目的 探討兒童氣道異物的診斷、治療及并發癥發生的原因,以減少誤診及降低并發癥的發生率。 方法 回顧分析2009年1月-2010年8月經病史、癥狀、體征及輔助檢查(胸部X線檢查或CT掃描)初診為氣道異物的317例患兒的臨床資料。所有患兒均行支氣管鏡檢查,明確有異物者行異物取出術,對術中、術后并發癥的原因和處理方法進行總結。 結果 本組患者中有105例(33.1%)患兒曾被誤診為支氣管肺炎或其他呼吸系統疾病,經支氣管鏡檢及異物取出術后,出現并發癥者共35例,包括:喉痙攣8例(22.8%),支氣管痙攣6例(17.1%),支氣管黏膜出血12 例(34.3%),皮下氣腫8例(22.8%),死亡1例(2.8%)。 結論 兒童氣道異物一經確診或高度懷疑,應盡快行支氣管鏡檢查,以保持呼吸道通暢。手術操作應輕柔準確,并注意觀察患兒全身狀況,是減少并發癥的關鍵。
Objective To evaluate the effect of the plasma treated PLGA nerve conduits seeded BMSCs on repairing SD rat sciatic nerve defects. Methods BMSCs were acquired from 30 newborn SD rats. After ampl ified and passaged for 3 times, PLGA nerve conduits were prepared and some of them were treated with plasma. A 1-cm-length sciatic nerve defect wasmade in 30 4-week-old SD rats, then they were randomly divided into 3 groups for three different nerve defects reconstruction methods (n=10). In the experimental group, defect was repaired by plasma treatment and PGLA nerve conduits seeded with BMSCs; in the control group, by normal PLGA nerve conduits seeded with BMSCs; and in the autologous group, by autologous nerve. At 6 weeks after the surgery, the dynamic walking pattern was recorded and the sciatic function index (SFI) was calculated; the electrophysiological test was taken; the gastrocnemius wet weight recovery rate was calculated; and the image analysis of regenerated nerve was made. Results All rats survived after the surgery and l ived to the end of the experiment. At 6 weeks after the surgery, the dynamic walking pattern of the experimental group and autologous group was better than that of the control group. The SFI value of the experimental, control and autologous groups was —51.02 ± 6.54, —58.73 ± 7.87 and —48.73 ± 3.95, respectively, showing statistically significant differences among the experimental group, control group and autologous group (P lt; 0.05). The results of the motor nerve conduction velocity and wave ampl itude showed that there were statistically significant differences between the experimental group and the control group (P lt; 0.05), and between the control group and the autologous group (Plt; 0.01); but no significant difference between the experimental group and autologous group(Pgt; 0.05); The gastrocnemius wet weight recovery rate of the experimental, control and autologous groups was 56.13% ± 4.27%, 43.14% ± 6.52%, 59.47% ± 3.85%, respectively; showing statistically significant differences among experimental group, control group and autologous group (P lt; 0.05). The density, diameter of regenerated nerve fiber as well as neural sheath thickness of the experimental group were all higher than those of the control group (P lt; 0.05) and lower than those of the autologous nerve group (P lt; 0.05); there was significant difference between the control group and the autologous group (P lt; 0.01). Conclusion Plasma treated PLGA nerve conduits seeded with BMSCs can effectively repair sciatic nerve defects and provide a new strategy for the development of tissue engineered nerve to repair the peripheral nerve defects.