呼出气一氧化氮在中央型气道疾病气管镜治疗前后的变化

目的 探讨中央型气道疾病患者气管镜治疗前后呼出气一氧化氮(FeNO)变化及意义。方法 选取2019年7月至2019年8月于应急总医院明确诊断的中央型气道疾病且需行气管镜治疗患者48例,其中良性中央型气道病变患者18例,恶性中央型气道病变患者30例,每例患者均于气管镜治疗前及治疗24h后行FeNO 检查。结果 良、恶性中央型气道病变患者FeNO水平差异无统计学意义;中央型气道病变位置不同,所测量FeNO 水平差异无统计学意义;良、恶性病变患者气管镜治疗后FeNO 均较治疗前明显下降(t 值分别为2. 701、2 .895,P值均<0 05)。结论 将FeNO 应用于中央型气道疾病气管镜治疗前后气道炎症研究有一定的提示意义。     

118例儿科支气管镜术护理

目的 探讨和总结118例患儿行支气管镜检查和护理的特点和体会.方法 时术前、术中、术后的护理进行回顾性总结、观察、分析,以增加该技术的安全性和成功率.结果 本组均获得成功,结果满意.术中血氧饱和度(SaO2)下降80％以下2例,80 - 90％ 15例,术后发热或发热加重7例,出血6例,未发生严重并发症.结论 认为严格遵守操作规程和细致周到的护理,有助于提高儿科支气管镜术成功率并减少并发症.     

儿童气管的解剖学观测和临床应用

目的研究支气管镜操作术的成功率和安全性。方法通过44例儿童尸体观测气管的解剖长度、临床长度和气管的横径、矢状径,并与儿童身高和上部量进行相关分析,另外分析临床资料85例,其中58例在使用支气管镜前做了气管横径、矢状和长度的预测。结果两性儿童的身高和上部量与气管的解剖长度、临床长度、气管内径之间密切相关。结论只要先测量儿童的身高和上部量就可根据他们之间的回归方程计算出气管的长度和内径大小,为临床准确选用气管镜型号和插管的深度提供可靠的依据,从而保证了气管插管的一次性成功率和安全性。     

小儿呼吸道异物115例手术麻醉和术中监测

目的:探讨小儿呼吸道异物取出术麻醉方法及围术期有关处理。方法:回顾分析1995～2006年间小儿呼吸道异物取出术115例的麻醉方法:采用静脉复合麻醉结合咽喉、气管及支气管表面麻醉方法同时监测动脉血氧饱和度、呼吸及心电图。结果:麻醉经过平稳,围术期死亡率低于1%。结论:小儿呼吸道异物取出术选用静脉复合麻醉结合咽喉、气管及支气管表面麻醉是安全、可行的麻醉方法。     

芬太尼联合咪达唑仑在ICU高龄重症患者无痛支气管镜检查中的应用

目的观察芬太尼联合咪达唑仑在支气管镜检查术中的作用,评估其术前镇痛应用价值。方法选取行2次以上支气管镜检查的高龄(≥80岁)重症患者16例,按前2次检查术前用药不同分为咪达唑仑组(对照组)和芬太尼+咪达唑仑组(观察组),比较两组药品用量及患者平均动脉压(mean arterial pressure,MAP)、心率(HR)、氧饱和度(SPO2)、耐受程度的变化。结果两组患者检查过程中心率、氧饱和度较术前均无明显变化,与对照组相比,观察组药品用量减少,血压维持相对稳定,患者耐受度优于对照组(P0.05)。结论支气管镜检查术中使用芬太尼联合咪达唑仑相对安全,患者耐受度好,不良反应较少。     

Closer location of the tracheoesophageal fistula to the carina in newborns with esophageal atresia and VACTERL association

BackgroundVACTERL is a complicated syndrome with an unknown etiology where many studies have failed to identify the cause. In esophageal atresia (EA) roughly 10%–23% also have concurrent anomalies that align with VACTERL disorder. The aim of this study is to investigate if there is a difference regarding localization of the tracheoesophageal fistula between patients with VACTERL and non-VACTERL patients.MethodsRetrospective chart review of newborn operated for esophageal atresia between 2006 and 2016 at our Institution was performed. Children with a C-type fistula according to Gross and reliable preoperative tracheoesophageal fistula to carina distance measurement at rigid tracheoscopy were included in the study.ResultsA total of 90 patients were included in the study. Fifteen of those were diagnosed with VACTERL. Before and after adjusting for weight and gestational week patients with VACTERL had significantly shorter carina to fistula distance at perioperative rigid tracheoscopy (p = < 0.001 nonadjusted, p = 0.016 adjusted).ConclusionPatients with VACTERL born with EA type C had shorter carina to fistula distance as shown at perioperative rigid tracheoscopy. The significantly shorter distance may not only present surgical difficulties but may also suggest a structural or molecular difference in the development of the esophageal atresia between the two groups.Level of evidenceIII.