Resolution of recurrent atelectasis in spinal cord injury patients with administration of recombinant human DNase

Atelectasis occurs frequently in patients with spinal cord injury (SCI). Impaired cough leads to ineffective clearance of secretions. If the secretions cannot be cleared and become thick and purulent, atelectasis may occur. Recombinant human DNase (rhDNase) has been shown to decrease purulent sputum viscosity in vitro. We report two SCI patients with repiratory failure due to recurrent atelectasis from purulent secretions in whom conventional treatment methods had failed. Administration of rhDNase resulted in successful resolution of atelectasis. These results suggest the need for a controlled clinical trial.     

小儿肺不张23例临床分析

肺不张是小儿肺部常见疾病之一。本组对23例肺不张患儿的病因、治疗进行了分析，结果炎症是小儿肺不张最常见的病因（52．2％），其次为异物（21．7％）。肺不张最常见的部位在右肺中叶，占69、6％，这与右中叶独特的生理、解剖结构有关。炎症性肺不张多由于反复炎症刺激，使支气管纤维化并引起肺泡表面活性物质生成减少，故病程较长，复张时间长，平均13～16天，复张率低，纤支镜下多表现为支气管粘膜充血水肿。异物性肺不张病程较短，经清除异物，解除气道阻塞后，多能在短期内复张，平均6天，复张率达100％。纤支镜直接观察气管、支气管病变，可对肺不张病因作出正确诊断，对异物性肺不张的治疗是非常有效的非外科手术疗法。支气管肺泡灌洗术配合药物治疗炎症性肺不张，复张率高于单纯性药物治疗。     

The effects of anesthesia and muscle paralysis on the respiratory system

Background Oxygenation is impaired in almost all subjects during anesthesia, and hypoxemia for shorter or longer periods is a common finding. Moreover, postoperative lung complications occur in 3–10% after elective abdominal surgery and more in emergency operations.Discussion Rapid collapse of alveoli on induction of anesthesia and more widespread closure of airways seem to explain the oxygenation impairment and may also contribute to postoperative pulmonary infection. Causative mechanisms to atelectasis and airway closure seem to be loss of respiratory muscle tone and gas resorption.Conclusion Avoiding high inspired oxygen fractions during both induction and maintenance of anesthesia prevents or reduces atelectasis, while intermittent vital capacity maneuvers recruit atelectatic lung regions.     

Effects of a single-lung recruitment maneuver on the systemic release of inflammatory mediators

Objective To study the hypothesis, that systemic levels of pro-inflammatory and anti-inflammatory cytokines may be affected by a single recruitment maneuver in mechanically ventilated patients.Design Prospective, interventional clinical trial.Setting Intensive care unit of a university hospital.Patients Sixteen mechanically ventilated patients with clinical and radiological signs of atelectasis.Interventions A single recruitment maneuver (RM) was performed by elevating the airway pressure to 40 cmH₂O for 7 s.Measurements and main results Plasmatic concentrations of interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12p70 and tumor necrosis factor (TNF-α), arterial blood gases and hemodynamic parameters were measured immediately before and 5–360 min after the RM. The RM caused a minor, nevertheless significant improvement of oxygenation (p = 0.02) and carbon dioxide elimination (p = 0.006) as well as a moderate drop of the mean arterial pressure (p = 0.025). In contrast, plasma concentrations remained unaffected by the RM in all six mediators measured.Conclusion A single inflation with an airway pressure of 40 cmH₂O for 7 s improved gas exchange only slightly and did not modify systemic levels of inflammatory mediators in mechanically ventilated patients with radiological evidence of atelectasis.This study was supported by departmental funds     

电子支气管镜检查对肺不张的诊断价值

目的：探讨电子支气管镜检查在不明原因肺不张诊断中的价值。方法：经X线、CT诊断为肺不张的患者120例,行电镜检查,组织、细胞学和细菌学检查等明确病因。结果：电镜检查结合组织、细胞学以及细菌学检查的结果,120例患者中确诊为肺癌65例,炎症31例,结核21例。结论：电子支气管镜检查对肺不张的病因的诊断具重要意义。     

纤维支气管镜检查96例肺不张病因临床分析

目的：探讨纤支镜检查在肺不张病因诊断及治疗中的应用价值。方法：对本院2008年1月-2010年2月收治的经CT检查诊断为肺不张的96例患者进行纤支镜检查、镜下活检、刷检等检查。结果：本组96例肺不张患者经纤支镜检查确定病因为恶性肿瘤46例（47．92％）,炎症40例（41．67％）,结核8例（8．33％）,其他2例（2．08％）。结论：肺癌、炎症、肺结核是肺不张的三种常见原因;纤支镜检查是明确肺不张原因的重要手段,对明确肺不张病因、发病部位以及定性诊断具有重要作用．值得应用。     

电子支气管镜灌洗治疗支原体肺炎伴肺不张患儿的临床效果

目的对支原体肺炎(MPP)伴有肺不张患儿实行电子支气管镜灌洗治疗,观察其临床疗效。方法以某院2018年3月至2019年9月收治的120例MPP伴有肺不张患儿为研究对象,按照随机数表法将其分为对照组与观察组,对照组行常规治疗,观察组在常规治疗基础上行电子支气管镜灌洗治疗,比较两组治疗第3天、1周后治疗转归情况。结果观察组治疗第3天肺复张有效率为93.3%,对照组为25.0%,观察组明显优于对照组,差异有统计学意义,P<0.05。治疗1周后,观察组总有效率为98.3%,对照组为61.7%,观察组明显优于对照组,差异有统计学意义,P<0.05。结论采用电子支气管镜灌洗治疗支原体肺炎伴肺不张患儿,可准确观察其病情状态,促进肺复张。     

药物雾化吸入疗法联合纤支镜介入疗法治疗支气管内膜结核患者的疗效分析

目的 探讨抗结核药物雾化吸入疗法联合纤支镜介入疗法治疗支气管内膜结核的可行性。方法 选取2018年3月～2019年3月在沈阳市第十人民医院住院治疗的80例支气管内膜结核患者作为研究对象,将患者随机分为两组,各40例。对照组予2HRZE/10HR方案口服药物抗结核治疗,研究组在对照组基础上,应用抗结核药物雾化吸入疗法联合纤支镜介入疗法。比较两组患者治疗效果、治疗的总疗程、不良反应及并发症的发生率。结果 研究组在总有效率、痰菌转阴时间及总治疗疗程方面分别为92.5%、(28.77±4.12)d、(39.2±6.28)周,相对于对照组的为75.0%、(39.49±5.72)d、(47.3±6.65)周,两组差异均有统计学意义(P0.05)。除术中出血方面两组有统计学差异(P0.05)外,两组其余不良反应者无明显差异(P0.05)。结论 对EBTB患者,在常规抗结核治疗基础上联合使用药物雾化吸入疗法和纤维支气管镜介入疗法治疗可迅速缓解患者临床症状,缩短菌阳患者的痰菌转阴时间及治疗疗程,促进肺不张恢复,提高治疗效果。     

Minimizing atelectasis formation during general anaesthesia—oxygen washout is a non-essential supplement to PEEP

Background: Following preoxygenation and induction of anaesthesia, most patients develop atelectasis. We hypothesized that an immediate restoration to a low oxygen level in the alveoli would prevent atelectasis formation and improve oxygenation during the ensuing anaesthesia.

Methods: We randomly assigned 24 patients to either a control group (n?=?12) or an intervention group (n?=?12) receiving an oxygen washout procedure directly after intubation. Both groups were, depending on body mass index, ventilated with a positive end-expiratory pressure (PEEP) of 6–8 cmH₂O during surgery. The atelectasis area was studied by computed tomography before emergence. Oxygenation levels were evaluated by measuring blood gases and calculating estimated venous admixture (EVA).

Results: The atelectasis areas expressed as percentages of the total lung area were 2.0 (1.5–2.7) (median [interquartile range]) and 1.8 (1.4–3.3) in the intervention and control groups, respectively. The difference was non-significant, and also oxygenation was similar between the two groups. Compared to oxygenation before the start of anaesthesia, oxygenation at the end of surgery was improved in the intervention group, mean (SD) EVA from 7.6% (6.6%) to 3.9% (2.9%) (P?=?.019) and preserved in the control group, mean (SD) EVA from 5.0% (5.3%) to 5.6% (7.1%) (P?=?.59).

Conclusion: Although the oxygen washout restored a low pulmonary oxygen level within minutes, it did not further reduce atelectasis size. Both study groups had small atelectasis and good oxygenation. These results suggest that a moderate PEEP alone is sufficient to minimize atelectasis and maintain oxygenation in healthy patients.     

B型超声对肺不张诊断价值探讨

目的探讨B型超声对肺不张的诊断价值。方法对2007年5月-2009年5月收治的67例肺不张患者的CT诊断与B型超声诊断进行对照、分析、总结。结果 B型超声诊断一侧肺不张和肺叶肺不张与CT诊断符合率为94.64%,肺段型肺不张诊断符合率为54.55%。结论 B型超声诊断可作为肺不张筛查的首选诊断方法。