支气管镜下高频电刀治疗气道平滑肌瘤的临床应用

目的观察电子支气管镜下高频电刀在治疗气道平滑肌瘤的可行性及其安全性,观察临床疗效。方法对6例确诊为支气管良性肿瘤所致的气道阻塞患者,在支气管镜下进行高频电刀电凝及电切术,观察气道打通程度、临床症状改善情况及并发症的发生率,并对治疗结果进行统计。结果 6例平滑肌瘤共行10次高频电刀电凝及电切术治疗后均完全打通气道,临床症状完全缓解,彻底治愈。电烧灼切割治疗过程中均未出现纵隔气肿、呼吸道穿孔及大出血等严重并发症。结论经支气管镜下高频电刀电凝及电切术在治疗气道平滑肌瘤引起的气道阻塞疗效显著,可达到临床根治,又避免了开胸手术及减轻医疗费用,可在临床推广。     

经电子支气管镜电刀切除主气道肿瘤34例分析

目的：观察电子支气管镜介导下高频电刀治疗良性气道肿瘤的临床疗效及其安全性,为临床治疗此类患者提供可靠的理论证据。方法：对34例支气管恶性肿瘤所致的气道阻塞患者,进行支气管镜下高频电刀烧灼切割术,对治疗结果进行统计,观察气道打通程度、肺通气功能、气促指数及并发症的发生率。结果：34例恶性肿瘤,其中16例鳞状细胞癌,8例小细胞癌,6例腺细胞癌,4例大细胞癌。电灼后完全打通气道,彻底治愈。电灼过程中均未出现大出血、呼吸道穿孔、纵隔气肿等严重并发症。结论：支气管镜下高频电刀治疗恶性肿瘤引起的气道阻塞疗效显著,避免了开胸手术。     

经纤维支气管镜高频电刀治疗气道阻塞性病变

目的探讨经纤支镜高频电刀对气道阻塞性病变的疗效及安全性。方法对49例气道肿瘤及肉芽肿阻塞性病变，经纤支镜高频电刀切除、电灼扩大管腔，观察疗效及并发症。结果47例（95．9％）患者解除了气道阻塞。呼吸困难缓解，反复感染消除。高频电刀治疗时发生心跳骤停及大出血各1例。随访8个月-4.5a，1例左主支气管结核治疗3个月后再发左全肺不张。结论经纤支镜高频电刀治疗气道阻塞性病变疗效好、并发症少。气道严重阻塞的重症病例有一定技术难度和治疗风险。     

经电子支气管镜高频电和氩气刀治疗气道狭窄21例临床分析

目的观察电子支气管镜下高频电和氩气刀治疗各种原因所致气道狭窄的临床疗效。方法使用ERBEVIO型氩等离子凝固器经电子支气管镜对21例气道狭窄患者进行治疗,其中肺癌17例,气管异物或炎性肉芽肿4例,以狭窄获得再通临床症状改善的疗效进行评价。结果完全有效9例(42.8%),部分有效8例(38.1%),轻度有效3例(14.2%),无效1例(4.7%),总有效率达95.2%。术中未见严重并发症出现。结论经电子支气管镜运用高频电和氩气刀治疗气道狭窄可明显改善症状,提高患者生活质量。     

经支气管镜介入技术治疗气道平滑肌瘤的临床研究

目的 探讨经支气管镜下联合荧光、氩离子束凝固术（APC）、二氧化碳冷冻术介入治疗气道平滑肌瘤的可行性及安全性,观察临床疗效。方法 回顾性分析2014年6月－2019年12月该院8例确诊为气道平滑肌瘤所致的气道阻塞患者,在支气管镜下联合荧光进行圈套、电切、APC和二氧化碳冷冻术治疗,观察气道打通程度、临床症状改善情况、并发症的发生率及复发情况,术中监测患者心率、血压、呼吸和血氧饱和度,比较治疗前后患者的气道狭窄分级情况、气促分级和Karnofsky评分（KPS）。评估此技术的疗效和安全性。结果 在8例平滑肌瘤中,行支气管镜下APC、电切和冷冻术共计21次,肿瘤切除后气道完全打通,临床症状完全缓解;无纵隔气肿、呼吸道穿孔及大出血等严重并发症;经随访,无复发。结论 经支气管镜下联合荧光进行APC、高频电刀和二氧化碳冷冻术在治疗气道平滑肌瘤导致的气道阻塞中疗效显著,可达到临床根治,避免了开胸手术创伤,适合临床推广。     

可弯曲支气管镜诊断和治疗食管癌相关性气道病变

目的探讨可弯曲支气管镜(简称支气管镜)在食管癌相关性气道病变[食管癌并发气管、支气管狭窄和(或)食管气道瘘]的诊断和治疗中的意义。方法回顾性分析17例经支气管镜检查确诊和治疗的食管癌相关性气道病变患者的临床资料。结果 17例患者全经支气管镜检查明确诊断,其中中央气道狭窄11例、食管气道瘘6例,经支气管镜介入高频电刀治疗5例、氩气刀治疗4例、气道金属支架置入12例,其中覆膜金属支架3例。全组病情好转且无严重并发症。结论可弯曲支气管镜在食管癌相关性气道病变的诊断和治疗中具有重要意义,经支气管镜高频电刀、氩气刀及金属支架置入等腔内介入治疗食管癌相关性气道病变微创、安全、有效。     

电子支气管镜下高频电切电凝治疗气道疾病护理体会

目的：探讨电子支气管镜下高频电切电凝治疗气道疾病的护理方法。方法：对17例气道肿瘤的患者行内镜下高频电烧灼治疗并精心护理。结果：17例均顺利完成高频电刀下圈套器切除肿瘤组织术,安全度过手术期,无严重并发症发生,术后1～2周出院。结论：电子支气管镜下高频电切电凝术良好和严密的护理措施是保证手术成功的关键。     

经电子支气管镜介导高频电治疗主气道肿瘤

目的 探讨经支气管镜介导高频电切除主气道肿瘤的治疗方法.方法 对12例主气道内肿瘤阻塞患者行支气管镜介导高频电切除,并分析疗效.结果 12例患者共治疗19次,6例患者治疗1次;5例治疗2次,1例治疗3次.治疗后患者症状明显减轻.有效率91.7%.结论 支气管镜介导高频电治疗主气道肿瘤能迅速缓解气道阻塞,操作方便,并发症少.     

16例晚期中央气道恶性肿瘤患者行高频电治疗的护理

总结16例晚期中央气道恶性肿瘤阻塞患者采取经电子支气管镜高频电治疗的护理经验.护理要点:术前重视患者心理护理及体位护理;术中在尽量维持有效血氧浓度的基础上,密切观察,熟练配合,缩短操作时间;术后做好出血、窒息、气道穿孔、感染等并发症的预防及护理,保证手术效果.本组患者共行29次高频电治疗,在最后1次治疗结束后,11例患者气道完全打通,5例部分打通.治疗后,患者在吸气性呼吸困难、刺激性咳嗽、强迫体位、气促指数等体征方面都有显著改善.     

纤维支气管镜下支架置入术治疗癌性气道阻塞的护理配合

目的探讨纤维支气管镜下支架置入术治疗癌性气道阻塞的护理配合要点.方法对14例肺癌、食道癌所致的癌性气道阻塞行纤维支气管镜下支架置入术治疗并对其进行术前、术中.术后护理.结果14例癌性气道阻塞患者支架置入术操作顺利完成,无并发症发生.临床上呼吸困难、气促症状均有明显好转,肺功能指标改善.结论术前、术中、术后护理对纤维支气管镜下支架置入术的顺利完成具有重要作用.     

Airway Sonography in Live Models and Cadavers

Sonography using cadavers is beneficial in teaching and learning sonoanatomy, which is particularly important because imaging of the airway can be challenging due to the cartilaginous landmarks and air artifacts. In this exploratory study, we have attempted to compare the airway sonoanatomy of cadavers and live models. Our observations support the use of cadavers as teaching tools for learning airway sonoanatomy and practicing procedures involving airway structures, such as superior laryngeal nerve blocks, transtracheal injections, and needle cricothyroidotomy, before performance on patients in clinical situations. We believe this process will improve patient safety and enhance the competency of trainees and practitioners in rare procedures such as needle cricothyroidotomy.     

An Unusual Cause of Intubating Laryngeal Mask Obstruction Preventing Successful Intubation in the Emergency Department

BackgroundThe intubating laryngeal mask airway (ILMA) allows providers to blindly intubate through the device. We report a case of foreign material obstructing passage of an endotracheal tube (ET) through an ILMA.Case ReportA 45-year-old man with unknown past medical history was found obtunded with an apparent intentional drug and alcohol overdose, and required tracheal intubation. We opted to use an ILMA to optimize preoxygenation prior to intubation. His upper dentures were removed and an ILMA was inserted without complication; ventilation was easily performed. Blind tracheal intubation was attempted; the ET was inserted through the ILMA and was unable to be advanced past 15 cm despite multiple attempts, including repositioning the ILMA and rotating the ET. The ILMA was removed to prepare for video laryngoscopy. He was subsequently successfully intubated using a standard geometry video laryngoscope, which showed no anatomical abnormalities. After the case, the ILMA was inspected and the bowl of the ILMA was found to be occluded with denture adhesive.Why Should an Emergency Physician Be Aware of This?This case report demonstrates that it is possible that foreign material within the ILMA can make successful intubation impossible, despite successful placement and ventilation through the device. Maneuvers may be performed to attempt successful ET intubation, but when unsuccessful, removal of the ILMA and alternate airway management must be performed.     

Use of Sonography for Airway Assessment

Objective. The purpose of this study was to evaluate the feasibility of sonography in identifying the anatomic structures of the upper airway and to describe their appearance on sonography. Methods. We enrolled 24 healthy volunteers, placed them supine with their head extended and neck flexed (the “sniffing” position), and performed a systematic sonographic examination of their upper airway from the floor of the mouth to the suprasternal notch. Results. We were able to visualize all relevant anatomic structures in all of the participants using either a linear or curved transducer oriented in 1 of 3 planes: sagittal, parasagittal, and transverse. Bony structures (eg, the mandible and hyoid) were brightly hyperechoic with an underlying hypoechoic acoustic shadow. Cartilaginous structures (eg, the epiglottis, thyroid cartilage, cricoid cartilage, and tracheal rings) were hypoechoic, and their intraluminal surface was outlined by a bright air‐mucosa interface. The vocal cords were readily visualized through the thyroid cartilage. However, the posterior pharynx, posterior commissure, and posterior wall of the trachea could not be visualized because of artifacts created by an intraluminal air column. Conclusions. Sonography of the upper airway is capable of providing detailed anatomic information and has numerous potential clinical applications.     

Acute upper airway obstruction from acquired angioedema

C1 esterase inhibitor deficiency is an unusual cause of acute upper airway angioedema. This case of angioedema is secondary to acquired C1 esterase inhibitor deficiency associated with neoplastic disease and triggered by the use of angiotensin converting enzyme inhibitors. It was sufficiently severe to require emergency airway management. A guide to the evaluation and management of angioedema is presented.     

微量注射泵持续气道湿化临床效果观察

[目的]观察气道开放后持续泵入湿化液后气道湿化的效果.[方法]将40例气道开放病人随机分为实验组和对照组各20例,实验组采用0．9％氯化钠50mL沐舒坦15mg配成湿化液持续泵入2mL／h～5mL／h。对照组采用相同方法配制的湿化液,每隔30min～60min沿套管或插管壁滴入2mL～5mL,时间为5min。观察两组吸出痰液及痰痂形成、刺激性咳嗽、气道黏膜出血等情况。[结果]实验组痰液黏度明显低于对照组（P〈0．05）,痰痂形成、刺激性咳嗽、气道黏膜出血发生率显著低于时照组（P〈0．05）。[结论]气道开放病人气管内持续泵入湿化液可预防气道干燥和消除痰痂形成,对改善和保持病人呼吸道通畅有明显效果。     

脊柱骨折伴高位截瘫合并气道高反应性患者的气道护理

目的探索脊柱骨折伴高位截瘫合并气道高反应性患者气道的有效护理方法。方法密切观察呼吸的频率、节律、幅度等情况,保持呼吸道通畅,加强气道湿化,保持正态通气方式,维持机体有效循环,保证体内血氧处于正常状态。结果患者好转出院16例,因家庭因素及经济原因自动出院3例。结论患有气道高反应性的脊柱骨折伴高位截瘫的患者,应加强气道湿化,保持呼吸道通畅,保持正态通气方式,能保证机体血氧处于正常状态,促进患者早日康复。     

人工气道湿化的护理进展

人工气道建立是抢救及治疗危重症患者的重要措施,是危重患者的生命通道。正常时人体的鼻、咽腔、呼吸道对吸入气体有加温和湿化作用,人工气道建立后,气体未经鼻腔的过滤和湿润直接进入气道,可造成气道黏膜损伤,细菌未经阻挡直接进入下呼吸道引起继发感染。有实验证明,肺部感染率随气道湿化程度的降低而升高。因此,人工气道充分有效湿化,可维持支气管黏膜细胞纤毛的正常功能,使支气管内分泌物向上移动,从而降低肺部感染的发生率,是保持呼吸道通畅的一项重要措施。近年来,国内外对人工气道的湿化做了大量研究,现将有关护理进展综述如下。     

口咽通气管在非确定性人工气道吸痰中的应用

目的 观察使用口咽通气管在非确定性人工气道吸痰中的应用效果.方法 选择2010年5月～2011年3月在ICU治疗的102例需无创吸痰的重症患者,随机分为观察组52例和对照组50例.观察组采用经口咽通气管吸痰法吸痰.对照组采用传统无创吸痰法吸痰.比较两组每日吸痰次数、吸出痰量、双肺呼吸音改善情况、血氧饱和度、体温变化、气管插管及气管切开例数等.结果 观察组能减少吸痰次数,明显改善肺部情况,降低气管插管和气管切开发生率,两组比较有显著性差异（P＜0.01,P＜0.05）.结论 与传统无创吸痰比较,经口咽通气管辅助吸痰效果好,并发症少,明显降低耗材,减轻护理工作量,提高患者满意度.     

鼻咽通气道在急重症脑动脉瘤栓塞术患者恢复期的应用

目的：观察恢复期早期拔除气管导管并置入鼻咽通气道对预防急重症脑动脉瘤栓塞术患者拔管期不良反应的效果。方法60例急诊行脑动脉瘤栓塞术的患者,GCS评分8～10分,ASAⅢ～Ⅳ级,随机分为鼻咽通气道组（ A组）、口咽通气道组（ B组）和手托下颌组（ C组）,每组20例。记录三组患者拔除气管导管前（ T0）、置入鼻／口咽通气道（ C 组手托下颌）后1 min （ T1）、5 min（ T2）、10 min（ T3）和20 min（ T4）的SpO2、HR、SBP、DBP、PaCO2、血浆肾上腺素（ E）及去甲肾上腺素（ NE）浓度（桡动脉血）,并观察拔管后20 min内的不良反应包括呛咳、躁动、恶心呕吐及喉痉挛等。结果 T1时B组HR、SBP、DBP、PaCO2、血浆E及NE浓度高于A组和C组（ P＜0.05）,A组HR、SBP、DBP、PaCO2、血浆E及NE浓度略高于C 组,但差异无统计学意义（ P＞0.05）;T2、T3、T4时B组和C组HR、SBP、DBP、PaCO2、血浆E及NE浓度高于A组（P＜0.05）。 A组不良反应发生率明显低于B组和C组（P＜0.05）。结论鼻咽通气道应用有利于急重症脑动脉瘤栓塞术患者全麻苏醒期,可有效地保持患者呼吸道通畅并减轻患者拔管期的不良反应。