环甲膜切开选择性代替气管切开251例临床分析

目的:环甲膜切开选择性代替气管切开的可行性。方法:251例需行气管切开用环甲膜切开代替。结果:术后随访2年,无声音嘶哑,无气管狭窄,无特殊不适。结论:环甲膜切开速度快,出血少,定位准确,可长期戴管,在有适应证的情况可在临床推广。     

Laryngo-tracheal anastomosis: post-operative evaluation by helical CT and computerized reformations

OBJECTIVE: Our purpose was to evaluate the role of post-operative helical computed tomography (CT) and computerized reformations in patients after laryngo-tracheal segmental resection with anastomosis. METHODS: Helical CT and computerized reformations were obtained in 11 consecutive patients who underwent laryngo-tracheal resection with anastomosis for obstruction or stenosis caused by longstanding intubation or tracheostomy. Post-operative computer assisted cross-sectional area, coronal and sagittal diameter measurements at the level of maximal narrowing of the trachea were compared with clinical assessment in all patients. The additive value of various coronal and sagittal computerized reformations over axial images was subjectively evaluated by a consensus of a thoracic radiologist and a neuroradiologist who were blinded to clinical information. RESULTS: Various degrees of restriction in daily activities were reported by patients with cross-sectional area narrowing of more than 50%, by 4/6 patients with cross-sectional area of less than 90mm(2), by 4/5 and 4/6 patients with coronal or sagittal narrowing of more than 25% respectively, and by 4/5 patients with sagittal diameter of less than 12mm. All five patients with cross-sectional area stenosis of less than 50% assessed themselves as 'asymptomatic'. Sagittal multi-planar and volume rendering reformations clarified or added additional information over axial images in all six patients with significant cross-sectional area stenosis (>50%). Volume rendering scores were significantly higher than minimal intensity projection reformations (P=0.01). CONCLUSION: Our preliminary results suggest that CT-based cross-sectional area and diameter measurements of the trachea represent a clinically helpful tool for post-operative evaluation of patients with tracheoplasty. The need for post-operative endoscopy may be obviated in some cases.     

等效剂量曲马多和芬太尼术后镇痛对全麻患者拔管期循环和呼吸的影响

目的比较等效剂量曲马多和芬太尼持续静脉镇痛对全麻患者气管拔管循环和呼吸的影响。方法60例ASAⅠ、Ⅱ级全麻手术病人随机分为T组和F组,分别于手术结束前30min给予曲马多或芬太尼静脉镇痛,观察拔管后1、5和10min时的SBP、HR、SpO2和PEtCO2。结果拔管时间F组长于T组,两组同期比较拔管后F组HR明显低于T组(P<0.01),SpO2较T组低,而PEtCO2较T组高(P<0.05)。结论曲马多用于全麻术后静脉镇痛几乎不影响患者的清醒及恢复,对患者拔管期间循环和呼吸的影响小于芬太尼。     

气管腺样囊性癌5例报告及国内131例文献分析

目的 提高对气管腺样囊性癌（TACC）的认识。方法 回顾性分析长海医院1995年-2003年收治的TACC5例及检索国内期刊发表的23篇共131例患者临床资料。结果 该病临床上以咳嗽、喘鸣和进行型吸气性呼吸困难为主要表现形式；易与支气管哮喘、慢性支气管炎等混淆。122例行手术治疗，气管支架置入6例，纤支镜下介入治疗3例，局部放疗47例。死亡20例。结论 TACC临床症状不典型，术前误诊率高，尽早积极手术切除加放疗为最佳治疗方法。内镜下介入治疗是较好的姑息治疗手段，可明显改善患者生活质量。     

Microvascular remodelling in chronic airway inflammation in mice

1. Chronic inflammation is associated with blood vessel remodelling, including vessel proliferation and enlargement, and changes in vessel phenotype. We sought to characterize these changes in chronic airway inflammation and to determine whether corticosteroids that inhibit inflammation, such as dexamethasone, can also reduce microvascular remodelling. 2. Chronic airway inflammation was induced in C3H mice by infection with Mycoplasmapulmonis and the tracheal vessels treatment also decreased the immunoreactivity for P-selectin and the number of adherent leucocytes (595 +/- 203 vs 2,024 +/- 393 cells/ mm2 in treated and non-treated infected mice, respectively). 6. We conclude that microvascular enlargement and changes in vessel phenotype are features of some types of chronic inflammation and, furthermore, that dexamethasone reverses the microvascular enlargement, changes in vessel phenotype and leucocyte influx associated with chronic inflammatory airway disease.     

Electrophysiological characteristics of the Ca2+-activated Cl- channel family of anion transport proteins

1. A protein isolated from the bovine tracheal epithelium behaves as a Ca2+-activated Cl- channel (CaCC) when incorporated into planar lipid bilayers. 2. An antibody raised against this protein was used to screen a cDNA expression library and resulted in the isolation of a cDNA clone that exhibited nearly identical electrophysiological characteristics to the isolated endogenous protein when expressed. 3. Recent cloning of several related proteins has revealed that the cloned bovine CaCC is one of a large and growing family. All new family members so far examined are associated with the appearance of a novel Ca2+-mediated Cl- conductance when heterologously expressed. 4. This new group of proteins may underlie the Ca2+-mediated Cl- conductance upregulated in the cystic fibrosis (CF) knockout mouse and thought to be responsible for the escape from the significant airway pathology associated with CF.     

Pleomorphic Adenoma (Benign Mixed Tumor) of the Trachea

A 15-year-old “asthmatic” found to have a pleomorphic adenoma of the trachea was treated by staged CO₂ laser excision Primary tracheal tumors, the clinicopathologic features of mixed tumor in this rare location, and therapeutic options are briefly reviewed Immunohistochemical stains for cytokeratin, S-100 protein, and glial fibrillary acidic protein are reliable methods of evaluating component cell types in pleomorphic adenoma, but immunohistochemical evidence has not resolved the issue of tumor histogenesis.     

国人无名动脉的应用解剖学研究

本文在国人成人男性尸体材料上测量了无名动脉上端、中点至环状软骨上缘的距离;无名动脉上端、中点至2、3气管环间的距离。对气管套管气囊的位置、气管套管末端的位置及无名动脉对应的气管环的位置进行了观察。对临床上气管切开的位置及选择气管套管的长度,有效的防止气管切开术后造成无名动脉被腐蚀破裂出血,甚而使病人死亡。所以具有较重要的临床指导意义。     

小儿支气管异物79例分析

本文报告一九八九年一月至十二月收治的79例气管支气管异物,均在全麻下经口支气管镜直接插入法取出异物,抢救或功率100%,无手术并发症,无气管切开。     

Is there any Evidence of β1-Adrenoceptors Mediating Relaxation of Guinea-pig Lung Parenchyma?

Abstract: We tried to find functional evidence for the existence of β₁ - and β₂-adrenoceptors in the isolated guinea-pig lung parenchymal strip preparation, using potent and selective β₁- and β₂-adrenoceptor stimulation. To obtain potent β₁-adrenoceptor stimulation the nonselective β-adrenoceptor agonist isoprenaline was combined with a highly selective β₂-adrenoceptor antagonist ICI 118,551. Potent β₂-adrenoceptor stimulation was obtained by procaterol. Practolol (β₁-adrenoceptor antagonist) and ICI 118,551 were used as antagonists. ICI 118,551, 10⁷ mol/l, shifted the concentration response (C/R) curve of isoprenaline to a higher concentration range. The C/R curve of procaterol was shifted in the same way and to the same degree by this concentration of ICI 118,551. The C/R curve of isoprenaline was not further shifted after blockade with a combination of ICI 118,551, 10^-7 mol/l, and practolol, 10^-6 mol/l. However, in the trachea preparation, a tissue containing both β₁- and β₂-adrenoceptors, there was a further shift of the C/R curve of isoprenaline to a higher concentration range after blockade with a combination of ICI 118,551 and practolol in the concentrations given above. In this preparation the shift of the C/R curve of procaterol was ten times greater than that of isoprenaline after blockade with ICI 118,551, 10⁷ mol/l. We conclude that it is possible to characterize small fractions of β₁-adrenoceptors coexisting with β₂-adrenoceptors with the technique used. Furthermore there is still no functional evidence of the existence of β₁-adrenoceptors in the lung parenchyma.: