经硬质支气管镜实施气道狭窄介入治疗过程中的并发症

目的 分析经硬质支气管镜实施气道狭窄介入治疗过程中的并发症发生情况。方法 119例气道狭窄患者均经硬质支气管镜实施气道狭窄介入治疗（包括氩等离子体凝固术、高频电凝术、冷冻治疗、呼吸道球囊扩张术或气道支架植入术），观察治疗过程中并发症发生情况。结果 119例患者共经硬质支气管镜进行气道狭窄介入治疗264次，治疗后患者气促及气道狭窄程度均有改善。治疗中并发症发生情况为声门水肿21例、低氧血症15例、高碳酸血症8例、心律紊乱8例、气道黏膜撕裂1例、声带损伤1例、牙齿脱落2例、大出血1例、气道黏膜坏死1例、气胸1例及肺部感染1例。操作过程中硬质支气管镜进出声门的次数越多，声门水肿发生率越高（t=4.355, P <0.05）。结论 经硬质支气管镜进行气道狭窄介入治疗过程中声门水肿、低氧血症、高碳酸血症等并发症相对较多，在操作中需要注意减少硬质支气管镜反复进出声门频率。     

经电子支气管镜氩气刀治疗气道狭窄的探讨

目的探讨经电子支气管镜氩等离子体凝固疗法（氩气刀）治疗气道狭窄的疗效及安全性。方法采用德国ER-BE公司生产的APC300型内镜专用氩气刀,经电子支气管镜对66例气道狭窄患者进行氩气刀治疗。其中恶性肿瘤41例（肺癌32例,甲状腺癌侵及气管1例,食道癌侵及气管6例,肺转移癌2例）;支气管内膜结核9例;气道良性肿瘤2例（气管多形性腺瘤及气管平滑肌瘤各1例）;炎性肉芽组织增生14例。以病变处狭窄获得再通、临床症状改善进行疗效评价。结果66例进行了182次氩气刀治疗（28例1次,30例2-4次,8例5次以上）。显效及部分有效51例（77.27％）,轻度有效14例（21.21％）,无效1例。结论氩气刀治疗气道狭窄疗效佳,并发症少,安全性好,有较高的临床推广价值。     

经支气管镜氩气刀治疗中央型晚期肺癌

目的探讨经支气管镜介导氩气刀治疗中央型晚期肺癌气道狭窄的临床效果。方法对55例经支气管镜活检确诊的合并中心气道狭窄的晚期肺癌患者,在支气管镜引导下行氩气刀治疗,并追踪观察。以病变狭窄获得再通、临床症状改善进行疗效评价。结果 55例患者共行氩气刀治疗150次,临床评价完全有效12例（21.82%）,部分有效25例（45.45%）,轻度有效17例（30.91%）,无效1例（1.81%）。结论经支气管镜介导氩气刀治疗中央型晚期肺癌疗效好、并发症少、安全性高。     

支气管镜下联合介入治疗75例良性中央气道狭窄效果分析

目的 通过对支气管镜下联合介入诊疗方法治疗良性中央气道狭窄疗效及预后评估,分析优化中央气道狭窄支气管下介入诊疗方法的选择。方法 收集我院呼吸与危重症医学科2016年8月至2021年12月中央气道良性狭窄患者75例,共计行232例次支气管镜下介入诊疗,主要方法有高频电刀、氩气刀、冷冻治疗、激光消融、球囊扩张、气管支架置入等。术前对患者进行狭窄气道内径测量,评估狭窄程度及分级、Borg呼吸困难评分、术前风险评估,针对每名患者狭窄病因和部位不同制定对应支气管镜下治疗策略。结果 对于支气管结核引起的狭窄,80%以上患者可在支气管镜下介入联合治疗后得到有效治疗,能缩短抗结核治疗疗程。对于气管上段插管或气切后狭窄的患者行内镜下介入诊疗能快速缓解临床症状,但是对于气管结构性损坏或反复多种方法治疗后仍有疤痕挛缩的患者置入硅酮支架是理想选择,经过随访,1～2年后取出硅酮支架患者气道狭窄段结构稳定,黏膜完整光滑。对于气道良性肿瘤及异物引起的各段气管、支气管狭窄,支气管镜下介入诊疗能达到根治的目的。而因结构性肺病引起的气道牵拉变形狭窄治疗方法不理想。结论 中央气道良性狭窄病因多样,针对不同病因采取不同的支气...     

无创呼吸机正压通气治疗急性左心衰竭在临床中应用

目的:探讨全封闭面罩接呼吸机无创正压通气在急性心功能不全时的治疗价值。方法: 对45例急性心功能不全的患者, 在常规抗心衰治疗的基础上加用全封闭面罩接呼吸机无创正压通气治疗, 同时进行动脉血气、心率、呼吸频率等生命体征的检测和分析。结果: 本组患者40例（89%）,经全封闭面罩接呼吸机无创正压通气后,临床症状在30 min病情均有明显改善,心率、呼吸频率均显著低于治疗前(P<0.01);而动脉血氧饱和度（SaO2）均显著上升(P<0.01),6~24 h脱机,总有效率为89%。3例因为患者面罩密封性不好,呼吸机提示漏气严重,后改为气管插管有创机械通气进行抢救。2例急性左心衰并发慢性肺部阻塞性病变的患者使用呼吸机后出现动脉血二氧化碳分压（PaCO2）升高,出现神志模糊及呼吸暂停现象,停用呼吸机。结论: 急性心功能不全伴低氧血症的患者,　早期应用全封闭面罩接呼吸机无创正压通气能迅速纠治并改善心功能,　并发症少,是一种安全有效的治疗方法。     

硬质支气管镜联合可弯曲支气管镜治疗淋巴结瘘型气管支气管结核所致中心气道狭窄2例

淋巴结瘘型气管支气管结核由纵隔或肺门淋巴结结核破溃侵入气管支气管形成, 破溃期通常需要在全身抗结核药物治疗的基础上接受可弯曲支气管镜下介入治疗。本文报道了2例淋巴结瘘型气管支气管结核所致中心气道狭窄的患者, 因经可弯曲支气管镜治疗后疗效欠佳, 故采用硬质支气管镜联合可弯曲支气管镜及冷冻、氩气刀等方式, 对气道内病灶进行介入治疗, 迅速解除了中心气道堵塞, 且在保障安全的前提下, 尽可能多地清除了病变淋巴结组织, 促进了瘘口愈合。     

支气管镜下氩气刀介入治疗肺癌中央气道阻塞1例的护理配合

正氩气刀又称氩离子凝固,是一种应用高频电流将氩气对离,以非接触性方式使组织凝固的方法,其原理是利用特殊装置将氩气离子化,一般将氩气刀用导管经支气管镜导入气道内对病灶进行治疗[1]。临床上常用于支气管镜下止血及肿瘤切除。我科应用氩气刀在呼吸机支持下经电子气管镜治疗晚期肺癌中央气道阻塞患者1例,取得了满意效果,现将护理体会报道如下。临床资料患者,男,61岁,因反复咳嗽、咳痰5个月,心累气紧1个     

阻塞性睡眠呼吸暂停低通气综合征经鼻气道正压通气治疗的新进展

阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome，OSAS）是由于上气道狭窄或阻塞造成睡眠时反复出现呼吸暂停、低通气，导致血氧饱和度下降，睡眠结构紊乱。患者有晨起头痛、白天嗜睡、注意力不集中、记忆力下降、疲倦、性功能下降等症状，并可有心、肺、脑、肾、内分泌紊乱等一系列并发症。其病因复杂，治疗方法多样。效果不一。随着近年无创呼吸机的应用越来越广泛，利用各型无创呼吸机经鼻持续气道正压通气逐渐成为OSAS患者的首选治疗方式，本文对近年来OSAS的通气治疗进展加以综述。     

经支气管镜氩气刀治疗气道狭窄临床观察

目的 探讨经支气管镜氩气刀治疗在气道狭窄的作用及安全性评价.方法 对140 例确诊为中心气道狭窄的患者,在积极治疗原发病的同时,经支气管镜引导进行氩离子凝固术APC.根据狭窄再通和气促评分情况评价疗效.结果 经支气管镜介入治疗1 个月后评价疗效.完全有效62 例(44.3%),部分有效55例(39.3 %),轻度有效2...     

电子支气管镜下支架植入联合氩气刀治疗恶性肿瘤引起中央气道狭窄的临床观察

目的观察电子支气管镜下支架植入联合氩气刀治疗恶性肿瘤引起中央气道狭窄的临床疗效,缓解患者呼吸困难症状。方法回顾31例患者的临床资料,分析支架一次性置入成功率等、治疗前后p H值、动脉血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2)、动脉血氧饱和度(Sa O2)、用力肺活量(FVC)、一秒用力呼气容积(FEV1)和气促评分变化,评价治疗后中央气道狭窄疗效,以及术后并发症及处理情况。结果30例患者支架一次性置入成功,成功率96.77%。治疗1周,患者气道阻塞症状减轻,p H值、Pa O2、Pa CO2、Sa O2及FVC、FEV1较治疗前明显改善,差异有统计意义(P0.05)。气道支架置入后1周,呼吸困难症状均明显缓解,治疗后患者气促评分明显优于治疗前,差异有统计意义(P0.05)。治疗即刻及治疗后3月患者中央气道狭窄疗效相似,差异无统计意义(P0.05)。术后6例咽喉及胸骨后疼痛、10例刺激性咳嗽、7例痰中带血、3例术后再次狭窄、1例大咯血猝死和1例术后支架边缘出现瘘口。中央气道狭窄程度级别越高,并发症发生的例次越高,差异有统计意义(P0.05)。结论电子支气管镜下支架植入联合氩气刀能有效缓解恶性肿瘤引起的中央气道狭窄,快速缓解患者呼吸困难症状,是非常有效的姑息治疗手段之一,但是中央气道狭窄程度越重,术后并发症发生率越高。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.