目的 探討經臍單孔腹腔鏡膽囊切除的可行性、安全性及實用性。 方法 回顧分析2010年11月－2011年2月27例行經臍單孔腹腔鏡膽囊切除術患者的臨床資料。其中男15例，女12例；年齡19～53歲，平均39.5歲。膽囊息肉樣病變12例，病程6個月～8年；膽囊結石17例，結石數量1～9個，大小0.5～1.5 cm，均為非急性期患者，病程1個月～13年。 結果 27例手術均順利完成，無1例中轉開腹或轉為傳統三孔腹腔鏡膽囊切除術，術中生命體征平穩。手術時間35～149 min，平均63 min；術中出血10～20 mL，平均15 mL。所有患者術后2～3 d出院。患者均獲隨訪，隨訪時間6～24個月，平均13個月。術中及術后隨訪期間未發生任何并發癥。臍部瘢痕不明顯，患者滿意度高。 結論 經臍單孔腹腔鏡膽囊切除安全可行，具有創傷小、瘢痕不明顯等優點。
摘要:目的：探討纖支鏡經口引導氣管插管在慢阻肺合并重度呼吸衰竭救治中的臨床應用價值。方法：237例慢阻肺合并重度呼吸衰竭患者,隨機分為纖支鏡經口引導氣管插管組(纖支鏡組)125例和喉鏡經口引導氣管插管組(喉鏡組)112例,分別在纖支鏡和喉鏡引導下按常規進行氣管插管術。結果：纖支鏡組和喉鏡組一次獲得插管成功率分別為984%和920%(P＜005),平均插管時間分別為（613±391） min 和（926±415） min(P＜005)。纖支鏡組有5例患者出現咽喉部少量出血,并發癥發生率為40%;喉鏡組共有12例發生并發癥,并發癥發生率為107%(P＜005),其中齒、舌、咽或喉部損傷6例,反射性嘔吐致誤吸2例,單側肺通氣1例,插入食管2例,心跳呼吸驟停1例。結論：纖支鏡經口引導氣管插管在慢阻肺合并重度呼吸衰竭救治中是一種簡便快速、成功率高和并發癥少的有效方法,值得臨床推廣應用。Abstract: Objective: To evaluate the efficacy of endotracheal intubation under fiberoptic bronchoscope through mouth in severe respiratory failure. Methods:Two hundreds and thirtyseven cases of severe respiratory failure were divided into two groups at random (fiberoptic bronchoscope group and laryngoscope group), 125 cases were intubated through mouth under fiberoptic bronchoscope, the others were intubated through mouth by laryngoscope. Results: The successful rates of endotracheal intubation were 98.4% and 92.0% in two groups respectively (P ＜005), the mean intubation timewere (613±391) min and (926±415) min respectively ( P ＜ 005), 4 cases in fiberoptic bronchoscope group appeared a little blood in throat, the complication rate was 32% 12 cases in the laryngoscope group had complications, the complication rate was 107%( P＜ 005). Among it, 6 cases had the injury of tooth, tongue, gullet and larynx.The cases of reflexvomiting were 2,pulmonary ventilation by single lung were 1, intubation in esophagus were 2, cardiopulmonary arrest were 1.Conclusions:Endotracheal intubation under fiberoptic bronchoscope through mouth was accurate, the fewer complications and effective for patients, and could be used widely in clinical applications.
Objective To investigate the safety and effectiveness of a self-made bronchoscopic catheter ( an improved artificial airway) in bronchoscopic interventional therapy.Methods 126 patients planning to receive bronchoscope between October 2012 and February 2013 were divided into A, B and C groups. Three groups received inhalation of 2% lidocaine 5mL for surface anesthesia, and the venous channel was build up. Then the patients in group A ( n = 45) were treated with conventional bronchoscope. The patients in group B ( n =40) were treated with painless bronchoscope ( received intravenous injection with midazolam0. 06 mg/kg and fentanyl 1μg/kg before operation) . The patients in group C ( n = 41) were treated with painless bronchoscope through improved artificial airway ( after anesthesia similar to group B, the improved artificial airway was implanted through the mouth guided by bronchoscope, then the bronchoscopy was performed through artificial airway) . Blood pressure, respiration rate, heart rate and the pulse oxygen saturation were measured by multi-parameter ECG monitor before and during the operation, and the differences were compared among three groups. Body movement, transient respiratory depression during the operation, and postoperative feelings and reactions after operation were also observed. Meanwhile, the convenience of operation by physicians was evaluated. Results The blood pressure fluctuations in group C and group A had no significant difference ( P gt;0. 05) . Heart rate of three groups was somewhat increased,but there was no significant difference between group C and group A ( P gt; 0. 05) . Body movement and postoperative pain memory in group B and group C were better than those in group A ( P lt; 0. 05) .Respiratory depression of three groups had no significant difference ( P gt; 0. 05) . The operative convenience and the comfort of physicians in group C were better than those in group A and group B ( P lt; 0. 05) .Conclusions Operation safety of bronchoscopic interventional treatment with improved artificial airway is similar to the conventional procedure, but the reaction of the intra-operation and postoperative painful memories are significantly superior to conventional bronchoscopy. The convenience of operation and comfort of physicians are much better than the conventional bronchoscopy. It can be concluded that the improved artificial airways is worthy of clinical application.
目的:評價無創正壓通氣(NIPPV)在救治慢性阻塞性肺疾病(COPD)急性加重期并嚴重呼吸衰竭患者中的臨床療效。方法:對2006年1月至2008年1月入選的47例COPD急性加重期并嚴重呼吸衰竭患者使用雙水平無創正壓呼吸機面罩輔助通氣, 患者均伴有不同程度的意識障礙,動態觀察NIPPV治療前和治療后2 h、8 h、1 d及3 d動脈血氣、神志、治療后患者的轉歸,NIPPV的不良反應及并發癥。結果:本組47例患者中,41例經NIPPV治療2 h、8 h、1 d及3 d后與治療前比較,PaO2明顯升高Plt;0.01,PaCO2明顯降低Plt;0.01,pH明顯升高Plt;0.01,均脫機出院,有效率達87.23%(41/47);6例改為有創通氣,其中3例經有創機械通氣治療后脫機成功,1例因上消化道出血死亡,2例自動出院.結論:雙水平無創正壓通氣對有選擇的COPD急性加重期并嚴重呼吸衰竭患者治療療效確切,它能迅速緩解病情,減少患者的氣管插管和氣管切開以及相應的并發癥,提高生活質量。
目的:探討老年人自發性氣胸的臨床特點、治療及預后。方法:對本院在2005年11月至2008年4月間收治的79例老年人自發性氣胸患者臨床資料進行回顧性分析。結果:老年人自發性氣胸大多有肺部基礎疾病,臨床表現缺乏特異性,本組誤診為慢性阻塞性肺病急性發作4例、左心衰2例、支氣管哮喘1例。氣胸類型: 張力性氣胸47例(72.1%),閉合性氣胸11例,交通性氣胸21例。采用以肋間閉式引流的為主的治療措施,效果好。結論:老年人自發性氣胸大多有肺部基礎疾病, 易誤診,氣胸的類型以張力性氣胸多見,治療多需排氣減壓術,及早的排氣減壓可望緩解癥狀,縮短肺復張時間,減少患者住院天數, 降低死亡率,提高老年人生活質量。
ObjectiveThrough measuring fractional exhaled nitric oxide (FeNO) and eosinophil levels of peripheral blood in chronic obstructive pulmonary disease (COPD) patients with different phenotype of acute exacerbation frequency, to predict the therapeutic effect of glucocorticoid therapy and guide the clinical treatment of different subtypes patients with acute exacerbations of COPD.MethodsA total of 127 patients with acute exacerbation of COPD in Suining Central Hospital from February 2017 to October 2019 were recruited. They were divided four groups according to the number of acute exacerbations in the past one year and the treatment scheme, ie. a frequent acute exacerbation with glucocorticoid treatment group (34 cases), a frequent acute exacerbation with non-glucocorticoid treatment group (31 cases), a non-frequent acute exacerbation with glucocorticoid treatment group (30 cases), and a non-frequent acute exacerbation with non-glucocorticoid treatment group (32 cases). FeNO value, eosinophil ratio in peripheral blood, COPD assessment test (CAT) score, and interleukin-8 (IL-8) concentration were measured before and on the 10th day of treatment, and the differences within group and between groups before and after treatment were compared.ResultsCAT score, FeNO, eosinophil ratio and IL-8 level in the four groups were significantly improved on the 10th day after treatment (all P<0.05). The declines of FeNO value, eosinophil ratio, and IL-8 level on the 10th day of treatment compared with those before treatment in the frequent acute exacerbation with glucocorticoid treatment group and the frequent acute exacerbations with non-glucocorticoid treatment group were larger than those in the non-frequent acute exacerbation with glucocorticoid treatment group and the non-frequent acute exacerbation with non-glucocorticoid treatment group (all P<0.05). The declines of FeNO value, blood eosinophil ratio and IL-8 level in the frequent acute exacerbation with glucocorticoid treatment group were also statistically significantly larger than those in the frequent acute exacerbations with non-glucocorticoid treatment group (all P<0.05). The improvement of CAT score in the frequent acute exacerbation with glucocorticoid treatment group was greater than that in other three groups (all P<0.05). There was no significant difference in CAT score between the non-frequent acute exacerbation with glucocorticoid treatment group and the non-frequent acute exacerbation with non-glucocorticoid treatment group (P>0.05).ConclusionsThe degree of airway inflammation is more obvious in patients with frequent acute exacerbation phenotype of COPD. FeNO value can reflect the level of airway inflammation in patients with frequent acute exacerbation of COPD and evaluate the response to glucocorticoid therapy.