嗜酸粒细胞性支气管炎气道炎症病理特征的探讨

目的： 观察嗜酸粒细胞性支气管炎（EB）气道粘膜炎症的病理特征，并与咳嗽变异型哮喘（CVA）进行比较。 方法： 对11例EB患者行纤支镜支气管粘膜活检，并以10例正常对照、10例CVA和14例典型支气管哮喘的支气管粘膜标本作对照。光镜下测量各组气道粘膜上皮的基底膜厚度，并通过免疫组化和特殊染色技术，计算EB和CVA组气道粘膜固有层中炎症细胞（嗜酸粒细胞、肥大细胞、T淋巴细胞）的浸润密度。 结果： EB组支气管粘膜基底膜厚度［2.92 μm(2.10-6.50)μm］显著高于对照组［2.08 μm(1.62-3.40 μm)］, P<0.05，同时显著低于CVA组［5.64 μm (3.23-8.48 μm)］, P<0.05，而CVA组的基底膜厚度又显著低于典型哮喘组［9.08 μm (6.61-11.99 μm)］, P<0.01；EB组气道粘膜固有层可见肥大细胞和嗜酸粒细胞散在分布，浸润密度分别为［75 cells/mm2(35-112 cells/mm2)］和［7 cells/mm2(0-31 cells/mm2)］，显著低于CVA组［148 cells/mm2(34-200 cells/mm2)，114 cells/mm2(1-768 cells/mm2)］, P<0.05，淋巴细胞浸润密度无显著差异。 结论： EB是以嗜酸细胞浸润为特征，涉及多种炎症细胞的慢性气道炎症性疾病，但气道粘膜基底膜厚度显著低于CVA和典型哮喘，炎症细胞浸润程度低于CVA，均可能是EB缺乏气道高反应性的重要机制。     

Ventilatory and upper-airway resistance responses to upper-airway cooling and CO2 in anaesthetised rats

The effects of upper airway (UA) cool air and CO₂ on breathing and on laryngeal and supraglottic resistances were studied in anaesthetised rats breathing spontaneously through a tracheostomy. Warm, humidified air containing 0, 5 and 9–10% CO₂ and cool, room-humidity air were delivered at constant flow to either the isolated larynx to exit through a pharyngotomy or to the supraglottic UA to exit through the mouth and/or nose (nose open or sealed). Spontaneous tracheal airflow and UA airflows, temperatures and pressures were recorded. CO₂ had no effect on breathing but caused a slight increase in laryngeal resistance which was abolished by cutting the superior laryngeal nerves (SLN). Cool air caused a decrease in respiratory frequency and/or peak inspiratory flow when applied to the isolated larynx or to the supraglottic airway with the nose closed. These effects were abolished by SLN section. With the nose open, the ventilatory inhibition was not abolished by SLN section. Cool air also caused substantial decreases in laryngeal and supraglottic resistances which were attenuated by SLN section and which persisted following recurrent laryngeal nerve section. In conclusion, whilst UA cooling inhibits breathing and decreases UA resistances, UA CO₂ has minimal effects.     

A comparison between two emergency cricothyroidotomy instruments

As part of a training programme for younger doctors, two commercially available, emergency cricothyroidotomy sets were evaluated. Prior to the surgical procedure, half of the doctors in each group received an audiovisual lesson. In a simulated but realistic emergency situation, involving autopsy material, cricothyroidotomy was performed utilizing either the "Nutrake" or the "Gentofte" system. The audiovisual lesson increased the speed and the success rate of the doctors performing this procedure as well as strengthening their confidence. Both systems allowed positive pressure ventilation. The participating doctors achieved a higher success rate at a faster speed with the "Nutrake" set.     

降低重症患者人工气道湿化不足发生率

目的降低重症患者人工气道湿化不足发生率。方法开展品管圈活动,通过医护双方合作,优化气道管理团队,完善人工气道湿化评估方案,改良气道湿化装置,增加气道湿化途径,实行复合序贯式湿化-排痰护理管理模式等,实现了气道湿化、辅助排痰、气道廓清一体化。结果重症患者人工气道湿化不足发生率从28.57%降低至11.26%,目标达标率为100.58%,进步率为60.59%。结论通过开展品管圈活动,规范了重症患者人工气道湿化方案,降低了气道相关并发症发生率,有效改善了患者治疗结局,提升了医疗质量。     

腹腔注射舒芬太尼对SD大鼠气道反应性的影响

目的观察腹腔注射舒芬太尼对SD大鼠气道反应性的影响。方法将32只雄性SD大鼠按随机数字表法分为4组,正常对照为A组(n=8,腹腔注射生理盐水,3 ml);实验组,B1组(n=8,腹腔注射舒芬太尼60μg/kg,3 ml)、B2组(n=8,腹腔注射舒芬太尼90μg/kg,3 ml)和B3组(n=8,腹腔注射舒芬太尼120μg/kg,3 ml)。第1天对4组大鼠进行气道阻力和气道反应性应用非侵入性气道阻力仪测定并作为参考基线。第15天按照分组要求对4组大鼠进行腹腔注射干预措施,测定腹腔注射后1、2、3、5、10 min气道阻力(specific airway resistances,Raw)(cmH2O·s),第30天按照分组要求对4组大鼠进行腹腔注射干预措施,3 min后进行气道反应性测定。采用t检验和Fisher确切概率法对实验数据进行分析。结果实验第1天,与对照组A组比较,B1组、B2组、B3组大鼠腹腔注射前基线气道阻力(3.27±0.74比3.35±0.65、3.30±0.81比3.35±0.65、3.41±0.68比3.35±0.65)差异无统计学意义(t=0.230,P>0.05、t=0.136,P>0.05、t=0.180,P>0.05);实验第15天,与对照组A组干预后1、2、3、5、10 min的气道阻力比较,B1组在1、2 min气道阻力(4.15±1.27比3.95±0.89、4.74±1.05比3.78±0.85)差异无统计学意义(t=0.365,P>0.05、t=2.010,P>0.05),在3、5 min气道阻力(4.92±1.33比3.55±0.69、4.89±1.43比3.47±0.71)差异有统计学意义(t=2.586,P<0.05、t=2.516,P<0.05),在10 min气道阻力(3.86±1.28比3.41±0.69)差异无统计学意义(t=0.875,P>0.05);B2组在1 min气道阻力(4.77±1.15比3.95±0.89)差异无统计学意义(t=1.595,P>0.05),在2、3、5 min气道阻力(6.01±1.47比3.78±0.85、6.95±1.68比3.55±0.69、5.75±1.52比3.47±0.71)差异有统计学意义(t=3.715,P<0.05、t=5.295,P<0.05、t=3.844,P<0.05),在10 min气道阻力(3.95±1.18比3.41±0.69)差异无统计学意义(t=1.117,P>0.05);B3组在1、2、3、5 min气道阻力(5.14±1.25比3.95±0.89、7.91±1.35比3.78±0.85、8.15±1.48比3.55±0.69、7.69±1.23比3.47±0.71)差异有统计学意义(t=2.194,P<0.05、t=7.322,P<0.05、t=7.968,P<0.05、t=8.404,P<0.05),在10 min气道阻力(4.16±1.08比3.41±0.69)差异无统计学意义(t=1.655,P>0.05);实验第30天,4组大鼠腹腔注射后气道反应性阳性率为,与对照组A组(0%)比较,B1组37.5%差异无统计学意义(P>0.05)、B2组75%差异有统计学意义(P<0.05)和B3组87.5%差异有统计学意义(P<0.05)。结论腹腔注射舒芬太尼对大鼠呼吸系统的影响表现在气道阻力增加和气道反应性增高,并呈剂量依赖性。但这种变化在短时间内逐渐增加并达到高峰后,进而逐渐减弱。     

Complicaciones durante la intubación traqueal repetida en la unidad de cuidados intensivos. Estudio prospectivo,observacional comparando primera intubación y reintubación

Background of the studyThe goal of the study was to compare the incidence of complications, technical difficulty of intubation and physiologic pre-intubation status between the first intubation and reintubation performed on the same patient in an ICU.Materials and methodsThe study was approved by the ethics committee of Galicia (Santiago-Lugo, code No. 2015-012). Due to the observational, noninterventional, and noninvasive design of this study, the need for written consent was waived by the ethics committee of Galicia. Patients requiring tracheal intubation and reintubation in the ICU were included in this prospective observational study. Main endpoint was to compare the incidence of complications, physiologic pre-intubation status, and the rate of technical difficulty of intubation between the first intubation and reintubation performed on the same patient in an ICU.Results and discussion504 patients were intubated in our ICU during the study period, and 82 (16%) required reintubation. There was no difference between the first intubation and reintubation regarding number of total complication (35% vs 33%; P = .86), hypotension (24% vs 24%; P = 1), hypoxia (26% vs 26%; P = 1), esophageal intubation (1% vs 1%; P = 1), and bronchoaspiration (2% vs 1%; P = .86). Physiologic pre-intubation status and technical difficulty of intubation did not differ between the first intubation and reintubation.ConclusionsIn our ICU patients requiring tracheal reintubation, incidence of complications, physiologic pre-intubation status, and technical difficulty of intubation did not differ between the first intubation and reintubation.     

A rare case of a laryngeal leiomyosarcoma with a lymph node metastasis

IntroductionLeiomyosarcoma is a rare mesenchymal tumor that originates from smooth muscle cells. Head and neck LMSs represent only 3% of all leiomyosarcomas with less than 50 cases of laryngeal LMS reported in the literature till now.Case presentationWe report a case of 50-year-old male presented at our ENT department for a chronic hoarseness. Clinical examination investigations found small submucosal lesion in the right vocal cord. Treatment consisted of CO2 Laser excision of the lesion. The evolution was marked by the appearance of a tumefaction in the left submandibular region and a severe dyspnea requiring an emergency tracheotomy. Paraclinical examination investigations found a supraglottis–glottis-subglottis tumor. A total laryngectomy with bilateral functional neck dissection was performed and the histopathological examination found a laryngeal leiomyosarcoma.ConclusionLMS of the larynx a very rare malignancy. The accurate diagnosis is histological. Surgery is the mainstay of treatment. Its prognosis is correlated to local recurrence and distant metastases.     

Airway occlusion pressure (P0.1) — A useful predictor for the weaning outcome in patients with acute respiratory failure —

Twenty-five patients who required mechanical ventilatory support (MVS) after major surgery or severe burns were studied to determine whether airway occlusion pressure (P_0.1) is a clinically useful indicator to predict the success or failure of the weaning trial. A total of 33 weaning trials were attempted on these patients. Of the 33 trials, 24 were followed by successful weaning and 9 by failure. Although the success group, when compared with the failure group, had a lower respiratory rate (P 0.001), a lower minute ventilation (P 0.001), a higher maximal voluntary ventilation to minute ventilation ratio (P 0.01) and a higher forced vital capacity (P 0.05), no threshold values separated the success from the failure group. The alveolar-arterial P_{O 2} gradient, with an Fi _{O 2} of 1.0, in weaning success and failure showed no statistical difference. In contrast, all patients in the success group had a P_0.1 of less than 3.5cmH₂O and those in the failure group had a P_0.1 of greater than 3.5cmH₂O (P 0.001). We conclude that P_0.1 is a clinically superior indicator for discontinuing MVS in patients with acute respiratory failure.(Okamoto K, Sato T, Morioka T: Airway occlusion pressure (P_0.1)—A useful predictor for the weaning outcome in patients with acute respiratory failure—. J Anesth 4: 95–101, 1990)     

激光治疗器质性呼吸道阻塞

目的　观察激光在器质性呼吸道阻塞性疾病治疗中的应用价值。方法　应用Nd :YAG激光治疗 40例器质性呼吸道阻塞患者 ,观察治疗前后患者症状、肺功能、血气分析、气道内径的改善情况及治疗的安全性。结果　应用Nd :YAG激光治疗后患者气道全部通畅 ,气道内径明显扩大 :治疗前 (2 9± 1 7)mm ,治疗后 (8 0± 1 6)mm ,P <0 0 1;气促明显缓解 :气促指数治疗前 3 2± 0 8,治疗后 1 3± 0 9,P <0 0 1;PaO2 明显升高 :治疗前 (9 4± 1 81)kPa ,治疗后 (11 6± 1 1)kPa ,P <0 0 1;FEV1明显改善 :治疗前 (1 4± 0 3 )L ,治疗后 (2 4± 0 4)L ,P <0 0 1;FVC明显增加 :治疗前 (2 3±0 7)L ,治疗后 (3 3± 0 6)L ,P <0 0 1;治疗过程中 3 2例出现一过性低氧血症 ,2例出血 ,5例术后呼吸困难 ,2例术后发热。术后随访 :17例患者术后 3～ 4个月出现气道再次狭窄 ,11例经再次激光治疗后气道再次通畅。结论　Nd :YAG激光治疗器质性呼吸道阻塞是安全有效的手段并可反复应用 ,值得临床推广使用     

Acute airway obstruction following placement of a subclavian Hickman catheter

The purpose of this case report is to describe the events, intervention, and aetiology which led to acute airway obstruction in an adult patient after the placement of a Hickman catheter. Airway obstruction secondary to superior vena cava obstruction occurred after placement of a subclavian vein Hickman catheter. This was felt to occur, in part, to a narrowed superior vena cava as evident by subclavian venography. It resulted in emergency oral tracheal intubation to relieve airway obstruction. Shortly after removal of the Hickman catheter, the signs of superior vena cava obstruction syndrome resolved and the patient was extubated without incidence. It is concluded that, although rare, the serious complication of acute airway obstruction can occur after placement of a Hickman catheter.