呼出气温度对儿童哮喘气道炎症变化的预测意义

目的 探讨呼出气温度（EBT）对哮喘患儿气道炎症变化的预测意义。方法 选择门诊初诊时符合纳入标准的哮喘患儿60例作为哮喘组,另选60例健康儿童作为对照组,应用最新的三代产品（X-halo）检测EBT水平,记录儿童哮喘控制测试（C-ACT）评分,比较哮喘组和对照组EBT水平和C-ACT评分差异。1个月后复诊根据患儿C-ACT评分,将其分为良好控制组、部分控制组和未控制组,检测三组EBT和FeNO水平,比较三组EBT水平和C-ACT评分差异,分析EBT和FeNO相关性。追溯其初诊资料,比较初诊时三组EBT水平和C-ACT评分差异,最后比较复诊和初诊时三组EBT水平和C-ACT评分的差异。结果 初诊时,哮喘组EBT水平显著高于对照组（P < 0.05）,C-ACT评分显著低于对照组（P < 0.05）。复诊时,不同控制水平的三组EBT比较差异有统计学意义,即未控制组 > 部分控制组 > 良好控制组（P < 0.05）;三组C-ACT评分比较差异亦有统计学意义,即良好控制组 > 部分控制组 > 未控制组（P < 0.05）。三组初诊EBT水平和C-ACT评分的组间比较差异均无统计学意义（P > 0.05）。与初诊时比较,复诊时良好控制组EBT明显降低（P < 0.05）,部分控制组和未控制组均明显升高（P < 0.05）;良好控制组和部分控制组C-ACT评分均明显升高（P < 0.05）,未控制组明显降低（P < 0.05）。复诊时未控制组EBT和FeNO水平呈正相关（P < 0.05）。结论 EBT对儿童哮喘气道炎症的变化具有预测意义。     

Improved recovery profiles in sinonasal surgery Sugammadex: Does it have a role?

ObjectiveSinonasal surgery is one of the shared airway surgeries that are not uncommonly complicated intra or postoperatively. The proper anesthetic management of these cases plays a crucial role creating a bloodless field. Sugammadex is a new selective relaxant binding drug as it provides a rapid decrease in free rocuronium in the plasma and at nicotinic receptor that help proper awakening of these patients which is extremely important for minimizing the postoperative respiratory complications. The aim of this study is to compare recovery profile in sinonasal surgery in patients reversed by conventional anticholine esterase (Neostigmine) versus those reversed by Sugammadex.MethodsThis study included 40 patients ASA physical status I and II aged 20–45 years with chronic sinusitis undergoing endoscopic sinus surgery with or without septoplasty, hypotensive anesthesia to maintain MAP (50–60 mm Hg), muscle relaxation throughout the procedure at 1–2 posttetanic count (PTCs) by rocuronium infusion, and anesthetic depth maintained using BIS (50–60). Patients were allocated randomly into two equal groups to receive either Sugammadex 4 mg/kg (group I) or Neostigmine 0.05 mg/kg and atropine 0.02 mg/kg (group II) as a reversal agent, and assessment of postoperative respiratory complications was performed using the Postoperative Respiratory System Evaluation Score (PRSES) at 1st and 5th minutes after extubation.ResultsThe reversal time showed highly significant difference between the two groups. Patients in the Sugammadex group could reach a TOF of 0.9 in a mean time 2.47 (0.51) min versus 24.21 (4.7) min for the Neostigmine group; postoperative respiratory complications, the Sugammadex group and the Neostigmine group did not differ statistically; however, more patients in Neostigmine group showed respiratory complications at 1st and 5th minutes after extubation as shown by PRSES Scoring System.ConclusionThis study showed that the use of Sugammadex in reversing rocuronium induced neuromuscular block in patients undergoing functional endoscopic surgery is superior to Neostigmine. Further studies are required to weigh the cost benefit relationship of the use of Sugammadex in routine clinical practice.     

定时与自主湿化气道对肺叶切除术后患者排痰效果的疗效分析

目的探讨定时与自主湿化气道对肺叶切除术后患者排痰效果的影响。方法选择肺叶切除术后患者97例，随机分成实验组49例、对照组48例。实验组患者在术后采用定时予自主湿化气道方法促进痰液排出；对照组患者采用常规方法湿化气道促进痰液排出。观察两组患者术后痰液黏稠程度显著低于对照组，咳痰能力和术后并发症的发生率。结果实验组与对照组比较，实验组术后12h、18h、24h、30h痰液黏稠度、咳痰能力优于对照组，差异有显著意义（P〈0．005）；术后并发症的发生率实验组低于对照组，差异有显著意义（P〈0．05）。结论肺叶切除术后采用定时与自主湿化气道法促进患者排痰效果显著优于常规湿化气道法，可广泛应用于临床。     

Effect of Inspiratory Flow on Methacholine Challenge in Children

Regulation of inspiratory flow alters the outcomes of the methacholine (MHC) challenge in adults and cough receptor sensitivity in children. The effect of inspiratory flow on the reproducibility of the MHC challenge in children is unknown. The aim of this study was to evaluate the effect of inspiratory flow alteration on the repeatabilty of the MHC challenge in children with and without asthma. Twenty‐five children undertook the MHC challenge on three different days by using a dosimeter connected to a setup that allowed regulation of inspiratory flow and pattern. Children were randomized to commence the challenges at 20 or 60 L/min, and the last challenge was performed at 20 L/min. The within‐subject standard deviation, 95% range for change, and doubling dose for the differing inspiratory flow (20 vs. 60 L/min) was more than twice that of when inspiratory flow was maintained at 20 L/min for both occasions. The range of the “limits of agreement” of the Bland and Altman plot was smaller when inspiratory flow was constant. For short‐term comparative individual studies in children, inspiratory flow should be regulated. Laboratories and research measuring change in airway hyperrepsonsiveness to MHC should determine and report reproducibility indices of the challenge so airway hyperresponsiveness changes can be interpreted meaningfully.     

Endotracheal involvement from atypical mycobacterium causing respiratory difficulty: Case report and literature review

Atypical mycobacterium infections often present as cervicofacial lymphadenitis in pediatric patients. Endotracheal involvement, however, is rare, and has not been previously described with imaging and photographs.An infant with natural killer T-cell deficiency was admitted with cough, rhinorrhea, and cervical lymphadenopathy. Laryngotracheobronchitis-type symptoms persisted and imaging revealed an intraluminal abnormality of the trachea. Endoscopy confirmed a mediastinal lymph node with intrusion into the tracheal lumen. Intraluminal biopsy was deferred due to concerns of airway loss. Biopsy of the associated cervical lymph node confirmed Mycobacterium avium-intracellulare infection. The patient was managed with antibiotics and steroids with clinical resolution of his respiratory symptoms.     

Nano-TiO2 particles impair adhesion of airway epithelial cells to fibronectin

Titanium dioxide engineered nanoparticles (nano-TiO₂) are widely used in the manufacturing of a number of products. Due to their size (<100 nm), when inhaled they may be deposited in the distal lung regions and damage Clara cells. We investigated the mechanisms by which short-term (1-h) incubation of human airway Clara-like (H441) cells to nano-TiO₂ (6 nm in diameter) alters the ability of H441 cells to adhere to extracellular matrix. Our results show that 1 h post-incubation, there was a 3-fold increase of extracellular H₂O₂, increased intracellular oxidative stress as demonstrated by 2′,7′-dichlorodihydrofluorescein diacetate (DCFH-DA) oxidation, and a 5-fold increase of phosphor-ERK1/2 as measured by Western blotting. These changes were accompanied by a 25% decrease of H441 adherence to fibronectin (p < 0.05 compared to vehicle incubated H441 cells). Pretreatment with the ERK1/2 inhibitor U0126 for 3 h, partially prevented this effect. In conclusion, short-term exposure of H441 cells to nano-TiO₂ appears to reduce adherence to fibronectin due to oxidative stress and activation of ERK1/2.     

SLIPA与经典喉罩的临床应用比较

目的全麻下行择期妇科腹腔镜手术的病人,进行SLIPA(Streamlined Liner of the Pharynx Air-way)或经典喉罩(laryngeal mask airway,LMA)的应用效果比较。方法 60例病人随机分成两组,所有病人使用相同的麻醉药物。有食管胃反流危险因素的病人被排除。评估两种通气道应用的容易程度;呼吸道密封效果;通气情况;插管反应;副作用。结果 SLIPA或LMA均容易插入和通气,除了SLIPA有较大的峰值气道压,分别是16.2 cmH2O±3.8 cmH2O,13.4 cmH2O±2.3 cmH2O(P=0.03),其它参数比较无明显差异。平均呼吸道密封压分别是24.1 cmH2O±5.4 cmH2O,25.7 cmH2O±6.4 cmH2O(P=0.2)。SLIPA或LMA的密封质量:均能允许低流量麻醉,环路最低气流量分别为558 mL/min±377 mL/min,573 mL/min±382 mL/min(P=0.88)。插管反应:插入2 min后的血压,心率与基础值,诱导后的血压比较,两组均无显著性差异。24 h的咽痛发生率:两组相比无差异(P=0.95)。结论应用SLIPA或LMA进行控制通气,两种通气道均较容易插入,气道管理满意。     

Safe extubation of a parturient using an airway exchange technique

The difficult obstetric airway is a well-recognised anaesthetic challenge but little emphasis is placed on the difficulty of performing a safe tracheal extubation. We report the use of an airway exchange technique to extubate a difficult obstetric airway and discuss the role of these techniques in the obstetric population.