气管切开病人高压氧治疗的护理进展

概述气管切开病人高压氧治疗的护理，从吸氧方式的选择、气道的湿化、吸痰的护理、感染的预防、气囊的管理、脱管的预防及护理进行综述。     

喉气管外伤及狭窄的治疗

【目的】探讨喉外伤及狭窄的不同类型的临床治疗方法及效果。【方法】15年来收治各类喉外伤及狭窄患者38例。其中9例闭合性喉腔软组织伤,或合并软骨骨折而无移位,采用药物保守治疗,18例喉外伤颈部有开放性损伤伴有喉气管软骨损伤,或颈部无开放性损伤伴有喉气管软骨损伤,进行清创缝合,开放手术复位骨折,留置硅胶喉扩张管支撑,11例喉气管瘢痕狭窄采用瘢痕切除留置硅胶喉扩张管支撑,喉气管裂开肋软骨移植术,栅栏状喉气管成形术等方法治疗。【结果】37例患者呼吸通畅、发音满意,劳动力恢复,1例患者需终身保留气管造口。【结论】喉气管外伤应尽早明确诊断,早期治疗。喉气管外伤后瘢痕狭窄患者,根据狭窄部位和程度采取瘢痕切除留置硅胶喉扩张管支撑,栅栏状喉气管成形术及喉气管裂开肋软骨移植术,效果比较满意。     

气管切开后呼吸道管理的护理进展

介绍了气管切开后呼吸道管理的护理进展.重点阐述了气管切开的适应证,气道湿化的护理管理,吸氧、排痰的护理管理,气囊的护理管理,呼吸道感染的护理.     

Management of and indications for tracheostomy in care of the critically ill patient

Tracheostomy is a procedure that has evolved over many hundreds of years. In the 21st century, the majority of tracheostomies are now inserted by intensivists in the intensive care unit (ICU). Commonly performed to assist in weaning patients from mechanical ventilation, the procedure is performed using a percutaneous dilatational technique. Percutaneous tracheostomy can generally be performed safely in the ICU, although a number of contra-indications and complications do exist. Recent publications have highlighted weaknesses in the quality of care both in the immediate and longer term. Consequently, a number of organizations, based in the UK and internationally, have turned the focus in recent years to improving the quality of care delivered to these patients. Clinicians caring for patients with tracheostomies should not only be familiar with the indications, anatomy and insertion techniques, but also current guidance on routine care and the emergency management of complications.     

甲状腺癌侵犯喉和气管的外科处理

目的探讨甲状腺癌侵犯喉部和气管时的手术治疗。方法对8例甲状腺乳头状癌和滤泡状癌不同程度侵犯喉部和气管的惠者进行甲状腺切除、颈淋巴结清扫术、术中部分切除气管并用带蒂肌瓣一期修复，侵犯范围大的进行全喉切除。结果8例甲状腺癌均可全部切除，4例康复后发音和呼吸正常，3例呼吸正常但有不同程度的声嘶，1例同时喉全切除后用电子人工喉发音。8例术后均服用甲状腺素片，随访1～2年，没有复发。结论对甲状腺乳头状癌和滤泡状癌累及喉部和气管，手术范围可适当扩大，对于不超过气管直径1／3的气管缺损，可进行带蒂肌瓣一期修复，不会引起气管狭窄，喉部有较大的侵犯，可同时喉全切除术，甲状旁腺的再植可以存活，以提高患者的生活质量。     

Pilot study of a novel vacuum‐assisted method for decellularization of tracheae for clinical tissue engineering applications

Tissue engineered tracheae have been successfully implanted to treat a small number of patients on compassionate grounds. The treatment has not become mainstream due to the time taken to produce the scaffold and the resultant financial costs. We have developed a method for decellularization (DC) based on vacuum technology, which when combined with an enzyme/detergent protocol significantly reduces the time required to create clinically suitable scaffolds. We have applied this technology to prepare porcine tracheal scaffolds and compared the results to scaffolds produced under normal atmospheric pressures. The principal outcome measures were the reduction in time (9 days to prepare the scaffold) followed by a reduction in residual DNA levels (DC no‐vac: 137.8±48.82 ng/mg vs. DC vac 36.83±18.45 ng/mg, p<0.05.). Our approach did not impact on the collagen or glycosaminoglycan content or on the biomechanical properties of the scaffolds. We applied the vacuum technology to human tracheae, which, when implanted in vivo showed no significant adverse immunological response. The addition of a vacuum to a conventional decellularization protocol significantly reduces production time, whilst providing a suitable scaffold. This increases clinical utility and lowers production costs. To our knowledge this is the first time that vacuum assisted decellularization has been explored. Copyright © 2015 John Wiley & Sons, Ltd.     

Fetal Aortic Arch Anomalies

Aortic arch anomalies are present in 1% to 2% of the general population and are commonly associated with congenital heart disease, chromosomal defects, and tracheaesophageal compression in postnatal life. The sonographically based detection of aortic arch anomalies lies in the 3‐vessel and trachea view. Although highly sensitive, this view alone does not allow identification of the aortic arch branching pattern, which prevents an accurate diagnosis. The systematic addition of a subclavian artery view as part of a standardized procedure may be useful in the differential diagnosis of these conditions. We describe the sonographic assessment of fetal aortic arch anomalies by combining 2 fetal transverse views: the 3‐vessel and trachea view and the subclavian artery view, which are included in the cardiovascular system sonographic evaluation protocol. We also review the sonographic findings and the clinical implications of fetal aortic arch anomalies.     

休克时犬气管、舌和尾部脉搏氧饱和度的比较

目的比较休克对犬气管、舌和尾部脉搏氧饱和度的影响。方法犬麻醉后纯氧通气,将SpO2探头分别置于气管内、舌和犬尾部,连接于同一监护仪上。经股动脉快速放血,降低MAP至40mmHg,建立犬的休克模型。以录像方式记录StraO2,StonO2,StaiO2及ECG,BP。同时连续监测ScaO2作为对照。计算低血压时,气管、舌和犬尾部SpO2的监测失败率。结果放血前,气管、舌和犬尾部的SpO2信号好、读数准确。休克时,ScaO2无变化,为（96.8±0.8）%;气管、舌和犬尾部SpO2的监测失败率分别为19.70%、18.02%、35.35%（P〈0.05）。结论犬失血性休克模型中,中心位点的气管和舌SpO2监测好于外周。