内镜下钳取小儿消化道异物临床分析

目的:对内镜下钳取小儿消化道异物的相关情况进行分析。方法:选取接受治疗的30例消化道异物的小儿患者,采用内镜下钳取消化道异物。结果:上消化道异物30例完整取出,成功率为100%,手术过程及术后均没有患儿出现严重并发症。结论:内镜下钳取小儿消化道异物创伤小、费用低、并发症少,是一种安全有效的方法。     

小儿上消化道异物内镜治疗26例分析

目的探讨和总结经电子胃镜治疗小儿上消化道异物的可行性。方法回顾分析经胃镜治疗小儿上消化道异物26例的临床资料。结果25例异物成功取出,无并发症发生,1例失败。结论经内镜取异物安全可靠、成功率高。     

小儿上消化道异物内镜诊治体会

目的 总结小儿上消化道异物的内镜处理经验.方法 回顾性分析我院2005年5月—2017年3月诊治的76例小儿上消化道异物患者进行内镜处理异物的情况.结果 76例患者中异物位于食管内26例、胃内49例、十二指肠1例,其中3例异物经内镜治疗未能成功.未出现严重并发症(后自行排出),治疗不成功率3.9%.结论 采用内镜诊治小儿上消化道异物是安全有效的治疗方法.上消化道异物一旦确诊,又无内镜检查禁忌证者,均应积极行内镜处理.     

内镜下上消化道异物取出的配合技巧

目的:探讨上消化道异物取出的方法技巧。方法:对78例患者行内镜下上消化道异物取出的体会加以总结。结果:上消化道异物在内镜下试取成功率达97.5%。结论:内镜下取上消化道异物安全、简便、高效。     

无痛内镜下取上消化道异物42例临床分析

目的探讨无痛内镜下取上消化道异物的技巧。方法对42例患者无痛内镜下异物取出的经验教训给予总结。结果无痛内镜下取出成功率97%。结论无痛内镜下取上消化道异物安全、高效、无痛苦。     

上消化道异物163例内窥镜治疗分析

目的探讨内窥镜治疗上消化道异物的疗效和手术安全性及与传统手术相比的优势。方法回顾性分析2002年1月～2011年12月广东廉江市人民医院收治的163例因上消化道异物行内镜治疗的病例的临床特征、手术方式选择、成功率及并发症发生率。结果内镜下成功取出异物151例(占92.64%),其中12例(占7.36%)需传统外科手术治疗。163例就诊病例中以食管上段异物嵌顿为主,其中上消化道异物以骨性异物所占比例最高,占65.03%。结论内镜下采用圈套器、异物钳及取石网篮等行异物取出手术是一种安全、经济、有效的方法,值得临床推广。     

内镜治疗儿童上消化道异物30例临床分析

目的: 探讨内镜治疗儿童上消化道异物的方法、经验及技巧。方法: 对30例儿童(<12岁)上消化道异物行急诊内镜检查和治疗,咽喉部局麻下用成人细径胃镜进行操作,运用各种异物器械取异物。结果: 30例儿童32件异物,非全麻下取异物28例,全麻下取异物2例;食管异物19例,胃内异物9例,十二指肠异物2例。29例31件异物经内镜成功取出,仅1例1件异物进入小肠未能取出,成功率96.7%。除1例在操作过程中出现一过性呼吸抑制,余无其它并发症。结论: 内镜治疗儿童上消化道异物简便、安全、有效,可作为首选治疗方法。     

急诊内镜下取除上消化道异物的配合与护理体会

目的总结急诊内镜下取除上消化道异物的配合技巧与护理体会。方法对我院内窥镜室自2009年7月~2015年3月接诊的上消化道异物患者63例,应用内镜紧急取除的护理配合进行分析。结果 63例患者经急诊内镜下成功取除异物61例67件,成功率96.8%。结论急诊内镜下对上消化道异物进行早期积极的取除是安全有效的治疗手段,可最大程度解除患者痛苦,避免严重并发症的发生。     

上消化道异物的内镜治疗（附20例报告）

目的 探讨内镜治疗成人及小儿消化道与咽喉部异物的可行性。方法 回顾分析了本院1997－1999年间经胃镜治疗的上消化道及咽喉部异物20例患者的临床资料。结果 16例成功取出异物,无并发症发生。4例失败,3例因食物干扰视野未能找到异物,1例因异物嵌顿于食道中段不能松动。结论 经内镜取异物安全可靠,适用于成人与小儿。     

76例上消化道内异物内镜治疗临床分析

目的探讨上消化道异物内镜下取出方法,提高异物取出成功率。方法收集1998～2008年76例上消化道异物患者临床及胃镜资料,分析异物部位、大小、形状以及所选用的不同器械取出方法,比较不同类型异物取出率的差异,计算食管破裂、食管穿孔、大出血、纵隔炎、气胸、吸入性肺炎等并发症的发生率。结果 76例上消化道异物取出总体成功率92%（70/76）,其中圈套器取异物占39%（30/76）,成功率97%（29/30）;腭口钳取异物占38%（29/76）,成功率93%（27/29）;三爪钳取异物占15.7%（12/76）,成功率92%（11/12）,螺旋网篮形异物钳取异物占6.6%（5/76）,成功率60%（3/5）,均未见食管破裂、食管穿孔、大出血、纵隔炎、气胸、吸入性肺炎等并发症。结论根据异物特点选择合适器械,设计合理的取出方法,可提高上消化道内特殊异物的取出率,减少患者痛苦,降低并发症。     

Development of an Algorithm to Identify Cannabis Urine Drug Test Results within a Multi-Site Electronic Health Record System

With the rapid changes in the legalization of cannabis in the U.S., there is an urgent need to understand clinical outcomes and processes of care among patients who use cannabis, particularly among patients with chronic pain who are high utilizers of cannabis. Electronic health records (EHRs) are a common and convenient mechanism for examining processes of care; however, there is not an indication for cannabis use that does not meet criteria for a diagnostic disorder. We used urine drug test (UDT) results identified through EHRs to identify patients with confirmed cannabis use. We developed and tested an algorithm to identify outcomes of UDT results for cannabis because there is wide variability in reporting methodology, including in multi-site health systems. Among all patients receiving care in the Department of Veterans Affairs (VA) who were prescribed long-term opioid therapy for chronic pain, we identified a random sample who completed UDT for cannabis. Through an iterative process, we developed an algorithm to identify UDT cannabis results. Manual review of EHR data was conducted to verify accuracy of UDT results. The final UDT algorithm correctly identified 99% of cannabis positive UDT results and 100% of cannabis negative UDT results among 200 randomly sampled patients. Study findings suggest a high degree of accuracy for using an algorithm to identify samples of patients with positive cannabis UDT results across multiple institutions with disparate UDT reporting practices. The methodology for testing this algorithm is feasible and may be applied to other multi-site health systems.     

全身麻醉用于小儿特殊类型气管异物探取术

目的探讨一种使患儿舒适、安全,术者乐意采用、认可的取异物全身麻醉方法。方法采用表面麻醉与利多卡因、γ-羟丁酸钠、芬太尼、丙泊酚等药物静脉复合,使患儿术程中保留自主呼吸。在严密的生命指征监测指导下控制麻醉深度。结果51例手术圆满完成操作,49例异物一次性取出。平均手术时间20分钟。围手术期:患儿安静、无痛,探取顺利,术者满意。患儿全部在术后40±12分钟内清醒,无术中不良记忆和术后并发症。结论合理的药物组合、全身麻醉下探取小儿特殊类型气管异物是安全可行的方法,易于推广使用。     

The role of FB21 as a marker of glomerular endothelial cell injury

FB21 was reactive with the glomerular endothelial cells and distal tubules of the human kidney and was bound to a sialic-acid-dependent cell surface antigen. We evaluated the FB21 staining in fetal kidneys, and the kidneys of children and adults with normal kidneys and glomerulonephritis and investigated whether FB21 can be used as a marker for endothelial cell injury. FB21 was reactive with the endothelial cells of normal kidneys and was detected on the surface of endothelial cells by immunoelectron microscopy. FB21 was reactive with endothelial cells in the kidneys of over 32-week fetuses. The endothelial cell FB21 staining scores in the first renal biopsy specimens of patients with hemolytic uremic syndrome (HUS) were lower than in the kidneys of children with normal kidneys and was negatively correlated with their serum E-selectin concentrations. The FB21 staining of glomerular endothelial cells was similar to the staining for the other endothelial markers, CD34 and von Willebrand factor (vWF). However, FB21 staining of interstitial blood vessels was very weak and was distinct from that of other endothelial markers. These results suggest that FB21 can be used as a specific marker for glomerular endothelial cell injury in various types of glomerulonephritis.     

多层螺旋CT在婴幼儿气道透X线异物急症中的临床应用价值

目的:探讨儿童支气管异物的多层螺旋CT诊断价值.方法:对33例儿童气道异物进行三维重建,8例同时进行低毫安(ma)量的胸部CT扫描,回顾分析其影像学表现.结果:气管内5例,左主支气管13例,右主支气管8例;中间主支气管3例,左、右下支气管异物各2例.以花生米、瓜子类为主.CT征象包括:异物直接显示,阻塞性肺气肿.结论:多层螺旋CT能清晰显示气管支气管树,能直接而准确定位异物为支气管异物提供一种新的更准确的术前诊断途径.     

床旁纤维支气管镜检查在重症免疫抑制相关性肺病中的应用

目的探讨纤维支气管镜检查在重症免疫抑制相关性肺病中的应用价值。方法80例免疫抑制相关性肺病患者中有25例(31·2%)重症患者进行了经纤维支气管镜支气管肺灌洗,对其中10例(40%)进行透壁肺活检。分别对肺灌洗液和肺组织进行病原学和病理学检查。结果25例重症免疫抑制相关性肺病中,18例(72%)培养出病原微生物,7例(28%)培养阴性。其中细菌12例(66·7%),真菌6例(33·3%),细菌与真菌混合感染者3例。10例肺活检患者中有5例患者得到明确的病理诊断,5例为非特异性病理学改变。检查过程中25例患者中有6例(14%)血氧饱和度显著下降,4例(16%)术后少量咯血,2例(8%)在随后机械通气过程中发生气胸。结论对重症免疫抑制相关性肺病患者早期进行气管镜检查能提高病原微生物的检出率,及时指导调整治疗方案,进行针对性治疗。恰当的运用经气管镜肺活检,能进一步明确肺部并发症的性质,提高诊断正确率。对重症免疫抑制相关性肺病患者进行纤维支气管镜检查是安全可行的。     

Ferruginous bodies in cases with occupational and non-occupational exposure to inorganic dusts. A study with 40 matched cases.

In this study we evaluated the usefulness of ferruginous bodies (FB) quantification in lung digest and histologic sections from 40 patients with a history of exposure to inorganic dusts. The patients were matched with 40 cases without occupational exposure. The samples of peripheral lung tissue were digested and all FB were quantified. Lung sections were also evaluated in order to confirm the presence of FB. The concentrations of FB in the patients were higher than the controls (Wilcoxon test, p < 0.001). The patients group showed a median concentration of 194.5 FB/g of dry lung tissue (FB/g) vs. 34.0 FB/g in the controls. Seventy percent of the patients had more than 100 FB/g vs. 27.5% in the controls cases. Pneumoconiosis was diagnosed in 19 patients, 17 had FB/g above 100 and only 4 were positive to FB in lung sections. We can conclude that lung digest and FB counts help to confirm exposures to inorganic dusts above the background values found in the general population. FB counts can help when the clinical file does not confirm the exposure.     

纤维支气管镜对支气管异物漏诊患者的诊治价值

为探讨支气管异物的漏诊原因和总结纤维支气镜（ＦＢ）对该病的诊治经验,作者对曾被误诊经验,作者对曾被误诊为其它疾病并经ＦＢ检查确诊１２例支气管异物患者的诊治经验进行了总结分析,结果发现,该１２例患者均因无明确的异物吸入史,胸片上未能见及异物,仅见及肺不张,肺门阴影增大及阻塞性肺炎,以及临床再现为支气管肺感染或喘息等,而被误诊为肺癌、肺炎、哮喘和肺结核,经ＦＢ检查后均获确诊,其中１１例经ＦＢ成功地钳出     

胰十二指肠切除术后早期液体平衡与胰瘘相关

目的 评价胰十二指肠切除术（pancreaticoduodenectomy,PD）后48 h累积液体平衡量（cumulative fluid balance postoperative 48h,FB 48 h）与术后胰瘘（postoperative pancreatic fistula,POPF）发生率的关系。方法 回顾性分析首都医科大学附属北京朝阳医院外科重症加强治疗病房（surgical intensive care unit,SICU）连续收治的237例PD术后患者,收集并整理其术前、术中和术后临床资料。按照是否发生POPF将患者分为胰瘘组（POPF）和非胰瘘组（Non-POPF）,采用单自变量Logistic回归模型筛选POPF的危险因素,采用多自变量Logistic回归模型去除混杂因素,最终确定POPF的危险因素。进一步根据FB 48 h将患者分为液体负平衡组（FB 48 h ≤ 0 mL·kg^-1·h^-1）、少量液体正平衡组（0 mL·kg^-1·h^-1 < FB 48 h ≤ 0.5 mL·kg^-1·h^-1）、中等量液体正平衡组（0.5 mL·kg^-1·h^-1 < FB 48 h ≤ 1 mL·kg^-1·h^-1）和大量液体正平衡组（FB 48 h>1 mL·kg^-1·h^-1）等4个亚组,分析FB 48 h与POPF之间的关系。结果 30例（12.7%）患者发生了POPF,其中B级POPF 24例（10.1%）,C级POPF 6例（2.5%）。多自变量Logistic回归分析显示,性别（男性）（OR=23.917,95% CI：3.775~151.526,P=0.001）、高体质量指数（body mass index,BMI）（OR=1.313,95% CI：1.059~1.628,P=0.013）、罹患糖尿病（OR=9.120,95% CI：2.262~36.771,P=0.002）、入院时低白蛋白浓度（OR=0.876,95% CI：0.783~0.981,P=0.022）、术前高胆红素浓度（OR=1.008,95% CI：1.002~1.013,P=0.005）和FB 48 h（OR=4.870,95% CI：1.906~12.443,P=0.001）为POPF的独立危险因素。大量液体正平衡组患者C级POPF发生率显著高于少量液体正平衡组（P=0.002）和中等量液体正平衡组（P=0.002）。结论 PD术后FB 48 h是POPF的独立危险因素,FB 48 h>1 mL·kg^-1·h^-1时,C级POPF发生率显著增高。     

CT三维成像对142例儿童支气管异物的诊疗体会

目的：通过儿童支气管异物的诊断及治疗,观察CT三维成像在支气管异物诊断中的可靠性。方法对142例手术取出支气管异物的患儿进行回顾性研究,评价CT三维成像在支气管异物诊断中的作用。结果术前CT诊断明确的142例支气管异物全部由硬性支气管镜成功取出,无严重并发症。结论 CT三维成像在支气管异物的诊断中准确可靠,对于怀疑支气管异物的患者,应该尽早行CT三维成像检查。     

纤维支气管镜对支气管异物漏诊患者的诊治价值

为探讨支气管异物的漏诊原因和总结纤维支气管镜（ Ｆ Ｂ）对该病的诊治经验，作者对曾被误诊为其它疾病并经 Ｆ Ｂ检查确诊的１２例支气管异物患者的诊治经验进行了总结分析。结果发现，该１２例患者均因无明确的异物吸入史，胸片上未能见及异物，仅见及肺不张，肺门阴影增大及阻塞性肺炎，以及临床表现为支气管肺感染或喘息等，而被误诊为肺癌、肺炎、哮喘和肺结核。经 Ｆ Ｂ检查后均获确诊，其中１１例经 Ｆ Ｂ成功地钳出异物而治愈。提示 Ｆ Ｂ对被漏诊的支气管异物患者具有重要的诊治价值。