The modified Evan's blue dye procedure fails to detect aspiration in the tracheostomized patient: Five case reports

The modified Evan's blue dye procedure (MEBD) is a method of performing tracheal suctioning of the patient through the tracheostomy tube after administration of color-contrasted food and liquid. The MEBD is done when radiographic or fiberoptic procedures are not available or practical. In 5 tracheostomized patients, the MEBD does not detect aspiration.     

重症肌无力术后延长拔管时间的临床价值

目的　探讨重症肌无力 (MG)胸腺切除术后 ,延长气管拔管时间 ,减少气管切开的价值。方法　回顾分析 1978年至 2 0 0 2年 12月行MG胸腺切除 2 36例 ,按时间分A组 :1996年 12月以前手术者116例 ,对术后可能发生肌无力危象的高危因素病人施行预防性气管切开 ;B组 :1997年后手术 12 0例 ,对具发生危象高危因素者采用延长气管拔管时间 ,并对两组危象发生率及气管切开率进行比较。结果　全组发生危象 4 4例 (18 6 % ) ,气管切开 4 6例 (ARDS 1例除外 )占 19 5 %。其中A组发生危象 2 3例(19 8% ) ,气管切开 34例 (2 9 3% ) ;B组发生危象 2 1例 (17 5 % ) ,气管切开 12例 (10 % )。两组危象发生率无明显差异 ,但A组的气管切开率明显高于B组 (P <0 0 0 1)。结论　对MG胸腺切除术后具发生危象高危因素病人 ,采用延长气管插管时间及辅助通气 ,可显著减少气管切开率。     

Primary exophytic laryngeal amyloidosis presenting as sudden airway obstruction

Primary amyloidosis of larynx is an uncommon phenomenon, the precise etiopathogenesis of which is not yet clear. It can present with slowly increasing hoarseness or difficulty in breathing. It presents more commonly as infiltrative lesion, exophytic presentation is a rare occurrence.     

Conservative management of a major post-intubation tracheal injury and review of current management

Tracheal rupture represents a rare but serious complication of intubation. We discuss a case of a major post-intubation rupture. After investigation with CT scan tracheoscopy and bronchoscopy a low tracheostomy was formed protecting the rupture from pressure changes associated with ventilation. The patient was managed with minimal surgical intervention, low tracheostomy with antibiotic cover and monitoring in the intensive care unit for 24 h before being woken and moved to a ward after 48 h. The patient made a full and uncomplicated recovery and was discharged 2 weeks after the original injury. Most of the literature on the subject is made up of review of case reports that conclude management of such a major tear must be with surgical repair. This however confers significant morbidity and an associated high mortality. We suggest an alternative management protocol.     

气管造口扩大术

２１例行全喉切除术后０．５￣５年行气管造口扩大术,以能在气管造口置放发音钮,造瘘口上下径为２．０ｃｍ,左右径为１．５ｃｍ。全喉切除术中气管造口狭窄的主要原因有瘘口不够大或瘢痕形成,气管造口扩大术有：各种“Ｚ”字形成形,放射状切口成形,环形皮肤切除,侧裂开鱼嘴形造口成形,三角形皮瓣成形及双“Ｖ”字形切除插入皮瓣等。     

喉全切除气管食管分路发音重建的防误咽术

目的　观察喉全切除气、食管分路发音重建防误咽术的效果。方法　 1991年 10月～2 0 0 1年 5月对 79例T3、T4喉癌患者喉全切除术中行气、食管分路发音重建防误咽术 ,在食管前壁和气管后壁做一个长约 0 8～ 1 2cm发声口 ,同时保留环状软骨宽度 1 2cm ,长度 2 0cm做成软骨黏膜瓣防误咽檐 ,气管膜部向前外与皮肤缝合 ,做成防误咽斜度。结果　 79例患者中有 71例患者获得良好发声 ,71例患者中有 6 5例防误咽成功 ,6例失败。 6 5例患者随访 1年以上 ,均无误呛。 79例患者术后T3、T4期 3年生存率分别是 6 6 7% (14 / 2 1)和 6 4 9% (2 4 / 37)。T3、T4期 5年生存率分别是 6 / 10和5 0 0 % (10 / 2 0 )。结论　气、食管分路发音重建防误咽术能有效地防止误咽。     

Tracheoesophageal fistula: New option in management

Tracheoesophageal fistula is a life threatening condition. Patients not managed surgically ultimately die of their disease. Surgical management is the treatment of choice. We present a case of a patient that developed a tracheoesophageal fistula after tracheostomy. Surgical repair was done which failed due to infection. The patient was managed with the help of an esophageal stent and Trichloroacetic Acid cautery. This approach can be used in selected patients, depending upon the size and site of TEE Larger fistulae and those situated lower down e.g. supra carinal cannot be managed by this technique.     

经皮旋转扩张气管切开术在ICU中的应用

目的总结经皮旋转扩张气管切开术在ICU中应用的经验和效果。方法对我院ICU自2010年3月至2011年7月采用BRANDEN旋切型经皮气管切开套装行气管切开的24例患者进行回顾性分析。结果 24例患者均手术成功,手术时间6～14 min,仅一例术后少许渗血,无严重并发症。结论 ICU中行经皮旋转扩张气管切开术具有快速、创伤性小、手术操作精确易掌握、成功率高、并发症少等优势,值得推广。     

保护性毛刷盲取技术在念珠菌肺炎病原学诊断中的研究

目的初步探讨应用防污染保护性毛刷盲取技术在念珠菌肺炎病原学诊断中的临床价值.方法采用前瞻性、自身对照临床研究设计,对30例气管切开患者,疑诊肺部真菌感染,采用防污染保护性毛刷经气管套管盲取技术,行下呼吸道标本真菌培养病原学诊断,同时刷片观察组织细胞学及真菌菌丝、孢子体形态学证据.结果30例气管切开患者,采用防污染保护性毛刷经气管套管盲取技术,行下呼吸道标本真菌培养病原学诊断,阳性率为63.33%,与常规无菌吸痰管取标本真菌培养阳性病例相比,两种诊断技术比较无显著的统计学差异.同时与非气管切开病例常规采样真菌培养结果相比两种念珠菌混合感染少,病原污染可能性小,P＜0.05.组织细胞学及真菌菌丝、孢子体形态学证据诊断肺念珠菌感染阳性率为36.67%.结论气管切开病例肺部念珠菌感染,长期联合使用广谱抗生素、低白蛋白血症、中性粒细胞减低比例较高.防污染保护性毛刷盲取技术,可以作为气管切开患者念珠菌肺炎病原学诊断的可靠的取材方法.