TFE、CE-MRA主要显示大血管病变,3D TFE进行气管支气管成像,测量气管支气管影像信噪比（SNR）及信号强度（SI）,客观评价影像质量及气管边界清晰度。由2位医生采用双盲5分法评价影像噪声及影像质量,并采用Kappa分析对2位医生的评分结果行一致性评价。采用单因素方差分析比较3种序列影像的SNR、SI、气管边界清晰度和影像质量主观评分。结果 3D-TFE序列在显示气道的SNR、SI、气管边界清晰度及其影像质量主观评分均分别高于3D b-TFE和 CE-MRA序列（均P<0.05）。2位医生对3种序列影像质量的主观评分的结果一致性极好,κ值均>0.80。结论 3D-TFE序列显示气管支气管树的影像质量优于3D b-TFE和 CE-MRA序列,可应用于心脏MRI检查时辅助观察有无先心病伴随的气道异常,是先心病心脏MRI检查中不可缺少的辅助序列,可为先心病患儿术前评估提供更多信息。     

原发性气管肿瘤的影像诊断及评价(附42例分析)

目的：评估各种检查方法对气管肿瘤的诊断价值。方法：研究42例经各种影像检查并获得纤支镜、手术病理证实的原发性气管肿瘤的临床与影像表现。结果：根据病灶的影像表现分为6种类型，提出发现气管肿瘤的注意事项及良恶性肿瘤的鉴别要点。得出各种检查方法的优缺点。结论：气管肿瘤较易延误诊断，但只要提高警惕，加强对本病的认识并紧密结合临床，多数患者是能及早作出诊断的。直接数字化X线摄影(DDR)或高千伏摄影可作为首选检查项目；气管正侧位体层检查是诊断气管肿瘤较为可靠而廉价的方法；但从影像学角度，单项检查又以MRI最为优越。若能多项检查，综合诊断，效果更佳。     

64 排 CT 气道成像技术在气道异物检查中的临床应用

目的：评价64排CT气道成像技术对气管支气管异物检查的诊断价值。方法对50例临床怀疑气道异物的患者应用GE Light Speed 64排容积CT（VCT）进行容积扫描,将所得的容积数据经0.625 mm重建后传至工作站,运用CT仿真内窥镜（CTVE）、多平面重组技术（MPR）、容积再现技术＋透明化处理（VR＋Raysum）、最小密度投影（MinP）对图像进行后处理重建,以支气管镜检查为金标准,评估64排CT检查的敏感性和特异性,并采用χ2检验比较不同后处理方法与支气管镜诊断气管异物形态符合率。结果64排CT扫描结合气道成像技术诊断气道异物的敏感性为100%,特异性为60%,准确率为96%;不同后处理方法（CTVE、MPR、VR＋Ray-sum、MinP 4种方法结合）诊断异物形态与支气管镜检查的符合率分别为：98%、87%、82%、42%、100%,不同后处理方法与支气管镜诊断气管异物形态符合率之间差异有统计学意义（χ2=4.810,P＜0.05）。结论64排CT气道成像结合不同后处理方法能够提高气道异物诊断的准确性,不同后处理方法联合应用诊断异物形态对指导内窥镜检查或手术有重要意义。     

原发性气管软骨软化

原发性气管软骨软化是一罕见的婴儿疾患,一般认为是气管与支气管软骨发育不良的结果。本文复习了4例婴儿严重气管软骨软化的临床特点、诊断过程和处理。 病例报告: 例1:生后10周的女婴,因进行性喘息和呼吸窘迫3周而入院治疗。胸部X线照像和吞钡检查正常。支气管镜检查,呼气时可见主支气管和气管远端萎陷,气管环难以辨认。检查后喘息逐渐加重,     

低剂量CT后处理技术在小儿气道异物术前应用

探讨低剂量螺旋CT扫描及图像后处理技术在小儿气管、支气管异物术前诊断的临床应用价值.选取临床高度怀疑,X线诊断不甚明确的气管、支气管异物,行螺旋CT轴位扫描及MPR、CTVB图像后处理确诊为气道异物的211例为研究对象.根据CT异物所在气道位置及引起并发症程度建立分型标准,并以支气管镜检术结果为对照,比较各型异物在X线及CT图像后处理前后的诊断准确性差异并分析各型异物特点.Ⅰ型、Ⅱ型、Ⅲ型异物X线、CT轴位、CT轴位加后处理诊断准确率分为:9.52%、64.29%、44.44%;100.00%、93.51%、77.78%;100.00%、98.70%、97.22%.经统计学配对X2检验,P<0.05,CT轴位加后处理诊断准确率优于前两者.螺旋CT低剂量扫描及后处理技术可作为小儿气道异物阻塞术前检前最安全、最准确、最快捷的筛查的首选手段.     

支气管镜下腔内高电刀在气道内结核中的应用

气道内结核病是气管、支气管黏膜的结核病变，大多与肺结核并发。由于结核杆菌侵袭气管、支气管黏膜及黏膜下层，部分患者可损害肌层及软骨，最终疤痕愈合导致气管、支气管狭窄。若未及时有效地治疗，将导致支气管不可逆性瘫痕狭窄或管壁的软化，严重者可导致肺不张。随着支气管镜及其腔内介入技术的发展，可弯曲支气管镜介导的高频电刀治疗已被广泛应用于临床。高频电凝将电能转化为热能．利用热作用对肉芽组织及干酪坏死进行电切和电凝，可有效地清除肉芽组织及干酪坏死，恢复气道通畅。本文报告132例气管内结核患者行支气管镜下腔内高频电刀电凝治疗，取得了良好效果。     

小儿先天性气管性支气管的多层螺旋CT诊断

目的：介绍小儿先天性气管性支气管的分类及意义，探讨多层螺旋CT（MSCT）在该病中的诊断价值。方法：回顾性分析43例先天性气管性支气管患儿的计算机X线摄影（CR）、MSCT扫描影像资料，MSCT肺部常规10mm层厚扫描，在16层MSCT机进行1．25mm层厚、1．25mm层间隔重组，获得最小密度投影（minIP）、容积重组（VR）、表面遮盖技术（SSD）、仿真支气管内镜（VB）图像，记录病变的部位及与周围组织的关系和伴发异常。结果：43例病变经CT后处理技术全部清晰显示，CT横断面扫描显示37例，CR仅显示1例；43例中38例有先天性心血管病变，40例为右侧气管性支气管，3例为双侧气管性支气管，共有9例伴随气道狭窄，2例气管插管过深引起右肺上叶节段性肺不张。结论：MSCT对于诊断先天性气管性支气管，显示气道及其周围伴随组织有良好的价值。     

Bystander cricothyroidotomy performed with an improvised airway.

OBJECTIVE: We report a roadside cricothyroidotomy successfully performed with only a pocketknife and the drinking straw from a sports bottle. Our study compared the adequacy of standard medical airway devices with some readily available nonmedical items that might be used as temporary tracheostomy tubes (TT). METHODS: We compared the airway resistances (Raw) of two standard cricothyroidotomy airway devices against the barrel from a ballpoint pen and two sports bottle straws. RESULTS: There was no statistically significant difference in Raw between the straws and standard airway devices. However, the pen barrel had much higher Raw. CONCLUSION: This is the first study to compare available nonmedical items that might be used as temporary TTs for bystander cricothyroidotomy. Two types of straws found on sports bottles had relatively low Raw compared with standard TTs. However, the barrel from a ballpoint pen had a much higher Raw and is an unacceptable choice.     

Upper airway volume segmentation analysis using cine MRI findings in children with tracheostomy tubes.

OBJECTIVE: The purpose of this study is to evaluate the airway dynamics of the upper airway as depicted on cine MRI in children with tracheotomy tubes during two states of airflow through the upper airway. MATERIALS AND METHODS: Sagittal fast gradient echo cine MR images of the supra-glottic airway were obtained with a 1.5T MRI scanner on seven children with tracheotomy tubes. Two sets of images were obtained with either the tubes capped or uncapped. The findings of the cine MRI were retrospectively reviewed. Volume segmentation of the cine images to compare the airway volume change over time (mean volume, standard deviation, normalized range, and coefficient of variance) was performed for the capped and uncapped tubes in both the nasopharynx and hypopharynx (Signed Rank Test). RESULTS: Graphical representation of the airway volume over time demonstrates a qualitative increased fluctuation in patients with the tracheotomy tube capped as compared to uncapped in both the nasopharyngeal and hypopharyngeal regions of interest. In the nasopharynx, the mean airway volume (capped 2.72 mL, uncapped 2.09 mL, p = 0.0313), the airway volume standard deviation (capped 0.42 mL, uncapped 0.20 mL, p = 0.0156), and the airway volume range (capped 2.10 mL, uncapped 1.09 mL, p = 0.0156) were significantly larger in the capped group of patients. In the hypopharynx, the airway volume standard deviation (capped 1.54 mL, uncapped 0.67 mL, p = 0.0156), and the airway volume range (capped 6.44 mL, uncapped 2.93 mL, p = 0.0156) were significantly larger in the capped tubes. The coefficient of variance (capped 0.37, uncapped 0.26, p = 0.0469) and the normalized range (capped 1.52, uncapped 1.09, p = 0.0313) were significantly larger in the capped tubes. CONCLUSION: There is a statistically significant change in airway dynamics in children with tracheotomy tubes when breathing via the airway as compared to breathing via the tracheotomy tube.     

Semi-automatic measurement of the airway dimension by computed tomography using the full-with-half-maximum method: a study of the measurement accuracy according to the orientation of an artificial airway.

OBJECTIVE: To develop an algorithm to measure the dimensions of an airway oriented obliquely on a volumetric CT, as well as assess the effect of the imaging parameters on the correct measurement of the airway dimension. MATERIALS AND METHODS: An airway phantom with 11 poly-acryl tubes of various lumen diameters and wall thicknesses was scanned using a 16-MDCT (multidetector CT) at various tilt angles (0, 30, 45, and 60 degrees ). The CT images were reconstructed at various reconstruction kernels and thicknesses. The axis of each airway was determined using the 3D thinning algorithm, with images perpendicular to the axis being reconstructed. The luminal radius and wall thickness was measured by the full-width-half-maximum method. The influence of the CT parameters (the size of the airways, obliquity on the radius and wall thickness) was assessed by comparing the actual dimension of each tube with the estimated values. RESULTS: The 3D thinning algorithm correctly determined the axis of the oblique airway in all tubes (mean error: 0.91 +/- 0.82 degrees ). A sharper reconstruction kernel, thicker image thickness and larger tilt angle of the airway axis resulted in a significant decrease of the measured wall thickness and an increase of the measured luminal radius. Use of a standard kernel and a 0.75-mm slice thickness resulted in the most accurate measurement of airway dimension, which was independent of obliquity. CONCLUSION: The airway obliquity and imaging parameters have a strong influence on the accuracy of the airway wall measurement. For the accurate measurement of airway thickness, the CT images should be reconstructed with a standard kernel and a 0.75 mm slice thickness.     

Prolonged drip-infusion cholangiography.

Previous experimenttal work in animals has shown that the hpatic excretion of iodipamide and ioglycamide is subject to a transport maximum (TM). Doses in excess of this TM are largely excreted in the urine. In the present study the TM for man was estimated in three subjects with indwelling T-tubes: figures of 19-23 mg/minute for ioglycamide were obtained. It was thought that prolonged administration of contrast at levels slightly above the TM might have advantages in patients with impaired liver function. In obstruction the gradual excretion of contrast could improve the chances of filling the ducts completely, while in hepato-cellular disease the gall bladder might have time to concentrate the contrast. Ioglycamide was therefore given by slow overnight infusion, equivalent to 35 mg/minute, to patients in whom standard cholangiography had been unsuccessful. The overall success rate was 75 per cent with similar improvement in obstructive and hepatocellular disease.     

腋下小切口与传统后外侧切口肺癌根治术疗效对比

目的比较腋下小切口与传统后外侧切口肺癌根治术的临床效果。方法选择我院有手术指征的原发性肺癌患者127例,按患者意愿分为两组,分别接受腋下小切口和传统后外侧切口肺癌根治术,观察两组手术时间、术中出血、术后2个月肺功能、术后死亡、复发及转移率等指标。结果小切口组中5例因肺血管意外、淋巴结粘连严重和侵犯纵膈器官而转为标准后外切口肺癌根治术,两组在手术时间、术中出血、术后死亡、复发及转移率等方面差异无统计学意义（P〉0．05）。腋下小切口组术后2个月肺功能明显高于传统后外切口组（P〈0．05）,差异有统计学意义。结论腋下小切口肺癌根治术减少患者术后肺功能的损害。     

螺旋CT扫描在小儿气道异物诊治中的应用价值及适用范围

目的：探讨螺旋CT扫描在小儿气道异物诊治中的应用价值及适用范围。方法：对76例可疑气道异物的患儿行螺旋CT扫描及图象重建,以内窥镜或手术结果为金标准,评估MSCT检查的敏感度、特异度,总结其适用范围。结果：经内窥镜及手术确诊气道异物68例,未见异物8例,其中3例为肉芽肿,2例炎性狭窄;螺旋CT诊断气道异物72例（6例假阳性）,未见异物4例（2例假阴性）。螺旋CT对气道异物诊断的敏感度为94.3%（66/70）,准确率为85.9%（66/76）。结论：螺旋CT扫描对小儿气道异物的诊断敏感度及准确度高,定位准确,可显示各种合并症,是无创非侵入性检查的首选方法。但应适用于一定范围内,以减少不必要的检查。     

Advances in emergent airway management

The threatened airway is, fortunately, an infrequent occurrence in sports medicine, but one that requires up-to-date knowledge and skill in order to be managed in an effective and timely manner. Sports medicine physicians are responsible for having the education and tools required to secure a compromised airway in any setting. Often, careful positioning of the athlete with simple maneuvers learned through basic life support training is all that is necessary to secure the airway. At other times, however, more advanced techniques (including the use of advanced airways such as endotracheal tubes, laryngeal mask airways, esophageal tracheal combitubes, and surgical airways) will need to be utilized. This article offers physicians some perspective on the newest innovations that exist in airway management in comparison with the standard equipment and techniques. It is up to sports medicine physicians to develop treatment algorithms they are comfortable with, should they encounter an airway emergency.     

Does the ILMA make sense in HEMS?

As first reported by Brain(1) by the early 1980s, the laryngeal mask airway (LMA) represented a new approach to airway management. The LMA has been used to facilitate tracheal intubation by a variety of methods. In fact, the LMA has been used to intubate the patient with difficult tracheal access. A recent addition to this technique, the intubating laryngeal mask airway (ILMA), shown in Figure 1, first was proposed by Brain and coworkers in 1995.(1,2) Fig. 1. Components of the intubating laryngeal mask airway. An endotracheal tube may be passed through the airway tube. The ILMA incorporates the standard LMA cuff in sizes 3, 4, or 5, along with a metal airway tube and handle. The handle allows users to manipulate the device within the patient's airway. The airway tube component has a wider internal diameter and is shorter than the standard LMA tube. A silicone rubber bite block surrounds the upper portion of the stem.     

6MWT on a new self-paced treadmill system compared with overground

The 6-min walk test (6MWT) is a useful tool for clinicians and researchers to estimate gait performance and fatigue affecting functional mobility. A modified 6MWT administered on a treadmill (TM) can be an efficient, space-saving alternative to perform the 6MWT. The aim of this study was to investigate if a 6MWT on a self-paced (SP) TM produced similar results compared to an overground (OG) 6MWT among healthy participants with the hypothesis that users would demonstrate similar gait parameters. The second aim was to assess the reliability of SP TM sessions with the hypothesis that gait parameters would be reliable. Twelve healthy young adults performed one OG 6MWT and two SP TM 6MWTs, with the TM tests performed on two different testing days. The OG 6MWTs were conducted along a 20 m corridor with a portable optometric system. The SP TM 6MWTs were performed using a dual-belt instrumented TM with speed controlled by feedback from a LIDAR sensor. In the OG condition, participants walked 664.8 m ± 48.9 m when the standard method was used to calculate distance and 721.3 m ± 56.2 m with an average-speed-based estimation of distance, which corrects for U-turns. For the SP TM 6MWT, they covered 729.4 m ± 45.8 m in the first session and 727.4 m ± 56.0 m in the second session. Gait parameters showed good to excellent within- and between-day reliability on the adaptive TM. Gait parameters were similar between modalities. A significant difference in the 6MWT distance was found between modalities. This is attributable to the U-turns, because a comparison between TM 6MWT distance and the average-speed-based estimation of the distance for the OG modality showed no significant difference. However, this system produced similar spatiotemporal gait parameters among participants compared to OG.     

急性心肌梗死血栓调节蛋白改变与超敏肌钙蛋白T的相关性

 目的 观察急性心肌梗死(acute myocardial infarction,AMI)患者血栓调节蛋白(thrombomodulin, TM)的变化与超敏肌钙蛋白T(hypersensitivity troponin T, hsTnT)的相关性。方法 采用病例对照研究方法,选择符合入选标准的AMI患者(AMI组)和健康人(对照组)各30例(名),采集血液标本,采用酶联免疫检测法检测TM的浓度,利用SPSS统计软件进行数据分析。结果 AMI组TM、肌酐(简称Cr)及TM/Cr均大于对照组,差异有统计学意义(P<0.05);TM与hsTnT呈正相关(r=0.524, P<0.05),TM/Cr与hsTnT呈正相关(r=0.725,P<0.05)。结论 AMI患者TM明显增加,TM与hsTnT呈正相关,且TM/Cr可做为诊断急性心肌梗死的指标。