胸腔闭式引流并发大面积皮下气肿1例护理总结

目的：总结胸腔闭式引流并发皮下气肿的原因及护理措施。方法：对1例留置胸腔闭式引流管接水封瓶后出现大面积皮下气肿的患者进行护理并分析发生的原因。结果：患者病情好转。结论：胸腔闭式引流置管术后正确的护理是减少并发症的关键。     

慢性低频复合生理频率电刺激对肺气肿兔膈肌肌球蛋白重链及酶活性的影响

目的 研究不同频率慢性电刺激(chronic electrical stimulation,CES)后肺气肿兔膈肌肌球蛋白重链(MHC)亚型及酶活性的适应性变化,以了解间断低频复合生理频率电刺激对肺气肿兔膈肌结构及代谢的影响.方法 采用木瓜蛋白酶雾化吸入法建立肺气肿模型,测定正常对照组、肺气肿组和肺气肿CES组膈肌MHC亚型的适应性变化及肌浆网(SR)Ca2 -ATP酶、膈肌琥珀酸脱氢酶(SDH)、乳酸脱氢酶(LDH)的酶活性.结果 ①40、10、(10 40) Hz慢性电刺激后肺气肿兔膈肌MHC的相对含量都有所增加(P＜0.05).10 Hz组MHC-Ⅰ型比例明显增加,(10 40) Hz组MHC-Ⅱa型比例增加(P＜0.05).②(10 40)、40 Hz慢性电刺激后,膈肌SRCa2 -ATP酶活性增高(P＜0.05).40 Hz较(10 40) Hz Ca2 -ATP酶活性增高更明显(P＜0.05),10 Hz组Ca2 -ATP酶活性降低(P＜0.05).③间断低频复合生理频率电刺激(40 10 Hz)同肺气肿组比较,SDH酶活性明显升高(P＜0.05);与40 Hz组和10 Hz组比较,SDH亦明显升高(P＜0.05),40 Hz组和10 Hz组之间无显著性差异(P＞0.05).5组之间LDH酶活性均无差别(P＞0.05).结论 不同频率的CES可导致膈肌MHC亚型及酶活性产生不同的适应性变化,低频复合生理频率慢性电刺激可能是体外膈肌起搏对COPD患者膈肌康复治疗较好的频率模式.     

电视胸腔镜与传统开胸行肺减容术治疗慢性阻塞性肺气肿的临床疗效观察

目的探讨电视胸腔镜与传统开胸行肺减容术治疗慢性阻塞性肺气肿的临床疗效。方法比较2002年6月至2012年6月68例电视胸腔镜辅助行肺减容术（胸腔镜组）与22例常规开胸行肺减容术（开胸组）手术疗效及术后并发症。结果手术时间两组比较无显著差异（P〉0．05）;术后住院时间的比较胸腔镜组明显短于开胸组（P〈0．05）;术后并发症的比较：术后漏气比较两组无显著差异（P〉0．05）,其余5种并发症：术中出血量、术后第1天引流量、术后疼痛程度、患侧上肢活动是否受限、拔管时间长短等方面明显优于传统开胸手术（P〈0．05）;监测指标：术后1秒钟用力呼气容积（FEV1）、肺总量（TLC）、残气量（RV）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、6MWT与术前比较,两组均明显较术前明显改善（P〈0．05）,但组问比较差异无统计学意义（P〉0．05）。结论电视胸腔镜辅助行肺减容术治疗慢性阻塞性肺气肿,其安全性与可靠性与开胸手术比较,具有手术出血少、术后引流量少、术后疼痛轻、上肢活动不受限及术后胸管引流时间短等优点。     

1例自发性纵膈气肿患者的护理

纵膈气肿是纵膈内有气体积聚[1]。自发性纵膈气肿临床少见,我科于2006年6月收治了1例自发性纵膈气肿患者,经治疗、护理后痊愈出院,现将护理体会报告如下。1病例介绍患者,男性,22岁,2006年6月18日突然出现颈部及胸前正中疼痛不适,随呼吸运动呈阵发性胀痛,伴呼吸困难,不能平卧,发热,伴畏寒,口唇紫绀,稍烦躁,神志清。胸片示:纵膈气肿及颈部、肩部大量皮下气肿。予收治入院,查体:T 39℃,HR120次/min,R 35次/min,BP 90/60mmHg。呼吸困难,不能平卧,颈部、肩部触及明显皮下捻发感。立即置患者半坐卧位,给予持续双鼻导管5L/min吸氧。建立静脉通…     

Young convalescent COVID‐19 pneumonia with extensive pneumomediastinum emphysema: Case report

The development of the SARS‐CoV‐2 pandemic caused a common appearance of severe pulmonary complications, rarely seen as a result of the other infections. These are pneumothorax, pneumomediastinum, emphysematous bullae, cavitary lung lesions, or subcutaneous emphysema. Their formation is influenced by both—the natural course of the disease and the treatment strategy adopted.     

Lung morphometry with hyperpolarized 129Xe: Theoretical background

The ³He lung morphometry technique, based on MRI measurements of hyperpolarized ³He gas diffusion in lung airspaces, provides unique information on the lung microstructure at the alveolar level. In vivo 3D tomographic images of standard morphological parameters (airspace chord length, lung parenchyma surface‐to‐volume ratio, and number of alveoli per unit volume) can be generated from a rather short (several seconds) MRI scan. The technique is based on a theory of gas diffusion in lung acinar airways and experimental measurements of diffusion‐attenuated MRI signal. The present work aims at developing the theoretical background of a similar technique based on hyperpolarized ¹²⁹Xe gas. As the diffusion coefficient and gyromagnetic ratio of ¹²⁹Xe gas are substantially different from those of ³He gas, the specific details of the theory and experimental measurements with ¹²⁹Xe should be amended. We establish phenomenological relationships between acinar airway geometrical parameters and the diffusion‐attenuated MR signal for human and small animal lungs, both normal lungs and lungs with mild emphysema. Optimal diffusion times are shown to be about 5 ms for human and 1.3 ms for small animals. The expected uncertainties in measuring main morphometrical parameters of the lungs are estimated in the framework of Bayesian probability theory. Magn Reson Med, 2012. © 2011 Wiley Periodicals, Inc.     

迈瑞5300血细胞分析仪检测肺气肿等100例患者血液对比分析

目的:探讨迈瑞5300血细胞分析仪的临床应用价值。方法按照国际血液学标准化委员会(ICSH)制定的评价标准对迈瑞5300血细胞的几项参数进行统计学分析。结果:100例患者检测质量控制良好,稳定性高,CV<5%;线性γ>0.999;与ICSH推荐的参考方法和Sysmex SF3000血细胞分析仪的对比,相关性均较好(γ>0.970);胆红素和甘油三酯对各参数基本无干扰(P>0.005);在室温条件下至少可稳定48h,不精密度的CV均<5%;WBC分类重复性测试和异常白细胞检测均较理想。结论:迈瑞5300血细胞分析仪校准方便,质量控制良好,稳定性高;线性检查理想;携带污染率非常低,对大批量的全血细胞计数(CBC)和白细胞分类计数(DC)能进行快速和有效的筛检。     

The role of pulmonary resection in pulmonary interstitial emphysema in premature infants

The primary treatment of pulmonary interstitial emphysema is medical using ventilator manipulations, suctioning, positioning, and selective bronchial intubation. Three premature infants with pulmonary interstitial emphysema causing progressive hyperinflation of one or more lobes failed to respond to medical management and were ventilator-dependent until the hyperinflated lobe(s) were removed. While the role of surgery in treating pulmonary interstitial emphysema is limited, the results can be beneficial. Offprint requests to: G. Stringel     

肺减容术治疗晚期肺气肿

目的 总结肺减容术治疗晚期肺气肿的临床经验。方法 回顾性分析22例晚期肺气肿行肺减容术患者的临床资料。结果 患者术前1s用力呼吸量（FEV1）为24．5％、残气量（RV）为196．5％、总肺活量（TLC）为130．5％,术后FEV1为27．8％、RV为148．8％,TLC为112．5％。术前16例患者经常吸氧,术后5例活动后需吸氧。术前16例完成6min行走试验,平均行走198m,术后所有患者均完成行走试验,平均行走256m。术前呼吸困难14例3级,8例4级;术后5例2级,13例3级,4例4级。结论 靶区明确的非均质型尤其泡性肺气肿是肺减容术最佳适应证,经严格选择均质型肺气肿病例亦可手术。手术适应证及禁忌证值得进一步探讨;胸腔镜辅助腋下小切口单侧肺减容术安全、可靠、有效;机械缝切器和牛心包加垫可减少漏气。     

Measurement of heterogeneous distribution on Technegas SPECT images by three-dimensional fractal analysis

This review article describes a method for quantifying heterogeneous distribution on Technegas (99mTc-carbon particle radioaerosol) SPECT images by three-dimensional fractal analysis (3D-FA). Technegas SPECT was performed to quantify the severity of pulmonary emphysema. We delineated the SPECT images by using five cut-offs (15, 20, 25, 30 and 35% of the maximal voxel radioactivity), and measured the total number of voxels in the areas surrounded by the contours obtained with each cut-off level. We calculated fractal dimensions from the relationship between the total number of voxels and the cut-off levels transformed into natural logarithms. The fractal dimension derived from 3D-FA is the relative and objective measurement, which can assess the heterogeneous distribution on Technegas SPECT images. The fractal dimension strongly correlate pulmonary function in patients with emphysema and well documented the overall and regional severity of emphysema.