胸部体检人群气管憩室变化的MSCT随访观察

目的:随访观察胸部体检人群气管憩室(TD)的MSCT表现变化,探讨其机制及意义.方法:搜集行胸部CT健康体检及MSCT随访复查的78例TD患者,对比观察憩室大小、分隔、憩室气管间隔(DTS)、憩室气管间气瘘管(AFDT)、气管指数(TI)及肺大泡改变.结果:TD位于气管右侧75例,左侧3例.随访复查显示TD体积增大者明...     

气管支架置入术治疗气管恶性狭窄的并发症分析

目的探讨应用气管支架治疗气管恶性狭窄的并发症。方法回顾性分析1999年11月—2011年6月在局麻和数字减影血管造影机下应用气管支架治疗气管恶性狭窄的25例患者资料,其中6例置入Z型不锈钢支架,19例置入镍钛记忆合金支架,观察支架相关并发症。结果置入Z型不锈钢支架的6例患者中,所有支架置入后即刻完全扩张,2例出现支架移位,随访期中支架再狭窄3例,其中肿瘤增生性狭窄1例,黏稠痰液阻塞性狭窄1例,支架断裂伴肉芽增生性狭窄1例;置入镍钛记忆合金支架的19例患者中,术中无支架移位,2例即刻完全扩张,17例术后3天～3个月扩张完全,随访期内支架再狭窄2例,其中肿瘤增生性狭窄1例,肉芽增生性狭窄1例。所有患者术后呼吸困难即刻明显改善。结论应用气管支架治疗气管恶性狭窄有一定并发症,但仍是一种作用迅速、效果显著的治疗措施。     

国产曲马多对全麻围拔管期反应的影响

目的:观察国产曲马多对全麻围拔管期反应及术后疼痛的影响。方法:选择行静吸复合全麻患者42例,随机均分为两组。观察组在手术结束前约1小时肌肉注射国产曲马多1mg/kg,对照组不用曲马多。观察两组患者围拔管期血液动力学变化及不吸氧时SpO2值,有无躁动及躁动程度、初醒时间和拔管时间,术后疼痛程度评分及有无不良反应。结果:观察组围拔管期MAP、HR、SpO2没有明显变化(P>0.05);对照组MAP在拔管时明显升高(P<0.05);观察组重度躁动的发生率、术后8小时疼痛程度Ⅲ级者明显低于对照组(P<0.05),且不延长初醒和拔管时间。结论:国产曲马多肌肉注射可安全有效地抑制全麻围拔管期反应,且有明显的术后镇痛作用。     

老年气管插管患者舒适护理的管理

目的：探讨舒适护理在老年气管插管患者的应用及管理。方法：对46例老年气管插管患者，在整体护理中运用舒适护理，并评价其效果。结果：老年气管插管患者实施舒适护理，患者能适应非语言沟通方式，90％患者感觉身体舒适，能配合治疗；部分患者恐惧焦虑情绪逐渐好转，病人及家属满意度为96％。结论：舒适护理在老年气管插管患者中的应用，体现了以人为本的护理理念，提高了患者及家属的满意度，提高了护理服务质量。     

Wegener’s Granulomatosis Presenting as Mediastinal Soft Tissue Mass Invading the Tracheal Wall

Wegener’s granulomatosis (WG) is a clinicopathologic entity of unknown cause characterised by a necrotising granulomatous vasculitis affecting multiple organs, especially the upper and lower respiratory tracts, lung and kidney. The lung is the most frequently, and sometimes the only involved organ. Single or multiple nodules, with or without cavitation, are the most common pulmonary manifestations in WG, but mediastinal involvement is atypical. The sole tracheal involvement is rare and hilar and mediastinal involvement has been thought not to be part of the clinical feature. We experienced a rare case of WG presenting as paratracheal mediastinal lesions with tracheal wall invasion, which responded dramatically to corticosteroid treatment. We present this case with a review of the literature. Received: 22 October 1999 / Accepted: 20 April 2000     

地尔硫卓防治气管插管应激反应的临床观察

目的观察地尔硫卓对气管插管应激反应的防治效果。方法选择全麻病人60例,随机分为例数相等的A组和对照（B）组。A组在全麻诱导插管前静注地尔硫卓0.02 mg/kg;B组在诱导及插管前静注生理盐水10 ml。随后观察术前、插管即刻,插管后10 min 3个时段的收缩压（SBP）、舒张压（DBP）及心率（HR）。结果B组在插管即刻及插管后10min的SBP、DBP、HR均较术前明显升高,A组在插管即刻及插管后10 min有轻微变化;B组在插管即刻及插管后10 min的各项指标均高于A组。结论地尔硫卓可以有效防治气管插管时的应激反应。     

Aberrant left pulmonary artery with tracheal stenosis without vascular sling

Summary We report a case of abnormal origin of the left pulmoanry artery from the right pulmonary artery, associated with tracheal stenosis but with no vascular sling. This is the first such case, to our knowledge, without vascular sling.     

The efficiency of β2-agonist delivery through tracheal tubes with the metered-dose inhaler: an in vitro study

Purpose. To study the delivery efficiency of procaterol aerosols administered through the tracheal tube (ETT) with a metered-dose inhaler (MDI) during apnea. Methods. First, in a normal room air environment (at ambient temperatures of 24° to 26°C), we measured the amount of aerosol delivered through the ETT by comparing the weight of a 2-l bottle before and after firing the MDI directly into the 15-mm adapter of the ETT. The distal half of the ETT was inserted in the bottle. This procedure was repeated using five different ETTs with an internal diameter of 4–8.5 mm. The delivery efficiency was obtained by dividing the amount of aerosol delivered through the ETT by the total aerosol output per MDI puff. Next, we investigated whether the connector attached to the 15-mm ETT adapter could reduce the delivery, by repeating the same procedure with 4-mm and 5-mm ETTs. Finally, we compared the efficiencies of aerosol delivery through the 5-mm ETT and the 7.5-mm ETT in a normal room air environment with results obtained under a humidified condition (100% humid air at 37°C). Results. The percentages of aerosol delivered through the ETTs in a normal room air environment were 40%–60%, except for the 4-mm ETT, for which the percentage was 32.7% ± 6.6% (P < 0.05 vs that with the 5-mm ETT or the 6-mm ETT). A connector attached to the 15-mm ETT adapter significantly decreased the delivery efficiencies (19.0% ± 5.8% vs 32.7% ± 6.6% with the 4-mm ETT, 24.6% ± 11.8% vs 51.7% ± 10.8% in the 5-mm ETT) when compared with those without a connector. The delivery efficiencies under the humidified condition in the 5-mm ETT and the 7.5-mm ETT were 65.5% (P < 0.05) and 89.8% of those in the normal room air environment, respectively. Conclusion. The efficiency of delivery of procaterol aerosol through the ETTs was unexpectedly high (approximately half of the total aerosol output per MDI puff in the 5-mm to 8.5-mm ETTs, and one third of the total aerosol output per MDI puff in the 4-mm ETT). A connector attached to the 15-mm ETT adapter noticeably decreased the delivery efficiency. In the smaller-sized ETT, delivery efficiency was significantly lower under the humidified condition than in the normal room air environment. Received: September 28, 2001 / Accepted: June 24, 2002 Address correspondence to: T. Takaya     

Roles of brain prostaglandin E2 and thromboxane A2 in the activation of the central sympatho-adrenomedullary outflow in rats

This study addressed the question whether proximal and distal guinea pig tracheal segments respond differently to contractile agents. Using a perfused trachea set-up, histamine, KCl or the cyclo-oxygenase inhibitor, indomethacin, could be administered selectively to the mucosa (at the inside) or the serosa (at the outside) of the tracheal segments. Proximal parts contracted significantly more (40-60%) than distal parts when 1 mM histamine was administered to the mucosal or serosal side or when KCl (50 mM) was added to the serosal side. When histamine was administered to the mucosal side of epithelium-denuded segments, the contractions were twice as high in proximal than in distal parts (3057 vs. 1526 mg). Inhibition of tracheal cyclo-oxygenase with indomethacin at the mucosal side increased proximal and distal reactivity to mucosally administered histamine to the same extent. Serosal administration of indomethacin, however, increased histamine reactivity only in proximal segments (from 2690 to 5180 mg). In the latter segments, subsequent administration of histamine to the serosal side further increased the contraction, while serosal histamine in the absence of serosal indomethacin produced a relaxation (net difference of 4672 mg). In conclusion, the higher intrinsic contractility of proximal tracheal segments is counteracted by serosal cyclo-oxygenase products.