激光加气道内支架在气道完全闭塞治疗中的应用

目的探讨气道内激光加内置支架在气道完全闭塞治疗中的应用价值.方法对17例气道完全闭塞患者应用掺钕钇铝石榴石激光加气道内置支架治疗,并定期随访2～20个月.结果17例患者经激光治疗后气道均有扩大,平均扩大(5.82±1.01)mm;气促分级减少,除1例患者无变化外,减少1级4例,2级减少11例,3级减少1例;1秒钟用力呼气容积(FEV1)增加(0.49±0.18)L.14例患者经激光治疗后行气道内支架置入术,术后患者的气道直径平均又增大(3.50±0.94)mm;气促分级又进一步减少,除2例患者无变化外,有8例减少1级,4例减少2级;FEV1平均又增加(0.41±0.20)L.在激光治疗过程中有15例患者出现低氧血症,2例患者出现出血,有3例患者术后早期出现呼吸困难;支架置入后出现反复肺部感染者4例,支架网眼内肉芽组织或肿瘤组织生长形成阻塞5例,支架出现移位1例,经处理后气道均保持通畅.结论激光治疗加气道内置支架在气道完全闭塞患者的治疗中是行之有效的.     

气道内支架置入术治疗老年人癌性气道狭窄

一、对象和方法　　 1.对象 :选自我院 1997年 1月至 1998年 12月住院的晚期肺癌患者 2 2例 ,男 15例 ,女 7例 ,年龄 6 0～ 70岁 ,平均(6 6 0± 3 7)岁。鳞癌 16例 ,腺癌 6例。经影像学和气管镜确定狭窄部位 ,其中主气管 9例 ,左总支气管 7例 ,右总支气管 5例 ;狭窄口直径分别为 5 0～ 10 0ｍｍ〔(6 8± 3 0 )ｍｍ〕、4 0～ 6 0ｍｍ〔(4 8± 1 4)ｍｍ〕、3 0～ 6 0ｍｍ〔(4 5±1 4)ｍｍ〕 ,狭窄长度分别为 15 0～ 35 0ｍｍ〔(2 1 1± 8 2 )ｍｍ〕、11 0～ 32 0ｍｍ〔(2 5 0± 8 0 )ｍｍ〕、11 0～ 2 2 0ｍｍ〔(16 0± 5 5 )ｍ…     

局部动脉内纤维蛋白溶解治疗脑血栓栓塞性闭塞

文章将近年国外局部动脉内纤维蛋白溶解治疗脑血栓栓塞性概况及脑不同部位的动脉闭塞类型、治疗的方法、血栓溶解剂型、剂量、治疗结果和并发症作一概述，并对纤维蛋白溶解药物的作用做了讨论。     

局部动脉内纤维蛋白溶解治疗脑血栓栓塞性闭塞

文章将近年国外局部动脉内纤维蛋白溶解治疗脑血栓栓塞性闭塞概况及脑不同部位的动脉闭塞类型、治疗的方法、血栓溶解剂型、剂量、治疗结果和并发症作一概述,并对纤维蛋白溶解药物的作用做了讨论。     

放射治疗联合局部热疗对肿瘤细胞的协同治疗作用

目的 研究放射治疗联合局部热疗对Lewis肺癌细胞及荷瘤小鼠的辐射增敏及协同治疗作用.方法 体外培养Lewis肺癌细胞株,不同方法处理后采用MTT检测及荷瘤动物模型观察方法研究局部热疗联合放疗的辐射增敏效果及协同治疗作用,并对不同方法治疗后的荷瘤皮肤副反应进行对比观察.结果 放疗联合局部热疗对体外培养的Lewis肺癌细胞有较显著的辐射增敏作用,两者协同治疗效果明显;放疗联合局部热疗能减缓荷瘤小鼠肿瘤生长速度、提高肿瘤缓解率,表现出一定的协同作用.结论 放射治疗联合局部热疗能有效地控制实体肿瘤的生长,但局部皮肤的副反应发生率有所提高.     

激光和电热消融术在治疗气道狭窄中的应用

器质性气道狭窄是由气道外压和气道内新生物的阻塞造成，其病因主要是各种良恶性肿瘤、气管、支气管内膜结核、气道外伤、气管插管后的瘢痕狭窄等。这些病变可造成严重的呼吸困难。既往手术治疗是惟一选择。近10年，随着内窥镜介入治疗技术日臻成熟和在我国的广泛应用，为气道狭窄的治疗提供了新的方法。气道外压性狭窄可以通过     

诱导痰在评估气道炎症中的应用

近年来,相对无创且又能直接反映气道炎症的检测技术引起关注。诱导痰（ｉｎｄｕｃｅｄｓｐｕｔｕｍ）具有无创、精确、重复性较好等优点,适于连续监测及客观评估药物的抗炎效果。能更真实反映气道炎症状态,与气道活检的病理改变基本一致［１］。一、诱导痰的方法与产生机制早在１９５８年Ｂｉｃｋｅｒｍａｎ等已使用吸入高渗盐水以诱导痰诊断肺癌,随后亦曾用于肺结核及肺机会性感染的诊断。９０年代初,Ｐｉｎ等［２］。及Ｆａｈｙ等改良诱导方法,使之能更安全地用于研究哮喘患者的气道炎症。目前多采用改良Ｐｉｎ法：诱导前先测定受试…     

金属支架联合放疗治疗胆管恶性梗阻的临床观察

目的探讨应用经内镜胆道金属支架置入术（EMBE）联合放射疗法治疗晚期胆管恶性梗阻的疗效。方法12例失去手术机会的晚期胆管恶性梗阻患者,接受经内镜胆管金属支架置入术,支架置入2～3周后行放射治疗,观察随访。结果置管成功率100％,没有出现与手术有关的严重并发症。术后1周胆红素平均下降50％～60％。所有患者术后2～3周均给予放射治疗,随访6个月未再出现黄疸。有5例生存期超过1年。结论胆道金属支架置入联合放射疗法治疗晚期胆管恶性梗阻患者,可改善临床症状,提高患者的生活质量,延长生存期。是一种较好的姑息治疗手段。     

Perception of Airway Obstruction and Airway Inflammation in Asthma: A Review

Dyspnea has a multifactorial nature and the exact mechanism that causes breathlessness in asthma is not fully understood. There is compelling evidence that factors other than merely mechanical ones take part in the pathophysiology of breathlessness. Some recent reports attribute airway inflammation, which may contribute to the unexplained variability in the perception of dyspnea associated with bronchoconstriction. Eosinophil airway inflammation has been proposed as a determinant of breathlessness via mechanisms affecting either the mechanical pathways that control breathlessness or the afferent nerves involved in perception of dyspnea. In this review, data on the interrelation between inflammation and dyspnea sensation and the impact of treatment on dyspnea sensation are discussed. We conclude that regardless of whether mechanical or chemical inflammatory factors are involved, much variability in dyspnea scores remains unexplained.     

Habituation to Prolonged Airflow Obstruction

The hypothesis that absence of dyspnea during airflow obstruction is caused by habituation to sensory information was tested. Adolescents without respiratory disease breathed through a mouthpiece interrupting airflow analogous to ≈64% reduction in forced expiratory volume in 1 sec. They were randomly assigned to labored breathing for 1 min, 30 min, or twice 30 min (with a 30-min interval in between). Dyspnea was measured pretest without mouthpiece and posttest with mouthpiece in. Results showed no significant difference in posttest dyspnea between conditions. Dyspnea remained remarkably mild. Severe secondary symptoms (excessive saliva) during the experiment made habituation unlikely and the results were interpreted in favor of the alternative hypothesis: lack of or mild dyspnea is associated with a low-anxiety situation without connotation of suffocation, irrespective of level of airflow obstruction.     

Poor Perception of Airway Obstruction in Children with Asthma

The aims of this study were to evaluate children's perception of asthma symptoms and to determine a clinically useful method for identifying poor patient perception of airway obstruction. Three methods were used to analyze the relationships among indices of lung function and perception of breathlessness in 35 children. Approximately half the children in our sample did not perceive either airway obstruction or bronchodilation. We propose that <20% improvement in visual analog scale scores post-bronchodilation may provide a simple index for identifying patients with poor perception of airway obstruction, who may be at risk for fatal or near-fatal asthma.     

纤维支气管镜下高频电刀术联合气管腔内放疗治疗支气管肺癌气道阻塞

目的观察纤维支气管镜下高频电刀术联合气管腔内放疗治疗支气管肺癌致气道阻塞的近期疗效。方法对18例支气管肺癌所致气道阻塞患者进行纤维支气管镜下高频电刀烧灼切割术,再行气管内192Ir放疗,观察治疗前和治疗后临床指标的改善情况。结果治疗后18例支气管肺癌患者的临床气促分级、Kamofsky评分与肺功能指标均有显著好转,无明显副反应。结论纤维支气管镜下高频电刀术联合腔内放疗是治疗肿瘤性气道阻塞的有效方法,操作简便易行,值得推广。     

气管镜介入治疗对120例良性气道狭窄的疗效分析

目的探讨多种气管镜介入治疗方法对不同病变类型气道内良性狭窄的疗效。方法经气管镜治疗的良性气道狭窄患者120例,其中气道内瘢痕组55例,肉芽肿组53例,气道良性肿瘤12例。采用支气管镜下氩等离子体凝固（argon plasmacoagulation,APC）、冷冻、内支架等方法进行治疗,并从狭窄程度及气促评分等方面进行疗效分析。结果经支气管镜APC结合冷冻对气道内瘢痕、肉芽肿、良性肿瘤的处理效果相似。治疗后三组狭窄程度和气促评分较术前均有明显改善,表明APC结合冷冻对良性狭窄的治疗效果立竿见影。结论 APC可一次性大部分清除气道内良性肿瘤和肉芽组织,快速缓解气道梗阻症状。同时配合冷冻治疗,延缓复发时间,后期单用冷冻治疗,可达治愈效果。治疗过程中慎用金属支架。     

Airway obstruction lability helps distinguish levels of disease activity in asthma

Classifying disease activity in asthma relies on clinical and physiological variables, but these variables do not capture all aspects of asthma that distinguish levels of disease activity. We used data from two pivotal trials of montelukast in asthma to classify disease activity as "high" or "low". We performed a principal component analysis (PCA) of disease activity using 21 efficacy outcome variables, including several novel derived outcome variables reflecting clinical and airway obstruction lability. Then we performed discriminant analysis (DA) based on disease activity classification. PCA revealed 6 factors (daytime asthma control, nighttime-predominant asthma control, airway obstruction, exacerbations, clinical lability, airway obstruction lability) that explained 76% of the variance between outcome variables. Although airway obstruction lability (comprising both diurnal variability in peak expiratory flow and diurnal variability in β-agonist use) accounted for only 6% of the explained variance in PCA, in DA it was more accurate (canonical coefficient 0.75) than traditional measures of asthma severity such as obstruction (-0.54) and daytime control (-0.56) in distinguishing between high and low disease activity. We conclude that airway obstruction lability, a parameter not typically captured in clinical trials, may contribute to more complete assessment of asthma disease activity and may define an emerging clinical target of future therapy.     

Predictors of New Airway Obstruction – An 11 Year’s Population-Based Follow-Up Study

In the present study we aimed to investigate the incidence and predictors of spirometry based airway obstruction in a representative population-based sample. Altogether 3,863 subjects, 1,651 males and 2,212 females aged ≥30 years had normal spirometry in year 2000. Fifty-three percent of them were never and 23% current smokers. A re-spirometry was performed 11 years later. Several characteristics, such as level of education, use of alcohol, physical activity, diet using Alternate healthy eating (AHEI) index, body mass index, circumwaist, sensitive C reactive protein (CRP) and cotinine of the laboratory values and co-morbidities including asthma, allergic rhinitis, sleep apnoea and chronic bronchitis, as potential risk factors for airway obstruction were evaluated. Using forced expiratory volume in one second/ forced vital capacity below the lower limit of normal, we observed 124 new cases of airway obstruction showing a cumulative 11-year incidence of 3.2% and corresponding to an incidence rate of 5.6/1,000 per year (PY). The incidence rate was higher in men than in women (6.3/1,000 PY vs. 5.0/1,000 PY, respectively). The strongest risk factors were current smoking (Odds ratio [OR] 2.5) and previously diagnosed asthma (OR 2.1). Sensitive CRP associated with the increased risk and high AHEI index with the decreased risk of airway obstruction. Using the similar study approach our findings on the incidence of airway obstruction are in line with the previously published figures in Europe. We were able to confirm the recent findings on the protective effect of healthy diet.