Forgarty双腔球囊导管球囊充气与充液定位气胸肺漏气支气管的对比研究

目前,Forgarty双腔球囊导管（导管）广泛用于支气管胸膜瘘和气胸肺漏气所属支气管的定位,由于球囊充气难以控制球囊外径大小,影响了靶支气管定位效果。我们采用Forgarty双腔球囊导管球囊充液方法,并与球囊充气相对照。现将报道如下。     

应用双腔球囊漂浮导管定位气胸破裂口所属支气管的临床研究

我科应用双腔球囊漂浮导管气道内介入定位气胸破裂口所属支气管，并与纤维支气管镜专用球囊导管方法进行对照，现将方法和结果报道如下。     

白蛋白泡沫定位气胸肺漏气支气管的临床应用

目的 探讨经气道人体白蛋白泡沫定位肺漏气支气管的方法,并评价其效果及安全性.方法 29例气胸患者,在纤维支气管镜直视下,人体白蛋白泡沫靶支气管内注射,定位肺漏气所属支气管.结果 29例患者肺漏气支气管均定位成功,从泡沫注射至确定肺漏气支气管定位所需平均时间为(4.0±1.2)min,20%人体白蛋白用量平均(8.0±2.6)ml/例.医用生物蛋白胶封堵成功21例,α-氰基丙烯酸酯封堵成功8例.并发症:剧烈咳嗽6例,发热和胸腔出血各4例,胸痛1例.结论 人体白蛋白泡沫靶支气管内注射是一种操作简单、价格低廉、安全和有效的肺破裂支气管定位的方法.

Abstract：

Objective To evaluate the efficacy and safety of a new method to determine the bronchus for air leakage in pneumothorax by injection of human albumin foam.Methods In 29 cases with pneumothorax,the bronchus responsible for air leakage was localized by injecting foam of human albumin into target bronchus under direct view of bronehoscopy.Results The bronchus for air leakage was successfully localized in all the 29 cases of pneumothorax.The average time for locating(from injection of the foam to the localization of the bronchus)was(4.0±1.2)min.and the average amount of 20%human albumin used was(8.0±2.6)ml for each patient.The air leakage Was treated accordingly,and occlusion by fibrin glue was successfully carried out in 21 cases and by OB glue in 8 csses.Severe couth was noted in 6,fever in 4,thoracic bleeding in 4 cases,and chest pain in 1 case.Conclusion Injection of human albumin foam into target bronchus under bmnchoseopy was a simple,safe and effective method for the localization of the bronchus for air leakage in pneumothorax.     

支气管镜下白蛋白泡沫定位顽固性气胸漏气支气管的应用效果

目的探讨顽固性气胸患者应用支气管镜下白蛋白泡沫定位漏气支气管的应用效果。方法选择该院呼吸科确诊的45例顽固性气胸患者,采用随机数字表法随机分为两组,观察组25例,采用纤维支气管镜下白蛋白泡沫定位漏气支气管,对照组20例,采用双腔球囊充液定位。比较两组患者的气胸定位情况,定位时间以及封堵后并发症情况。结果观察组患者共定位出支气管漏气部位段、亚段、次亚段各18、5、2例,对照组各16、1、0例,两组比较均具有统计学差异(P=0.027、0.005、0.015);两组总定位成功率比较有统计学意义(P=0.045);两组定位时间比较有统计学意义(P=0.001);两组患者的封堵成功率比较不具有统计学差异(P=0.577);两组患者并发症支气管充血水肿发生率无显著性差异(P=0.362),对照组患者的邻近气管受压和支气管变形扩张的发生率较观察组高,差异具有统计学意义(P=0.034,0.027)。结论采用纤维支气管镜下白蛋白泡沫定位漏气支气管是一种安全、更为准确的治疗方法,特别适合于顽固性气胸的定位治疗。     

经纤维支气管镜球囊定位及生物材料填塞治疗顽固性气胸

临床资料 2例气胸患均为男性，年龄19～88岁，经插管引流及负压吸引17天以上仍无效，负压吸引时患侧肺可复张，且见较多气泡逸出。     

球囊探查加选择性支气管封堵术治疗难治性气胸

目的 探讨球囊探查加选择性支气管封堵术治疗难治性气胸的疗效、安全性及并发症.方法 收集福建省5家三级医院2000年8月至2007年lO月期间进行球囊探查加选择性支气管封堵术的住院患者.40例中男39例,女1例,年龄20～84岁,平均(59±17)岁.接受本方法 治疗的40例患者均为经负压闭式胸腔引流7 d以上无效者.在常规支气管镜检查基础上采用Olympus B7-2C双腔球囊导管对脏层胸膜瘘口所属的引流支气管进行探杳定位,然后向确认的支气管注入不同剂量的自身全血加凝血酶.治疗组10例及常规支气管镜检查10例(对照组)采用美国Heahhdyne920M型记录仪动态记录,比较两组的血氧饱和度.治疗组10例术后复查胸部CT,20例术后复查静脉血白细胞总数.统计学方法 采用t检验进行处理.结果 40例均经球囊探查,其中34例确定了引流支气管进行封堵术.34例中4例第1次封堵时不成功,转而接受其他治疗,其余30例经封堵后引流瓶气泡明显减少或完全停止.30例中5例于72 h内复发,其中3例行第2次封后例封堵成功,2例接受外科胸腔镜治疗,最终封堵成功率为82%(28/34).操作期间治疗组最低SaO2为(89.0±2.8)%,对照组为(78.2±2.7)%;治疗组平均SaO:为(93.4±2.6)%,对照组为(92.2±1.4)%;治疗组SaO2＜90%占检查时间的百分比为(10.7±17.5)%,对照组为(2.1±1.1)%;各指标2组比较均无统计学意义.术后10例复查胸部CT均未见阻塞性肺不张.术后3/20例患者外周血白细胞计数高于10×109/L,术前均合并肺部感染,且其中2例术前白细胞计数升高.34例接受封堵者有5例出现中、低热,均易得到控制.结论 球囊探查加支气管封堵术对难治性气胸是一种安全、有效的治疗方法 ,尤其适用于全身情况差、肺功能明显减退以及暂不愿接受手术者.     

经皮胸腔置入中心静脉导管治疗气胸临床疗效分析

目的探讨经皮穿刺胸腔置入中心静脉导管持续引流替代反复多次胸腔穿刺抽气治疗各种病因所致的自发性气胸临床疗效和安全性。方法对我院2004年1月-2008年12月收治的各种病因的气胸病例中经胸部X线检查确诊为气胸的病例28例,随机分成2组（治疗组11例及对照组17例）,分别用中心静脉导管持续胸腔引流和反复多次的胸腔穿刺抽气治疗,对这两种治疗方法的效果、出现并发症情况、住院费用进行比较。结果治疗组11例患者均得到根治性治愈,治愈率达100％,鼹种方法相比：胸膜腔气体吸收时间（3.24±1.76天 vs 10.14±2.72天）,胸膜反应（0％ vs 11.76％）,住院费用（1291.52±716.59元 vs 1736.49±1211.43元）,各项指标对比其差异均有统计学意义（P〈0.05）。结论中心静脉导管胸腔置人治疗气胸简单易行,出血少,创伤小,抽气过程中可随意控制抽气速度,可反复使用,治疗彻底,值得临床推广。     

中心静脉导管在气胸中应用24例观察

目的探讨中心静脉导管在气胸治疗的效果。方法分析2002年2月至2007年7月内蒙古阿拉善右旗人民医院应用中心静脉导管在气胸治疗中应用24例,与胸腔闭式引流术在治疗效果,术后并发症等方面相比较。结果治疗效果满意,治愈率高,术后并发症少。结论中心静脉导管在气胸的治疗中疗效满意,操作简便,术后并发症少,值得临床进一步验证推广。     

应用中心静脉导管引流治疗自发性气胸18例

临床上治疗自发性气胸,多采用肋间切开插粗硅胶管,患者痛苦较大,创伤大,感染率较高,并发症多.我院自2005年以来即采用中心静脉导管引流治疗自发性气胸18例,取得成功,减少了并发症及患者痛苦,现报道如下.     

中心静脉导管治疗自发性气胸的临床观察

目的 比较中心静脉导管与粗硅胶管行胸腔闭式引流治疗自发性气胸的疗效及并发症.方法 我科收治的64例自发性气胸患者随机分治疗组和对照组,治疗组32例行中心静脉导管闭式引流接TFR型胸腔引流储液瓶3-1300加DY-1A型低压电动负压吸引器吸引;对照组32例行粗硅胶管接水封瓶闭式引流,观察两组疗效及并发症.结果 中心静脉导管组与粗硅胶管组疗效相近,差异无统计学意义,但粗硅胶管行闭式胸腔引流并发症多.结论 中心静脉导管闭式胸腔引流家负压吸引治疗自发性气胸是一种痛苦小,并发症少,操作简便,病人易接受的方法.     

Percutaneous pulmonary angioscopy using a guiding balloon catheter

The applicability of angioscopy for observation of the pulmonary arterial lumen was examined in 7 anesthetized dogs and in 10 patients with various heart diseases during cardiac catheterization. A novel guiding balloon catheter (#11F shaft diameter and 1.5 cm in balloon diameter) was introduced through the right femoral vein into the pulmonary artery by Seldinger's method. Then, a fiberscope (1.3 or 1.8 mm in diameter) was introduced through the guiding catheter into the desired portion of the artery. The balloon was inflated, saline was infused, and the pulmonary arterial lumen was photographed on 16-mm color cinefilms. In all dogs and patients examined, an increase in diameter of the pulmonary artery during systole and the backflow of blood from the pulmonary vein were clearly demonstrated. Also, pulmonary thrombi or emboli experimentally induced in dogs could be observed. No complications were observed in the patients. The results indicate the experimental and clinical applicability of angioscopy using a guiding balloon catheter for observation of the pulmonary arterial lumen.     

应用人血白蛋白泡沫定位支气管胸膜瘘所属支气管1例

目前,国内外广泛采用双腔球囊导管定位支气管胸膜瘘(BPF)所属支气管,已有大量报道证实双腔球囊导管定位BPF所属支气管的有效性和安全性[1]。然而,我们在临床应用中感到:该方法存在诸多缺陷,妨碍了进一步推广和应用。本研究旨在探讨应用人血白蛋白泡沫定位BPF所属支气管的方法、有效性和安全性。     

Entrapment of an angioplasty balloon catheter: a case report

This report presents a case in which an angioplasty balloon catheter became entrapped within the lumen of a coronary artery after rupture during percutaneous transluminal coronary angioplasty (PTCA). Prior to this report, balloon rupture had been considered a relatively benign occurrence. However, this case demonstrates that balloon rupture may lead to serious complications.     

Usefulness of a new radiofrequency thermal balloon catheter for pulmonary vein isolation: a new device for treatment of atrial fibrillation

INTRODUCTION: A rapidly firing or triggered ectopic focus located within a pulmonary vein (PV) or close to the PV ostium could induce atrial fibrillation (AF). The aim of this study was to evaluate the efficacy and safety of a radiofrequency thermal balloon catheter for isolation of the PV from the left atrium (LA). METHODS AND RESULTS: Twenty patients with drug-resistant paroxysmal AF were treated by isolating the superior PVs using an RF thermal balloon catheter. Using a transseptal approach, the balloon, which had an inflated diameter 5 to 10 mm larger than that of the PV ostium, was wedged at the LA-PV junction. It was heated by a very-high-frequency current (13.56 MHZ) applied to the coil electrode inside the balloon for 2 to 3 minutes, and the procedure was repeated up to four times. The balloon center temperature was maintained at 60 degrees to 75 degrees C by regulating generator output. Successful PV isolation was achieved in 19 of the 20 left superior PVs and in all 20 of the right superior PVs and was associated with a decrease in amplitude of the ostial potentials. Total procedure time was 1.8 +/- 0.5 hours, which included 22 +/- 7 minutes of fluoroscopy time. After a follow-up period of 8.1 +/- 0.8 months, 17 patients were free from AF, with 10 not taking any antiarrhythmic drugs and 7 taking the same antiarrhythmic agent as before ablation. Electron beam computed tomography revealed no complications, such as PV stenosis at ablation sites. CONCLUSION: The PV and its ostial region can be safely and quickly isolated from the LA by circumferential ablation around the PV ostia using a radiofrequency thermal balloon catheter for treatment of AF.     

Fracture of a perfusion balloon catheter during coronary angioplasty

In a 74-year-old patient with increasing angina, an attempt was made to dilate an ostial stenosis in the first diagonal artery. The initial attempt with a long balloon catheter was unsuccessful. Because of chest pain associated with hypotension during balloon inflations, a second attempt with a perfusion balloon catheter resulted in fracture of this catheter's tip (14 mm long) in the artery. Bypass graft surgery was performed and the retained fragment was easily removed by arteriotomy. The patient made an uneventful recovery. © 1994 Wiley-Liss,Inc..     

Vascular entrapment of a multipolar basket catheter (OrionTM) during catheter ablation

The IntellaMap Orion^TM (Boston Scientific) is a 64-electrode basket catheter allowing for ultrahigh-density mapping of complex cardiac arrhythmias. We report the case of a basket catheter vascular entrapment, requiring surgical removal.     

Ultrasound-guided insertion of pulmonary artery catheter: Case report

This is a case report of a 17-year old girl, who presented with aortic valve regurgitation and patent ductus arteriosus, and she underwent aortic valve replacement (AVR) and (PDA) ligation. Because of the extensive thrill and pulsation in the neck due to carotid artery dilatation, pulmonary artery catheter (PAC) was inserted under ultrasound guidance. This case report is to encourage the use of ultrasound for the safe puncture of internal jugular vein for the insertion of central line and PAC, particularly in the case of aortic valve regurge patients where carotid artery dilatation expected.