纤维支气管镜在严重胸部创伤诊断及治疗中的价值

目的 探讨纤维支气管镜(简称纤支镜)在严重胸部创伤的诊断及治疗中的价值.方法 回顾性分析我院1999年1月-2007年7月应用纤支镜进行诊断及治疗的严重胸部创伤患者114例.总共应用纤支镜检查、灌洗治疗289次.纤支镜进入途径:经鼻腔181次,气管插管32次,口腔20次,气管切口套管56次.术前、术中、术后严密监护和监测SaO:及血气分析,同时给予吸氧或呼吸机支持.结果 114例经纤支镜检查明确诊断,对102例患者进行了灌洗治疗.全部患者经1～4次纤支镜检查及灌洗后SaO2均明显提高(P<0.01),术后2 h PaO2改善明显(P<0.05).无因纤支镜检查治疗导致死亡的患者.结论 纤支镜在严重胸部创伤中有重要的诊断及治疗价值,不但可及时明确支气管损伤的诊断,而且可以有效清除气道异物、分泌物、血及痰痂,治疗阻塞性肺不张及阻塞性肺炎,明显改善呼吸功能、提高救治成功率.     

支气管灌洗术治疗重型颅脑伤并严重肺部感染疗效观察

目的 :观察重型颅脑伤合并严重肺部感染早期经纤支镜吸痰和灌洗的疗效。方法 :将重型颅脑伤合并严重肺部感染 87例中的 4 3例行常规治疗为对照组 ;在常规治疗基础上早期经纤支镜灌洗、吸痰 4 4例为纤支镜灌洗组 ,两组治疗后均对体温、白细胞 ,并对其疗效进行分析。结果 :纤支镜灌洗组治愈 2 3例(5 2 3% ) ,对照组 1 2例 (2 7 9% ) ,两组比较 ,差异显著 (P <0 0 1 ) ;治疗后第 5天 ,纤支镜灌洗组平均体温和白细胞计数分别为 36 8℃和 7 2 1× 1 0 9/L ;而对照组则分别为 37 9℃和 1 2 83× 1 0 9/L ,两组比较 ,差异显著(P <0 0 5 )。结论 :经纤支镜灌洗、吸痰是治疗重型颅脑伤合并严重肺部感染的安全、有效的方法     

三通喉罩通气下纤维支气管镜在重症肺部感染中的应用

目的探讨三通喉罩通气下纤维支气管镜(纤支镜)对重症肺炎患者的治疗作用及安全性。方法 30例重症肺炎患者(治疗组)在快速诱导麻醉下插入三通喉罩,其标准端口连接呼吸机,另一带有密封胶帽端口置入纤支镜,实施支气管肺泡灌洗术。另选取30例重症肺炎患者作为对照组,表麻下经纤支镜常规行支气管肺泡灌洗术。观察两组术前、术中、术后心率、血压、脉搏氧饱和度的变化,并观察术后疾病的转归情况。结果治疗组全部30例手术顺利完成,三通喉罩通气不同时间点血流动力学指标稳定,通气效果良好,无明显并发症;术中治疗组心率、血压显著低于对照组(P<0.01),脉搏氧饱和度显著高于对照组(P<0.01)。总有效率治疗组(93.3%)明显优于对照组(76.7%)(P<0.05)。结论三通喉罩通气下经纤支镜治疗重症肺炎相对于常规纤支镜治疗,具有安全、可靠、并发症少、效果满意等优点。     

西宁地区重症胸部创伤患者纤维支气管镜早期临床应用

目的：探讨纤维支气管镜（纤支镜）在高原重症胸部创伤早期临床应用价值.方法：对46例高原重症胸部创伤患者入院12小时内应用纤支镜检查、镜下止血、支气管冲洗、治疗肺不张及纤支镜引导下经鼻气管插管并总结分析其临床资料.结果：46例患者纤支镜检查和治疗后SaO2、心率、血气分析,胸部X片均出现明显改善,其中有21例ARDS患者经纤支镜引导下经鼻插管后呼吸机辅助呼吸抢救成功.结论：纤支镜早期检查和治疗,操作简单,诊断明确,抢救及时,防止病情恶化,对气道管理起到较好的作用.     

纤维支气管镜肺灌洗防治重型颅脑创伤肺部并发症的疗效分析

重型颅脑创伤后肺部并发症是影响患者预后的重要因素之一。笔者通过纤维支气管镜 (简称纤支镜 )肺灌洗方法有效纠正了患者的低氧血症。报告如下。临床资料　 (1)一般资料 :男 82例 ,女 44例 ;年龄 12～ 69岁 ,平均 3 9.8岁。入院时格拉斯哥昏迷评分 (ＧＣＳ)均在 8分以下 ,其中合并胸廓损伤所致血气胸11例。均行气管切开或气管插管、颅内压监测。将本组患者按入院先后 1∶3的方法分为传统治疗组 3 0例 ,纤支镜肺灌洗组 96例 ,进行疗效观察和对比分析。传统治疗组 :常规建立人工气道 ,药物解除支气管痉挛 ,雾化吸入 ,气管内湿化 ,翻身拍背吸…     

纤支镜在机械通气患者中的临床应用

目的评价纤维支气管镜(纤支镜)在机械通气患者中的应用价值。方法在监护下对192例机械通气患者行纤支镜检查及治疗。结果对血氧饱和度下降、呼吸和心率不稳定、气道压力明显不稳定、血痰、肺不张、严重肺部感染等能查找出原因,并予相应的镜下治疗,效果显著;纤支镜引导经鼻气管插管、换管及引导插胃管成功率高、效果好。结论纤支镜在机械通气患者中的应用可以发挥重要作用。     

经纤支镜灌洗治疗肺心病141例报告

目的：本文是通过纤支镜对肺源性心脏病肺段灌洗治疗清除积痰后可使病人缺氧状态得以改善，使氧饱和度明显上升，肺部感染能有效控制，通气功能得到明显改善，生命得以延长。方法：按常规纤支镜操作方法，采用配有抗菌素、化痰、止喘等物的生理盐水进行灌洗治疗，病人易接受，安全而且疗效好。结果：通过分次灌洗治疗，患者血氧饱和度明显上升，可达85％—93％，平均提高8％—25％，肺部感染能有效控制，通气功能明显改善。结论：经纤支镜灌洗治疗肺心病是目前的一种行之有效、病人生命得以延长的一种好的治疗方法。     

经纤维支气管镜灌洗治疗难治性肺部感染的临床评价

目的探讨纤维支气管镜灌洗治疗难治性肺部感染的临床疗效。方法37例难治性肺部感染患者随机分为治疗组与对照组，治疗组在常规治疗基础上采用纤支镜灌洗治疗，单纯全身抗感染治疗作为对照组。结果治疗组总有效率为94．74％，对照组总有效率为61．11％，治疗组疗效优于对照组。结论经纤支镜灌洗治疗难治性肺部感染是安全有效的方法之一．具有一定的临床意义。     

纤维支气管镜在抢救呼吸系统急重症患者中的应用

1993年～1998年我院对68例呼吸系统急重症患者采用纤支镜引导气管插管、支气管冲洗及局部治疗,取得良好疗效。1　资料和方法11　一般资料　本组68例中男46例,女22例,年龄26～89岁,平均67岁。其中慢性阻塞性肺疾病24例,胸腹外伤、胸腔术后及脑血管意外致肺不张38例,哮喘持续状态2例,气管肿瘤3例,支气管异物1例,支气管扩张、支气管动脉—肺动脉瘘大咯血各1例。12　方法　使用ＯＬＹＭＰＵＳＢＦＰ20纤支镜及其配件,经鼻高频喷射通气给氧,经皮氧饱和度仪和心电图仪监护,用2%利多卡因喷雾麻醉,再用1%麻黄素液喷雾鼻腔,危重者也可不麻醉,均在床边…     

高频通气支持下纤支镜治疗高危肺结核33例

两肺广泛浸润或多叶毁损的进展期肺结核，常发生呼吸衰竭，严重低氧血症是引起死亡的主要原因。纤维支气管镜(纤支镜)介入治疗，包括吸除痰液、支气管肺泡灌洗、导管注药，既能充分清除气道分泌物，又能注入高浓度抗生素，起到疏通气道、强化抗结核、改善呼衰、挽救生命的治疗作用，但纤支镜进入气道的治疗过程，可使PaO2进一步降低，从而引起心律失常、心跳骤停等严重并发症。为提高纤支镜治疗的安全性，我们于1999年6月～2003年6月，在高频喷射通气(HFJV)支持下，行纤支镜介入治疗肺结核呼吸衰竭33例，取得良好疗效。     

Comparison of vertical and oblique CT in evaluation of bronchial tree

A prospective evaluation of segmental and subsegmental bronchi of 104 right and 109 left lungs was made from oblique CT scans of patients with normal airways. The frequency of identification of each of these bronchi was compared with the results of a similar retrospective analysis of 107 right and 113 left lungs, studied with standard vertical CT slices. The percent visualization of all bronchial ramifications is tabulated, allowing us to state that the 20 degrees cranially oblique slice considerably improves CT analysis of the bronchial tree. Several potential uses of oblique CT are discussed and applied to bronchial disease evaluation.     

Mild intermittent asthma: CT assessment of bronchial cross-sectional area and lung attenuation at controlled lung volume

PURPOSE: To evaluate, with thin-section computed tomography (CT), changes in bronchial cross-sectional area and lung attenuation induced by bronchial stimulation in patients with mild intermittent asthma, at a given lung volume monitored with pneumotachography. MATERIALS AND METHODS: Twelve patients with mild intermittent asthma who were nonsmokers (National Institutes of Health staging) and six nonsmoking healthy volunteers, age and sex ratio-matched, were examined by using helical thin-collimation CT at the level of basal bronchi at 65% of total lung capacity. Three sets of acquisitions were obtained: at baseline and after inhalation of methacholine and then salbutamol. Cross-sectional areas of bronchi greater than 4 mm(2) were segmented and calculated from CT images. Lung attenuation was measured in the anterior, lateral, and posterior areas of the right lung parenchyma. Gas trapping was evaluated by using thin-section CT at residual volume in six of the patients with asthma. Statistical analysis included two factors repeated-measurement analysis of variance and Mann-Whitney and Kruskal-Wallis nonparametric tests. RESULTS: Bronchial cross-sectional areas and lung attenuation did not vary significantly compared with baseline values following bronchial challenge in healthy volunteers or patients with asthma. However, in patients with asthma, bronchial cross-sectional areas were significantly smaller than in healthy volunteers, except after inhalation of salbutamol. Lung attenuation and anteroposterior attenuation gradient were significantly higher in patients with asthma than in healthy patients (P <.001). Air-trapping scores were significantly higher after methacholine challenge. CONCLUSION: Helical thin-collimation CT at controlled lung volume and at full expiration associated with bronchial challenge may help evaluate bronchoreactivity and inflammation in mild intermittent asthma.     

口咽通气道用于ECT患者麻醉恢复期气道管理的效果

目的评价口咽通气道用于电抽搐治疗(ECT)患者麻醉恢复期气道管理的临床效果及实用性。方法 ECT治疗术毕恢复期患者80例,年龄20～50岁,ASAⅠ～Ⅱ级,随机分成两组,口咽通气道组(Ⅰ组,40例)和自然恢复组(Ⅱ组,40例),待通电治疗完成后,Ⅰ组即刻经口腔置入口咽通气道,Ⅱ组采取头偏侧位,至苏醒,两者均给予面罩吸氧,SpO2<90%时采取补救措施,于术毕恢复期2 min(T1)、3 min(T2)、5 min(T3)、10 min(T4)记录RR、SpO2、HR、SBP和DBP。结果两组患者的RR、HR、SBP、DBP在相应的各时点差异无统计学意义(P>0.05),与Ⅰ组相比较,Ⅱ组T2、T3时点SpO2明显降低(P<0.05)。结论 口咽通气道在维持ECT患者麻醉恢复期上呼吸道通畅的效果明显。     

Interobserver variation in the diagnosis of bronchiectasis on high-resolution computed tomography

The purpose of our study was to determine interobserver variation in the analysis of high-resolution computed tomography (HRCT) in the lungs of patients with clinically suspected bronchiectasis. HRCT scans of 88 patients were analysed independently by three radiologists with variable experience in thoracic radiology using a subjective scoring system to record bronchi as normal, mildly abnormal or severely abnormal. The presence, severity and distribution of bronchial dilatation and bronchial wall thickening were recorded. Kappa values were calculated for assessment of interobserver agreement. Agreement between the three readers was good for the detection of bronchiectasis (kappa 0.78) and assessment of its severity (0.68), detection of bronchial wall thickening (0.64) and moderately good for the assessment of its severity (0.58) on a per-patient basis. When individual lobes were analysed, agreement was moderately good for the detection of abnormal bronchi (0.59). Agreement on the extent of abnormal bronchi using five categories was only fair (0.39), but was good when differences of one category were ignored (0.63). Interobserver variation with HRCT in suspected bronchiectasis appears satisfactory for comparative studies.     

Bronchial artery perfusion scintigraphy to assess bronchial artery blood flow after lung transplantation.

The bronchial arterial system is inevitably interrupted in transplanted lungs when removing the organs from the donor, but it can be reestablished by direct bronchial artery revascularization (BAR) during implantation. The purpose of this study was to visualize and quantify the distribution of bronchial artery perfusion after en bloc double lung transplantation with BAR, by injecting radiolabeled macroaggregated albumin directly into the bronchial artery system. METHODS: BAR was performed using the internal mammary artery as conduit. Patients were imaged 1 mo (n = 13) or 2 y (n = 9) after en bloc double lung transplantation with BAR. Immediately after bronchial arteriography, 100 MBq macroaggregated albumin (45,000 particles) were injected through the arteriographic catheter. Gamma camera studies were then acquired in the anterior position. At the end of imaging, with the patient remaining in exactly the same position, 81mKr-ventilation scintigraphy or conventional intravenous pulmonary perfusion scintigraphy or both were performed. Images were evaluated by visual analysis, and a semiquantitative assessment of the bronchial arterial supply to the peripheral parts of the lungs was obtained with conventional pulmonary scintigraphy. RESULTS: The bronchial artery scintigraphic images showed that the major part of the bronchial arterial flow supplied central thoracic structures, but bronchial artery perfusion could also be demonstrated in the peripheral parts of the lungs when compared with conventional pulmonary scintigraphy. There were no differences between scintigrams obtained from patients studied 1 mo and 2 y post-transplantation. CONCLUSION: Total distribution of bronchial artery supply to the human lung has been visualized in lung transplant patients. This study demonstrates that this nutritive flow reaches even the most peripheral parts of the lungs and is present 1 mo as well as 2 y after lung transplantation. The results suggest that bronchial artery revascularization may be of significance for the long-term status of the lung transplant.     

支气管结核的MSCT诊断

目的:分析支气管结核的多层螺旋CT表现,评估其诊断价值。材料和方法:回顾性分析50例经支纤镜及手术、病理证实的支气管结核的多层螺旋CT表现。结果:支气管结核的MSCT表现有以下特点:(1)多支段受累,好发于上肺叶及中肺叶;(2)病变支气管范围长,多为主支气管、叶支气管、段支气管连续或间断受累;(3)管腔多为不规则狭窄;(4)管壁多为不规则增厚,密度增高或钙化;(5)胸内多见结核并发灶。病变支气管壁的MSCT表现与支纤镜病理分型有相关性。结论:MSCT对支气管结核的诊断及治疗方法的选择有较高的临床应用价值。     

Bronchopulmonary arterial anastomosis at the precapillary level in human lung. Visualization using CT angiography compared with microangiography of autopsied lung

PURPOSE: To investigate the interrelationships between the bronchial and pulmonary circulations including the existence of precapillary bronchopulmonary arterial anastomoses. MATERIAL AND METHODS: CT of bronchial arteriography (BAG-CT) was performed in 10 patients and BAG-CT during a pulmonary artery block test (PA-block) in 5 patients with lung cancer. Bronchial and pulmonary circulations were evaluated in 5 autopsied normal lungs by injecting silicone rubber with different colors into the bronchial and pulmonary arteries. RESULTS: BAG-CT correlated well with the findings at silicone rubber injection into lung autopsy samples. BAG-CT demonstrated inflow of contrast medium into the pulmonary artery during PA-block in all cases, while no inflow was observed before and following reversal of PA-block. Mixed silicone rubber was observed in the lobar to subsubsegmental bronchial arteries in all cases and in the subsubsegmental pulmonary artery in one case. CONCLUSION: Precapillary bronchopulmonary arterial anastomoses may exist at the level of the lobar bronchi to the periphery. If either the pulmonary or bronchial circulation is disturbed, flow occurs inside the anastomoses to supplement the other flow, especially flow from the bronchial to the pulmonary arteries via the anastomoses, which occurs within 30 min.     

Powdered diatrizoic acid for radiography of the respiratory tract. Part I. Experimental investigation

Powdered diatrizoic acid as a contrast medium administered by inhalation and insufflation for visualization of the airways was tested in vitro and in 21 dogs. Good radiopacity of the contrast medium and its antibacterial activity was found in vitro. In the majority of animal experiments visualization of the bronchial tree down to segmental and partially to subsegmental bronchi with only minimal agglomeration of contrast medium and with good or very good demonstration of anatomic details was achieved. In the majority of dogs contrast medium was eliminated from the lungs within 18 hours. Arterial blood gases tested on 5 dogs showed only unimportant changes after contrast medium administration. No adverse reactions were observed. Histologic and ultrastructural examinations after contrast studies showed phagocytic reaction to diatrizoic acid, transient impairment of production of surfactant, reactive changes of bronchial mucosa, and no fibrotic changes in the long-term observation.     

高住低训过程中血氧饱和度变化及其与血红蛋白变化的关联

目的:观察低氧运动过程中脉搏血氧饱和度(SpO2)和血红蛋白(Hb)的变化规律,探讨科学进行高住低训的评价指标.方法:8名男性受试者每晚于15.4%O2低氧环境中暴露10小时,白天在常氧环境下训练.测定高住低训过程中,常氧运动、急性低氧暴露10小时、高住低训第1、2、3、4周时低氧运动(15.4%O2,76.5%VO2max强度)中SpO2及安静时Hb.结果:(1)常氧状态下运动时SpO2下降幅度最小,急性低氧暴露时最大.随着受试者对低氧运动的适应,SpO2下降幅度逐渐减小.(2)常氧运动中,SpO2在运动开始时下降.随着运动时间的延长SpO2逐渐回升到运动前水平;急性低氧运动时,SpO2一直处于低水平,至恢复期10分钟仍未恢复到运动前水平.随着受试者对低氧运动的适应,虽然运动中SpO2下降,但运动后10分钟已恢复到安静时水平.(3)高住低训过程中,Hb呈上升趋势,第4周时有所下降,且SpO2与Hb的变化存在较大个体差异.结论:进行4周HiLo,机体逐渐适应了低氧环境;个体SpO2和Hb的变化可能存有一定的关联性.提示可以将SpO2作为评价低氧适应的生理指标.