舒适护理在老年慢性阻塞性肺气肿护理中的应用

目的:探讨舒适护理在慢性阻塞性肺气肿患者护理中的应用.方法:将我院2008年5月～2010年5月收治的慢性阻塞性肺气肿患者共128例,随机分为观察组68例和对照组60例.对照组患者给予常规护理,观察组采用舒适护理方法,比较两组患者的康复结果.结果:观察组康复情况优于对照组(P＜0.05).结论:舒适护理有利于慢性阻塞性肺气肿患者的康复,值得推广.     

头孢呋辛钠联合清开灵治疗老年肺气肿合并感染的疗效观察

目的：探讨头孢呋辛钠联合清开灵注射液治疗老年肺气肿合并感染的临床效果。方法：将我院老年肺气肿合并感染患者56例随机分为观察组和对照组,两组均给予头孢呋辛钠治疗,在此基础上观察组联合清开灵治疗,评估两者治疗效果。结果：观察组患者症状缓解时间、体温恢复正常时间及住院时间明显短于对照组（P〈0.05）。观察组总有效率为96.43%,对照组为71.42%,两者比较差异具有统计学意义（P〈0.05）。两组均无明显的治疗副反应产生。结论：头孢呋辛钠联合清开灵治疗老年肺气肿合并感染的临床效果明确,副作用少,值得应用。     

己酮可可碱可降低实验性阻塞性肺气肿大鼠炎性反应

目的观察己酮可可碱(pentoxifylline,PTX)对实验性阻塞性肺气肿大鼠气道及全身炎性反应变化的影响,及其干预作用。方法采用Wistar大鼠36只,雌雄各半,分为对照组、实验性阻塞性肺气肿模型组(简称模型组:采用被动熏香烟加尾静脉注射内毒素的方法制备阻塞性肺气肿模型)、PTX干预组(模型制备同模型组,从第1天起每天熏烟或在注射内毒素前0.5 h腹腔内注射PTX 15 mg/kg,连续注射30 d)。模型制备后,测定各组肺功能;应用ELISA方法测定血清中肿瘤坏死因子(TNF-α)、白细胞介素-8(IL-8)、IL-10水平,及肺泡灌洗液中IL-6、IL-8含量。病理标本取每只大鼠右下肺叶最大横径气管分叉上组织横纵截面石蜡固定,HE染色光镜观察。结果肺功能:模型组肺功能测定FEV0.2/FVC%显著低于对照组(P<0.01),PTX干预组的FEV0.2/FVC%高于模型组,但低于空白对照组(P均<0.01)。细胞因子:3组间血清IL-8、IL-10、TNF-α差异有统计学意义(P均<0.01)。模型组肺泡灌洗液中IL-6水平高于对照组(P<0.01)。模型组与人类COPD病理变化类似,PTX干预组可见炎性浸润较模型组减少,肺气肿的形成较模型组明显减轻。结论PTX可以减少炎性反应损伤,减轻肺气肿形成,缓解肺功能损伤程度。     

老年慢性阻塞性肺气肿并发自发性气胸的护理探讨

目的探讨老年慢性阻塞性肺气肿并发气胸的护理方法。方法 46例老年慢性阻塞性肺气肿并发气胸患者被确诊后,即行胸腔穿刺抽气减压、胸腔闭式引流、卧床休息以及抗炎吸氧治疗,同时给予积极的综合护理支持,并观察记录临床疗效情况。结果治愈39例,5例肺大泡切除,死亡2例。结论对老年慢性阻塞性肺气肿并发气胸的患者要密切观察病情,在治疗的同时,加强心理护理及基础护理,防止并发症,以提高治愈率,降低病死率。     

Subcutaneous emphysema and pneumomediastinum following shoulder arthroscopy with brachial plexus block: a case report and review of the literature

A number of complications are associated with shoulder arthroscopic surgery. However rare, respiratory complications such as pneumomediastinum and related tension pneumothorax as well as spontaneous pneumothorax in patients undergoing shoulder arthroscopy by endotracheal intubation have been reported in the literature. Although the exact pathogenetic mechanisms remain undetermined, surgery-related factors as well as associated respiratory comorbidity have been hypothesized to intervene in the onset of respiratory complications. We report on one patient who developed subcutaneous and mediastinic emphysema after arthroscopic subacromial decompression performed by loco-regional anesthesia. Pathogenetic hypotheses including potential surgery- and anesthesia-related factors as well as associated respiratory comorbid illness are briefly discussed. Knowledge of potential pathogenetic variables may enable both surgeons and anesthesiologists to set up preventive and early treatment measures. Finally, patients’ perception of arthroscopic surgery as a minimally invasive procedure might challenge the patient–surgeon relationship if respiratory complications occur that have not been included in the informed consent.     

电视胸腔镜辅助小切口行双侧肺减容术治疗重度肺气肿

目的:评价电视胸腔镜辅助小切口行双侧肺减容术治疗重度肺气肿的疗效,并总结围术期的处理经验。方法:回顾分析2006年以来为18例重度肺气肿患者实施肺减容术的临床资料,对比分析手术前后肺功能指标和动脉血氧分压的变化。结果:本组无手术死亡病例,2例合并急性呼吸衰竭。术后随访半年,平均第1秒用力呼气量增加39.2%,用力肺活量增加20.1%,残气量下降26.5%,肺总量下降23.1%,动脉血氧分压平均上升15.1%,与术前相比差异有统计学意义(P<0.05)。结论:电视胸腔镜辅助小切口行双侧肺减容术是经济有效的治疗方法,能明显改善重度肺气肿患者的临床症状和生理状况,增加活动能力。     

肿瘤坏死因子α功能抑制剂对肺气肿大鼠气道炎症的影响

目的：探讨肿瘤坏死因子α（TNF-α）抑制剂———重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白（rhT-NFR：Fc）对肺气肿大鼠气道炎症的影响。方法：48只大鼠分为正常对照组、肺气肿组、rhTNFR：Fc干预组（干预组）和干预对照组,单纯吸烟法建立肺气肿模型;后3组烟雾暴露达1月时,干预组给予rhTNFR：Fc进行干预,干预对照组给予空白对照制剂;熏烟80 d后,处理所有大鼠,正常对照组和肺气肿组肺组织切片行苏木素-伊红染色观察形态学改变,定量测定肺平均内衬间隔（MLI）、平均肺泡数（MAN）;支气管肺泡灌洗液（BALF）计数各组白细胞总数、中性粒细胞和巨噬细胞计数及其百分比,用酶联免疫吸附法（ELISA）测定各组血清及BALF中的TNF-α浓度。结果：（1）肺气肿组MLI高于正常对照组,MAN低于正常对照组（P〈0.05）;（2）肺气肿组血清TNF-α浓度高于正常对照组和rhTNFR：Fc干预组（P〈0.05）,和干预对照组比较差异无显著性（P〉0.05）;肺气肿组BALF中TNF-α浓度高于正常对照组（P〈0.05）,但和rhTNFR：Fc干预组、干预对照组比较差异无统计学意义（P〉0.05）;（3）肺气肿组BALF中白细胞总数、中性粒细胞计数及百分比高于正常对照组（P〈0.01,P〈0.05和P〈0.05）和rhTNFR：Fc干预组（P〈0.01,P〈0.05和P〈0.05）,与干预对照组比较差异无统计学意义（P〉0.05）。结论：TNF-α与吸烟大鼠的肺气肿形成有关,并影响其气道炎症;rhTNFR：Fc对减轻其气道炎症具有一定作用。     

A case of dermatomyositis complicated with pneumomediastinum

We herein describe a 16-year-old boy with pneumomediastinum, pneumothorax, and subcutaneous emphysema as the initial symptoms of dermatomyositis (DM). His pneumomediastinum disappeared after strict bed rest and he was thereafter successfully treated with oral prednisolone and cyclosporine A. His condition was further complicated with mild interstitial lung disease, arrhythmia, and skin ulcers on his fingertips, right elbow, ear, and sacral region. Pneumomediastinum is a rare complication of DM and its pathogenesis remains unclear. We review the literature and discuss the possible mechanism of this disease.     

Tension pneumomediastinum and diffuse subcutaneous emphysema with severe acute respiratory syndrome coronavirus 2 infection requiring operative management for impending airway collapse: A case report

Tension pneumomediastinum is a rare complication of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection that has increased in incidence with the novel coronavirus disease 2019 pandemic. Although traditionally managed with conservative measures, we present the indications and methods for the first operative management of tension pneumomediastinum with concomitant SARS‐CoV‐2 infection.     

老年慢性阻塞性肺气肿并发自发性气胸的护理

目的及早诊断和治疗老年人慢性阻塞性肺气肿并发自发性气胸,防止急性呼吸及循环衰竭。探讨老年慢性阻塞性肺气肿患者并发气胸时的护理。方法对我科2006至2008收治的45例慢性阻塞性肺气肿并发气胸患者的临床资料及护理进行回顾性分析。结果治愈35例,6例行肺大泡切除,自动出院4例。结论对老年慢性阻塞性肺气肿并发气胸的患者要提高警惕,密切观察,加强心理护理及基础护理,防止并发症,以提高治愈率,降低病死率。