基于四维CT和ABC辅助下三维CT确定肝癌内靶区对照研究

目的 比较四维CT (4DCT)和ABC辅助下三维CT (3DCT)两种模拟定位技术,探讨3DCT进行原发性肝癌(HCC)个体化内靶区制定的可行性.方法 选取经导管肝动脉化疗栓塞术后HCC患者15例,依次完成4DCT和自由呼吸(FB)、主动呼吸控制(ABC)辅助下平静吸气末屏气(EIH)、平静呼气末屏气(EEH) 3D...     

Anesthetic (r)evolution from the conventional concept to the minimally invasive techniques in thoracic surgery—narrative review

Background and ObjectiveThanks to the growing experience with the non-intubated anesthetic and surgical techniques, most pulmonary resections can now be performed by using minimally invasive techniques. The conventional method, i.e., surgery on the intubated, ventilated patient under general anesthesia with one-lung ventilation (OLV) was considered necessary for the major thoracoscopic lung resections for all patients. An adequate analgesic approach (regional or epidural anesthesia) allows video-assisted thoracoscopy (VATS) to be performed in anesthetized patients and thus the potential adverse effects related to general anesthesia and mechanical OLV can be minimized.MethodsMultiple medical literature databases (PubMed, Google Scholar, Scopus) were searched, using the terms [(non-intubated) OR (nonintubated) OR (tubeless) OR (awake)] AND [(thoracoscopic surgery)] from 2004 to December 2021. Thirty hundred and six scientific papers were collected. The editorials, commentaries, letters, and papers were excluded, that focus on other than the non-intubated (aka awake or tubeless) VATS technique, as well as the full text scientific papers available in languages other than English.Key Content and FindingsAfter reviewing the literature, we identified “schools” with different techniques but with very similar results. Most of the differences were in the anesthetic technique, oxygenation and analgesia, however, the immunological results, and the qualitative parameters (inpatient hospital care days, complication rate, mortality) of the perioperative period showed great similarity, in addition, all three schools identified the same risk factors (hypoxia, hypercapnia, airway safety). The combination of spontaneous ventilation with double lumen tube intubation, called VATS-spontaneous ventilation with intubation (SVI) method seems to be suitable for reducing these risk factors, which may serve as an alternative for patients not suitable for the non-intubated technique in the near future.ConclusionsBased on the results, non-intubated thoracic surgery appears to be an increasingly widespread, safe procedure, that will be available to a wider range of patients as experience expands and by the implication of the constantly evolving new processes.     

“呬”字诀呼吸操对稳定期 COPD 患者生存质量的影响

目的：探讨“呬”字诀对稳定期COPD患者生存质量的影响。方法选取稳定期COPD患者63例,随机分为试验组（31例）和对照组（32例）,试验组在常规治疗和护理基础上进行3个月“呬”字诀呼吸操训练,对照组仅进行常规治疗和护理。待训练结束后,采用吸系统疾病特异性生存质量量表（ SGRQ）、医疗资源利用情况（住院次数、住院时间、访问急诊次数）等指标对两组患者的生存质量进行评价。结果经过3个月干预后,试验组SGRQ总分、活动领域、影响领域三者得分明显低于对照组（ P＜0.01）;住院次数、住院天数显著少于对照组患者（P＜0.01）。结论“呬”字诀简单易行,且能有效减少稳定期COPD患者住院次数、缩短住院时间,从而提高其生存质量,值得在临床、社区康复工作中推广、应用。     

中西医结合治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭临床研究

目的：观察清肺化痰汤联合无创间歇正压通气治疗慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）合并Ⅱ型呼吸衰竭的临床疗效。方法：60例COPD合并Ⅱ型呼吸衰竭患者随机平均分为试验组和对照组。对照组给予常规西药和无创间歇正压通气治疗;试验组在对照组的基础上给予清肺化痰药汤。观察两组患者治疗前后的动脉血气分析指标、两组成功脱机患者的无创通气时间。结果：治疗后两组患者的动脉血气分析pH值和PaO2均较治疗前明显升高（P〈0.05）,PaCO2明显下降（P〈0.05）;试验组在改善PaO2和PaCO2方面明显优于对照组（P〈0.05）。试验组呼吸机通气时间明显短于对照组（P〈0.05）。结论：清肺化痰汤配合无创间歇正压通气救治COPD合并呼衰（Ⅱ型）可改善患者的肺功能,缩短呼吸机通气时间,疗效显著。     

抗阻呼吸训练在预防老年脑肿瘤患者术后低氧血症中的应用

目的:探讨抗阻呼吸训练对老年脑肿瘤患者术后低氧血症的预防效果。方法:选取2017年3月至2018年9月我院神经外科收治的69例老年脑肿瘤患者临床资料进行研究,根据随机抽样法将所有入组患者分为对照组34例,接受常规呼吸训练;观察组35例,接受常规呼吸训练＋个体化抗阻呼吸训练。采用SPSS 17.0统计软件进行数据分析,脉搏、动脉血氧分压（PaO2）等计量资料符合正态分布的采用（±s）表示,进行t检验;不符合的采用M（QR）表示,进行Mann-Whitney U检验;计量资料采用n（%）表示,行χ2检验。结果:两组患者入院时、术前、术毕及术后0.5 h、1 h、1.5 h等不同时间点脉搏搏动次数比较差异均无统计学意义（P＞0.05）。两组患者术后各时间点的PaCO2差异无统计学意义（P＞0.05）;观察组患者术后各时间点的PaO2及SpO2均高于对照组患者,差异有统计学意义（P＜0.05）。观察组患者术后出现低氧血症的发生率明显低于对照组（8.57% vs 32.35%）,差异有统计学意义（P＜0.05）。结论:抗阻呼吸训练可有效预防老年脑肿瘤患者术后低氧血症的发生,降低其术后发生率。     

沙美特罗替卡松联合BiPAP在慢性阻塞性肺疾病治疗中的应用研究

目的：探讨沙美特罗替卡松联合双水平气道正压通气（BiPAP）在慢性阻塞性肺疾病（COPD）合并呼吸衰竭治疗中的应用价值。方法：选取本院2007年7月~2011年3月收治的250例COPD合并Ⅱ型呼吸衰竭患者的临床资料,随机分为治疗组（130例）和对照组（120例）,对照组患者采用沙美特罗替卡松粉吸入剂治疗,治疗组患者采用沙美特罗替卡松粉吸入剂联合BiPAP呼吸机治疗,随访4周,比较两组患者动脉血气分析及肺功能变化情况。结果：治疗组患者肺功能及动脉血气分析明显优于对照组,两组患者比较差异有统计学意义（P〈0.05）。结论：沙美特罗替卡松联合BiPAP呼吸机治疗慢性阻塞性肺疾病,疗效满意,值得在临床推广。     

呼吸气囊辅助下紧急经皮气管切开术在呼吸道灼伤并发上呼吸道梗阻中的应用

上呼吸道梗阻是吸入性损伤早期严重并发症。部分患者伤后早期无明显梗阻迹象,但在水肿高峰期（8-24h）逐渐增重,并发严重上呼吸道梗阻,被迫行紧急气管切开,但此时行气管切开或气管插管并非易事。及时建立有效人工气道是抢救成功的关键。我院ICU于2008—09—2013—03对8例因火灾引起气道吸入性损伤并发严重上呼吸道梗阻患者,在气管插管失败的情况下,在呼吸气囊辅助下紧急实施了经皮气管切开术,效果良好,现报告如下。     

儿童机械通气撤机管理

缩短机械通气时间是危重症中一项重要课题,但目前并没有公认的儿童撤机指南可以参照,撤机预测指标在儿童临床应用意义并不大,以自主呼吸试验为核心的程序化撤机是目前儿童可行方法。