Rigid bronchoscopy is an important tool for bronchoscope intervention,which can be performed under direct vision for a variety of operations.Bronchoscope intervention should be operated under intravenous anesthesia and jet ventilation.Anesthesia plays an important role in bronchoscope intervention.Based on the concept of enhanced recovery after surgery and clinical experiences,the author proposed enhanced recovery after bronchoscopy to accelerate the rapid rehabilitation development of bronchoscope intervention.In view of bronchoscope intervention,this article summarizes and discusses the best way of rigid bronchoscopy treatment from preoperative preparation,anesthesia,intraoperative operation and postoperative observation to improve the safety and comfort of perioperative patients and promote postoperative recovery of patients.
Objective To investigate the relationships between white blood cell (WBC),neutrophils,lymphocytes,neutrophil to lymphocyte ratio,platelet to lymphocyte ratio and serum IL-6 levels with pulmonary artery obstruction index (PAOI) in pulmonary embolism (PE) patients before and after short term treatment.Methods A prospective study was conducted on the PE patients first-diagnosed by computed tomographic pulmonary angiography in 3 hospitals from June 2015 to February 2017.The WBC,neutrophils,platelets,lymphocytes,neutrophil to lymphocyte radio (NLR),platelet to lymphocyte radio and serum IL-6 levels were examined pre-treatment and post-treatment on the 14th day.The relationships of these biomarkers with PAOI were analyzed pre-treatment and post-treatment on the 14th day.Results A total of 47 PE patients were enrolled from 3 hospitals.The PAOI was positively correlated with WBC,neutrophils,NLR,IL-6 pretreatment (all P ＜ 0.05).The PAOI was positively correlated with IL-6 post-treatment (r =0.498,P =0.000).The varied rate of PAOI pre-and post-treatment were negatively correlated with NLR pre-treatment (r =-0.352,P =0.015),positively correlated with lymphocytes pretreatment (r =0.335,P =0.021).Conclusions The WBC,neutrophils,NLR and IL-6 levels have correlations with PAOI,especially the IL-6 has closer correlation with PAOI,which could predict the degree of pulmonary artery obstruction better.The lower NLR and higher lymphocytes,the more significant of the embolus dissolution effect,they all have a certain clinical significance in predicting the degree of pulmonary embolus dissolution.
Chronic obstructive pulmonary disease (COPD) is a common inflammatory disease of the respiratory tract.It is one of the diseases with high morbidity and mortality in the world.Acute exacerbation of COPD(AECOPD) is an important event in the process of COPD,which often leads to the decline of patients' quality of life and the increase of mortality.Respiratory virus infection is closely related to AECOPD.Viral infection in patients with AECOPD is characterized by diversity,seasonality and locality.Respiratory virus infection can aggravate COPD by activating inflammatory mediators and participating in immune response.The effects and mechanisms of various viral infections on AECOPD may be different and require further study.
Objective To study the part of clinical characteristics of trachea or bronchi adenoid cystic carcinoma and clinical value of the bronchoscopy cavity interventional therapy about it.Methods This study summarized total 50 patients of tracheal or bronchus adenoid cystic carcinoma who are diagnosed,treated and carefully followed in Tangdu hospital,The Fourth Military Medical University from January 2010 to July 2018.They were divided into bronchoscope intervention group (24 cases) and operation group (26 cases) And a retrospective analysis was then performed with their part of clinical characteristics and the comparison of therapeutic effect between the bronchoscopy cavity interventional therapy and the surgery.Results There were 30 females and 20 males and the median age was 49.62 years old.The main symptoms of all 50 cases were cough,expectoration and shortness of breath and some of them also accompany with hemoptysis and chest pain.Among 50 cases,23 cases of carcinoma occurred in middle-to-lower bronchial segments,which is the largest part of all cases.8 cases scored grade Ⅰ at Borg index,18 cases scored grade Ⅱ,11 cases scored grade Ⅲ,and 13 cases scored grade Ⅳ.26 patients accepted surgery for the first time,and the other 24 patients accepted more than two kinds of bronchoscopy cavity interventional therapy for the first time.And the trachea or bronchi stenosis remission rate between two groups had no statistically difference (x2 =6.019,P =0.111).The Borg index after the bronchoscopy cavity interventional therapy (Z =-4.622,P ＜0.001) and the surgery (Z =-5.553,P ＜ 0.001) were both improved,and the difference was statistically significant.There was one case accepted the bronchoscopy cavity interventional therapy had a bad hemorrhage during the therapy.Conclusions Shortness of breath,unoperated patients with symptoms of bronchoscopy intervention can reduce the shortness of breath index,relieve shortness of breath,and the degree of stenosis of the humen is high.It is worthy of chlinical promotion.
Objective To study the role of hypoxia-inducible factor-1α (HIF-1α) in regulating the acute inflammation of lung.Methods Hif-1α knockout (Hif-1α+/-) mice and their wild-type (Hif-1α+/+) were stimulated with lipopolysaccharide to establish acute lung injury (ALI) model,respectively.The bronohoalveolar lavage fluid (BALF),blood and lung tissue were collected at 6th,12th,24th and 48th hour after LPS treatment.The number of total leukocytes and neutrophils in BALF of ALI model group and control group were counted.The levels of inflammatory factors such as tumor necrosis factor-α and KC in the serum of each group were detected by enzyme linked immunosorbent assay.The neutrophil infiltration in airway and lung tissue of all groups was assessed by hematoxylin-eosin staining.And the neutrophil apoptosis in lung tissue of all groups was detected by TUNEL.Results The number of leukocytes and neutrophils in BALF of Hif-1α+/-and Hif-1α+/+ ALI mice was significantly higher than that of control mice.And there was no significant difference in the number of leukocytes in BALF between Hif-1α+/-and Hif-1α+/+ ALI mice.But compared to Hif-1α+/+ ALI mice,the number of neutrophils in BALF of Hif-1α+/-ALI mice was significantly lower (P ＜0.05).The levels of TNF-α and KC in serum of both ALI model mice were significantly higher than those in control group.But the levels of TNF-α and KC in the Hif-1α+/-ALI mice were significantly lower than those in the Hif-1α+/+ ALI mice.Hematoxylin-eosin staining indicated that there were a large amount of neutrophils infiltrating into the lung tissue and airway of Hif-1α+/-ALI mice,which were much more than those of Hif-1α+/+ ALI mice.TUNEL staining further revealed that there were a large number of apoptotic neutrophils in the lung tissue of Hif-1α+/-ALI mice,which were significantly more than those of Hif-1α+/+ ALI mice.Conclusions HIF-1α enhances acute lung inflammation by inhibiting neutrophil apoptosis.
