纤维支气管镜检查并发症的防治

目的：探讨纤维支气管镜（纤支镜）检查术中并发症的防治方法。方法：对纤支镜检查中出现并发症者进行分析。结果：共行纤支镜检查１０２４５例，并发症３８例，其中窒息２例，气胸４例，大咯血８例，心律失常８例，继发感染１１例，声嘶５例，经及时抢救及处理，均获成功。结论：提高技术熟练程度及防范意识，可减少并发症的发生。     

纤维支气管镜在NICU合并肺部感染患者中的应用

目的 探讨纤维支气管镜(简称纤支镜)在神经外科重症监护病房(NICU)合并肺部感染患者中的应用效果.方法 回顾性总结了101例入住NICU合并肺部感染的重症患者进行纤支镜的操作经验.比较纤支镜治疗前后PaO2及SpO2的变化.结果 101例患者经1～4次纤支镜灌洗后,SpO2与治疗前相比有改善,差别有统计学意义(p<0.001),治疗后2小时PaO2较治疗前提高,差别有统计学意义(P<0.001).结论 对在NICU中合并肺部感染的重症患者使用纤支镜有利于改善患者的呼吸功能.     

纤维支气管镜在急诊与高危情况下的应用

目的　探讨急诊与危重病人纤维支气管镜检查的价值作用和安全性。方法　回顾性分析急诊科开展纤支镜工作 0 5a间 ,纤支镜检查治疗在急诊与危重病人中的作用和并发症情况。结果　共进行了 2 7例次纤支镜检查与治疗 ,其中年龄 >75岁者 1 2例 ,有各种高危因素者 1 6例 ,需急诊纤支镜检查者 8例次。在加强监护与防范措施下均顺利完成检查与治疗 ,无影响预后的严重并发症。结论　经过对急诊与高危病人检查中的安全性和并发症进行分析 ,我们认为急诊与危重病人纤支镜检查与治疗后有较好的安全性和临床应用价值 ,值得急诊科进一步探讨     

纤维支气管镜在胸部手术并发症防治中的应用

目的 探讨纤维支气管镜(纤支镜)对胸部手术后并发症的检查和治疗作用。方法 对22例胸部手术后各种原因所致肺不张患者床旁行纤支镜检查，发现其病侧主支气管或叶支气管被分泌物或血凝块堵塞，用活检钳钳夹，并用生理盐水冲洗后负压吸引，直至分泌物或血凝块被全部吸出。结果 18例患者经一次纤支镜治疗后肺复张，4例患者经二次纤支镜治疗后复张，无1例发生严重并发症。结论 纤支镜检查在胸部手术后并发症防治中有重要作用，纤支镜治疗胸部手术后肺不张是一种安全、简单有效的方法。     

纤维支气管镜检查致心律失常的预防及护理

做纤维支气管镜(纤支镜)检查时常合并心律失常,近来我们用心电图监护观察了36例患者做纤支镜检查时的心率、心律改变,现总结介绍如下。     

纤维支气管镜在呼吸系统急重症中的应用

目的探讨纤维支气管镜(纤支镜)在呼吸系统急重症中的应用价值及可行性。方法应用ohrmpus P20纤支镜在监护下对48例呼吸系统急重症患者实施88例次纤支镜检查与治疗。结果21例肺不张并发呼吸衰竭者应用纤支镜33例次，经抽吸及支气管灌洗(BL)17例被纠正，4例未纠正，有效率80．9％：21例重度肺部感染应用纤支镜49例次，21例中15例PSB培养获得阳性结果，阳性率71．4％，进行49例次BL及注药治疗，均达预期目的；6例大咯血患者应用纤支镜6次咯血症状均被控制。1例大咯血患者在操作中出现短阵室上性心动过速经治疗很快得以纠正。结论纤支镜在呼吸急重症的救治中可以发挥重要作用。     

纤维支气管镜引导下经皮气管切开术在重症监护病房中的应用

目的:比较在重症监护病房中纤维支气管镜(简称纤支镜)引导下的经皮气管切开术与无纤支镜辅助的经皮气管切开术的手术操作时间、围手术期和术后远期并发症的发生情况。方法:回顾分析江苏省常熟市第一人民医院重症监护病房2010年11月—2014年1月收治的73例气管切开患者的临床资料。根据有无纤支镜辅助将73例分为纤支镜引导下的经皮气管切开术组(A组,n=43)与无纤支镜辅助的经皮气管切开术组(B组,n=30),比较2组在经皮气管切开术中和术后近期及远期并发症发生情况。结果:2组手术操作时间差异无统计学意义(P0.05)。A组围手术期发生并发症4例,其中术后渗血48 h、切口感染各1例,皮下气肿2例;B组围手术期发生并发症15例,其中气胸、切口感染各1例,术后渗血48 h3例,皮下气肿5例,气管后壁、侧壁损伤5例。2组并发症发生率的差异有统计学意义(P0.05)。73例患者中33例得到随访。A组18例得到随访,其中仅2例发生并发症,1例诉声音嘶哑,1例喉部异物感。B组15例得到随访,其中2例发生并发症,1例诉声音嘶哑,1例吞咽困难。2组远期并发症发生率差异无统计学意义(P0.05)。结论:在纤支镜引导下行经皮气管切开术并不增加手术时间,但可降低围手术期并发症。     

纤维支气管镜在ICU的临床应用71例分析

目的：探讨纤维支气管镜（纤支镜）在ICU危重患者的应用价值。方法：回顾总结我院ICU71例患者行纤支镜检查及治疗的病历资料。结果：本组共行109次纤支镜检查及镜下治疗，包括纤支镜引导下气管内吸痰、支气管灌洗、经鼻气管插管、置入胃管及气管支架等，效果满意，无严重并发症。结论：纤支镜在ICU患者的临床应用中可以发挥重要作用，是安全有效的。     

纤支镜对急性肺不张的治疗价值

目的：观察纤维支气管镜（纤支镜）对急性肺不张的诊疗价值。方法：对住院期间发生肺不张的16例患者，在心电监护、经皮血氧饱和度监测下行纤支镜检查，并进行局部治疗。结果：16例患者均明确病因，纤支镜吸引治疗后肺复张，治疗过程均有心率增加，经皮血氧饱和率下降，无1例出现严重并发症。结论：纤支镜治疗急性肺不张安全有效，并发症少。     

床旁纤维支气管镜技术在危重症合并急性呼吸衰竭中的应用

【目的】探讨床旁纤维支气管镜（简称纤支镜）技术在危重病合并急性呼吸衰竭中的治疗价值。【方法】回顾性分析59例接受床旁纤支镜治疗的危重病并急性呼吸衰竭的病历资料，包括气管插管、机械通气过程中纤支镜检查、取痰培养、吸痰、支气管冲洗、支气管肺泡灌洗、止血治疗等情况。【结果】全部患者经床旁纤支镜引导下经鼻气管插管，成功率100％。插管操作均在2min内完成。142例次经纤支镜吸痰、支气管冲洗或支气管肺泡灌洗；106例次纤支镜取痰病原学培养，阳性率为100％；2例呼吸道出血致窒息患者经纤支镜止血治疗出血停止。【结论】床旁纤支镜技术在危重病合并急性呼吸衰竭治疗中具有较大的应用价值。     

电子膀胱尿道软镜的临床应用(附331例分析)

目的 探讨电子膀胱尿道软镜在临床上的应用价值。方法 总结2001年7月～2002年10月采用电子膀胱尿道软镜检查的331例患者的资料。结果 使用电子膀胱尿道软镜对331名患者共进行了404次检查，发现膀胱肿瘤68例，BPH49例，157例为术后复查病例，活检18例，失败2例，无1例因检查而致的术后肉眼血尿、尿频尿急及尿道热，平均检查时间7min。结论 电子膀胱尿道软镜具有损伤小，术后并发症少，视野无盲区，比普通软镜光亮度更高，成像更清晰、视野更大，是膀胱尿道检查的理想的新方法。     

心理干预对纤维支气管镜检查患者的影响观察

目的:观察心理干预对纤维支气管检查患者的影响。方法:收集60例纤维支气管检查者,在术前及术中实施心理干预。结果:60例患者经过心理干预后,均能顺利配合医师完成了检查,减少了不良反应的发生,从而得到了及时的诊断和治疗。结论:心理干预在纤维支气管镜检查中可以减轻患者的心理负担,提高患者术中检查的配合程度及纤维支气管镜检查的成功率,值得推广。     

高龄患者白内障超声乳化摘除术临床疗效观察

【目的】探讨90岁以上高龄患者白内障超声乳化＋人工晶体植入术的安全性与有效性。【方法】选择90岁以上白内障患者62例68眼,术前详细检查眼部及全身情况,术中心电监护,采用不同碎核乳化技术及低超声能量、高负压的工作模式,在较短时间内完成高质量的白内障超声乳化摘除＋人工晶体植入术。【结果]62例68眼患者均成功施行手术,无一例严重并发症。术后1个月矫正视力≥0．05者68眼（100．0％）,≥0．3者60眼（88．24％）。【结论]90岁以上高龄患者的白内障手术通过术前详细检查,术中谨慎操作,加上术后妥善处理,是安全有效的。     

再次免疫应答导致肾移植后早期严重急性体液排斥反应

背景:国内外有关预防高致敏受者肾移植后发生超急性、急性排斥反应提高人肾存活率取得满意效果,然而临床对群体反应性抗体检测阴性既往致敏受者肾移植后发生再次免疫应答研究则罕见报道。目的:探讨群体反应性抗体阴性的既往致敏受者肾移植后早期发生严重急性体液性排斥反应机制,为其早期诊断和治疗既提供参考依据。方法:选择21例群体反应性抗体阴性术后早期发生严重急性体液性排斥的首次肾移植患者,动态分析移植后14d内反映急性体液性排斥的相关指标,包括IgG型抗HLA抗体,病理苏木精-伊红染色、C4d及细胞表面分子原位检测。结果与结论:21例患者既往均有输血或妊娠史;18例患者移植后第7天抗HLAⅠ类IgG抗体阳性率>80%,11例于移植后第7天抗HLAⅡ类IgG抗体>80%;5例女性患者于移植后第5～8天发生移植肾破裂,抗HLAⅠ类和Ⅱ类IgG抗体均>96%;21例受者均检出抗供者特异性抗体(DSA),13例(61.90%)供、受者存在HLA-A2和HLA-A11的错配并产生对应DSA,包括5例移植肾破裂受者;病理组织形态学均有不同程度急性损伤,免疫组化可见管周毛细血管区(PTC)C4d沉积,原位染色CD34(+)、CD68(+)、CD4(+)。提示移植前群体反应性抗体监测不能完全反映受者的预致敏状态;移植后早期监测群体反应性抗体可预测和诊断既往致敏受者急性体液性排斥的发生;C4d、CD68(+)作为其的辅助诊断指标,可提高诊出率;HLA-A2和HLA-A11在既往致敏受者是高危致敏基因。     

Transcanalicular Endoscopic Laser-assisted Dacryocystorhinostomy (TELA-DCR)

Objective:To assess the results in combined dacryoendoscopy followed by lacrimal drainage surgery with a transcanalicular laser-assisted approach combined with microsurgical endonasal DCR (TELA-DCR).

Methods:Retrospective follow-up of a case series between 1998 and 2003. 82 patients were included in the study (43 females/39 males, age 47.8 years). All patients underwent a combined examination by an ophthalmologist (GVA) and an otorhinolaryngologist (AS/KL) consisting of a routine clinical examination of the eyes, the lacrimal system and the nasal cavity as well as the paranasal sinuses with probing and syringing of the lacrimal drainage system, a radiological examination with digital subtraction dacryocystography (dsDCG) and computerized tomography (CT) of the bony structures. Of 122 lacrimal systems with dacryoendoscopy (Schwind Vitroptic®, Germany), 68 had a bicanalicular silicone intubation without surgery, 12 had a transcanalicular laserdacryoplasty (Erb:YAG-Laser; Schwind-Sclerostome®, Germany) with bicanalicular silicone intubation (Ritleng; FCI Ophthalmics, France) and 42 had TELA-DCR with a silastic-sheet inlay in the bony window for two to three days. 7 of these 42 have already had lacrimal surgery elsewhere. 2 had external lacrimal surgery (Toti procedure) and 5 had endonasal surgery (West procedure). Dacryoendoscopy was used to review the diagnosis of digital subtraction dacryocystography (dsDCG) and for surgical intervention in the same session. Surgery was done in general anesthesia. All patients were admitted to the inpatient department for 24 hours and were discharged the day after surgery. Follow-up (4–65 months) was done by the surgeons only. The silicone tubes were left for three to six months and removed endonasally by the same surgeons again.

Results:Of 122 interventions with dacryoendoscopy 68 needed a bicanalicular stenting with a silicone tube for relative stenosis only. 12 of these needed further intervention by DCR (17.6%) due to restenosis. 12 out of 122 had primary laserdacryoplasty and 2 (16.6%) of these needed DCR later. 42 of 122 had primary TELA-DCR. 5 out of these 42 primary TELA-DCR were revision-DCR after external or endonasal DCR elswhere and 2 of these needed a 2^nd TELA-DCR for restenosis (4.8%). Anatomically all lacrimal systems are still patent ever since. 76 patients (92.7%) are free of symptoms. Overall anatomic patency rate was 82.4% in tubing as single intervention, 83.4% in laser-dacryoplasty and 95.2% in TELA-DCR.

Conclusions:Combined dacryoendoscopy and TELA-DCR is an efficient, safe and successful method in the managment of lacrimal obstructive disease. Our experience suggests that TELA-DCR may be considered as a treatment option in selected patients with lacrimal obstructive disease.     

Can nurses help identify patients with depression following stroke? A pilot study using two methods of detection

AIM: This paper reports a study to determine the accuracy of the Geriatric Mental State examination and the Montgomery-Asberg Depression Rating Scale, when administered by a nurse, in detecting depression in patients who have recently had a stroke. BACKGROUND: After a stroke, survivors spend considerable amounts of time in the direct care of nurses. Many show signs of depression, and this has been associated with an adverse effect on recovery and rehabilitation. Identifying those with depression when they have communication and cognitive difficulties is especially difficult. Treatments are available to assist in the management of depression, and early detection and intervention may assist in this process. METHOD: A cross-sectional pilot study was conducted, comparing (a) clinical diagnosis of depression by a psychiatrist with (b) two clinical interviews, using the Geriatric Mental State examination and the Montgomery-Asberg Depression Rating Scale, conducted by a nurse. The data were collected in 2002. FINDINGS: Twenty-eight patients, who were still in hospital in the second week poststroke, were included. The median age was 72 (interquartile range: 61-78). There were 14 males. The psychiatrist rated seven (25%) patients as depressed. The Geriatric Mental State examination had a sensitivity of 71%, a specificity of 67%, a positive predictive value of 42%, a negative predictive value of 88% in detecting depression and an overall efficiency of 68%. The Montgomery-Asberg Depression Rating Scale had a sensitivity of 100%, a specificity of 65%, a positive predictive value of 54%, a negative predictive value of 100% and an overall efficiency of 75%. CONCLUSION: In this study, the Geriatric Mental State examination and the Montgomery-Asberg Depression Rating Scale were at least as efficient at detecting the depression in patients who have had a stroke. However, as the Montgomery-Asberg Depression Rating Scale is quicker to administer, it may prove more useful to nurses clinically.     

The diagnostic value of combining flexible sigmoidoscopy and double-contrast barium enema as a one-stage procedure

Results from the consecutive examination of 675 patients using both flexible sigmoidoscopy and a double-contrast x-ray technique were analyzed with special reference to the detection of polyps in the rectum and sigmoid colon. A total of 193 polyps were found. Histological examination of 93 polyps revealed that half of those less than 5 mm in diameter and 93.3% of those more than 6 mm in diameter were adenomas. The x-ray examination failed to detect 44% of the proven adenomas smaller than 5 mm, 35.3% of those 6-10 mm in size, and 16.7% of those larger than 11 mm in diameter. These rates were significantly higher than those of flexible sigmoidoscopy, which had corresponding miss rates of 8, 11.2, and 0%, respectively. The double-contrast barium enema (DCBE) failed to detect every second polyp in the rectosigmoid. Every second polyp in the same region proved to be adenoma. The DCBE combined with flexible sigmoidoscopy gives the most reliable and precise diagnosis of various disorders of the rectum and sigmoid colon.     

Utility of flexible sigmoidoscopy as an adjunct to double-contrast barium enema examination

Background: There is controversy regarding the most appropriate investigation for suspected colorectal carcinoma. We offered these patients same-day flexible sigmoidoscopy (FS) and double-contrast barium enema (DCBE). Methods: We reviewed the results of 117 consecutive adult patients. All patients underwent FS followed by DCBE on the same day. The radiographs were reviewed by two of the authors who were blinded to the clinical information, flexible sigmoidoscopy reports, and the original DCBE report. Results: One hundred seventeen patients made up the study population. Thirty-four of the 117 patients had polyps and/or carcinoma. Three malignant tumours were detected by DCBE; one of these was also seen on FS, and the other two cancers were out of FS range. Fifty-three polyps were found by FS; nine were removed by biopsy prior to the enema examination. Of the 44 remaining polyps, DCBE failed to detect 87% of the 0–9-mm group and 67% of the >9-mm group. Ten polyps were seen only on DCBE; seven of these 10 were beyond the range of the sigmoidoscope, and the three remaining polyps were less than 5 mm. Conclusion: DCBE is insensitive in the detection of rectosigmoid polyps. FS should continue to be used as a complementary examination to DCBE in the investigation of suspected colorectal carcinoma. Received: 9 September 1996/Accepted: 8 January 1997     

A course of coronary heart disease and quality of life in patients with varying depressive states

AIM: To study a course of coronary heart disease (CHD) in patients with depressive disorders. MATERIAL AND METHODS: The trial included 77 CHD patients aged 39 to 68 years (mean age 54.9 +/- 0.9 years), 40 (51.9%) of them had myocardial infarction. All the examinees had effort angina of functional class II-IV by criteria of the Canadian Cardiology Association. All the patients have undergone standard clinical examination, stress tests, coronaroangiography (n = 30), assessment of the degree of vegetative dystonia and quality of life. The patients were divided into two groups depending on the depression degree. RESULTS: CHD patients with manifest depression vs those with subclinical depression had a higher level of personality and reactive anxiety. They had neurotic and psychopathological personality alterations associated with more pronounced vegetative disorders. These patients suffered from more severe coronary atherosclerosis, more hospitalizations for the previous year, more myocardial infarctions, lower physical activity and quality of life. CONCLUSION: CHD patients with manifest depression have lower physical performance and quality of life though this is not confirmed at exercise tests.     

急性颈内动脉闭塞颅内循环的变化及临床意义

目的 分析急性颈内动脉闭塞后颅内血流动力学的变化及临床意义.方法 对68例经影像学检查证实急性单侧颈内动脉颅外段闭塞患者,采用经颅多普勒超声(TCD)检测颅内主要动脉的血流动力学变化.结果 患侧大脑中动脉峰值流速和搏动指数均显著低于健侧(P<0.001).在侧支循环开放中,前交通动脉开放占48.53%(33/68),后交通动脉开放为42.65%(29/68),眼动脉参与的侧支循环占32.35%(22/68),无交通支开放14.71%(10/68).患者颅内侧支循环开放,侧支途径两支以上者、患侧大脑中动脉峰值流速>60 cm/s者,临床预后相对较好.结论 TCD检测颅内主要动脉的血流状况,可以快速方便地评价颅内侧支循环状态,对急性颈内动脉闭塞患者治疗方法选择和预后判断具有重要的临床价值.