气管肿瘤14例的围手术期护理

0 引言气管肿瘤因其病变位置重要,后期病变发展迅速,导致机体气体交换极其困难,患者常有频死的感觉. 故手术难度大,术后并发症多,而倍受重视. 现将其围手术期护理的要点和体会报道如下.     

Use of recombinant human granulocyte-macrophage colony-stimulating factor in autologous marrow transplantation for lymphoid malignancies

The use of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) following autologous marrow transplantation for lymphoid malignancies was explored in a phase I/II dose escalation study. rhGM-CSF given as a 2-hour infusion daily for 14 days was well tolerated at doses up to 240 micrograms/m2/day. When compared with 86 disease-matched and treatment-matched historical controls, patients receiving greater than or equal to 60 micrograms/m2/day rhGM-CSF recovered neutrophil and platelet counts more rapidly, had fewer days with fever, and were discharged from the hospital sooner.     

Refinements in method of evaluation and physical conditioning before and after myocardial infarction

A 54 year old white man with hypertension, obesity and an elevated serum cholesterol level volunteered for a physical training program. During the sixth week he became ill, and a repeated work-capacity test revealed physiologic evidences of myocardial insufficiency. The pre-exercise serum glutamic oxaloacetic transaminase level was elevated. A routine electrocardiogram four hours later revealed evidence of an acute inferoseptal myocardial infarction.

The course of the disease was uneventful and uncomplicated. Two months after infarction the patient resumed a physical activity program which provided for a slow increase in metabolic demands compatible with his capacity. Repeated work-capacity tests 20 and 23 weeks after infarction showed that he responded to training in exactly the same manner as has been observed in normal, healthy individuals. At that time he was normotensive, with a normal serum cholesterol concentration and near-normal body weight. The capacity for adequate cardiorespiratory adjustments to high metabolic demands was rated as “good.” This study illustrates how performance tests can be used in evaluating the work capacity and progress of a cardiac patient.     

Progressive systemic sclerosis: radionuclide esophageal scintigraphy and manometry

Radionuclide esophageal scintigraphy (RES) and manometry were used for prospective evaluation of esophageal involvement and disease severity in 11 patients (nine women and two men; median time since diagnosis, 1 year) with progressive systemic sclerosis (PSS). Quantitation of RES included calculation of the percentage of emptying at 30 seconds, while manometry provided measurements of proximal, distal, and lower esophageal sphincter (LES) pressures. The findings of both RES and manometry were abnormal in all 11 patients. There was a high correlation between the percentage of emptying and either distal esophageal pressure (r = .86, P less than .01) or LES pressure (r = .79, P less than .01). No significant correlation was found between the percentage of emptying and proximal esophageal pressure (r = .28, P = .39). RES is a safe, simple procedure that is readily accepted by patients and can be used in place of manometry for the detection and staging of esophageal involvement in PSS.     

Pulmonary Toxicity of Cytostatic Drugs: Cell Kinetics

Pulmonary Toxicity of Cytostatic Drugs: Cell Kinetics. WITSCHI,H., GODFREY, G., FROME, E., and LINDENSCHMIDT, R. C. (1987).Fundam. Appl. Toxicol. 8, 253–262. Mice were treated withthree cytostatic drugs: cyclophosphamide, busulfan, or l,3-bis(2-chloroethyl)-l-nitro-sourea(BCNU). The alveolar labeling index was measured following drugadministration with a pulse of ³H-labeled thymidine and autoradiography.In cyclophosphamide-treated animals, peak alveolar cell proliferationwas seen 5 days after injection of the drug. In animals treatedwith busulfan or BCNU, proliferation was even more delayed (occurring2–3 weeks after administration). In contrast, with oleicacid, the highest alveolar cell labeling was found 2 days afterintravenous administration. In animals exposed to a cytostaticdrug, proliferation of type II alveolar cells was never a prominentfeature whereas in animals treated with oleic acid there wasan initial burst of type II cell proliferation. It is concludedthat the patterns of pulmonary repair vary between chemicalsdesigned to interfere with DNA replication as compared to agentswhich produce acute lung damage such as oleic acid.