目的 探究放松训练结合舒适护理对经电子支气管镜治疗支气管扩张患者舒适度、心理状态与治疗依从性的影响.方法 选择2019年7月—2021年7月医院80例经电子支气管镜治疗的支气管扩张患者作为研究对象,按照组间基本特征均衡可比的原则分为观察组和对照组,各40例.对照组患者实施常规护理,观察组患者在对照组基础上实施放松训练结合舒适护理.对比分析两组患者收缩压、心率、血氧饱和度值及舒适度、护理满意程度、心理状态以及治疗依从性的差异.结果 两组患者治疗前、治疗中和治疗后收缩压、心率和血氧饱和度值比较,组间、不同时间点、组间与不同时间点交互比较,差异有统计学意义(P<0.05).护理后观察组SAS评分和SDS评分均低于对照组(P<0.05),且观察组患者满意程度和舒适度优于对照组(P<0.05).护理后,观察组患者治疗依从性评分高于对照组,差异有统计学意义(P<0.05).结论 放松训练结合舒适护理可改善经电子支气管镜治疗支气管扩张患者的治疗效果、满意度、舒适度以及患者的心理状态,从而提高患者的治疗依从性.

Objective:To explore the characteristics and countermeasures of patients treated by bronchoscopic removal of pulmonary aspergilloma.Methods:This study was a retrospective study. The clinical data of 52 patients undergoing bronchoscopic removal of pulmonary aspergilloma (the treatment group) and 52 patients undergoing ordinary bronchoscopy (the control group) were reviewed in Guangzhou Chest Hospital from November 2018 to December 2020. There were 46 males and 6 females in the treatment group, with an age of (47.00±13.48) years old; there were 44 males and 8 females in the control group, with an age of (48.00±16.28) years old. The differences of heart rate, oxygen saturation, blood pressure, operation time, and bleeding were compared between the two groups. Independent sample t test was used for the measurement data, and χ2 test was used for the count data. Results:The heart rate and operation time of the treatment group were (112.0±6.46) beats/min and (39.95±8.32) min, respectively, which were higher than those of the control group [(100.0±9.11) beats/min and (8.83±2.46) min], and the blood oxygen saturation was (96.0±0.69)%, which was lower than that of the control group [(98.0±1.11)%], with statistically significant differences (all P<0.05). There were no statistically significant differences in the systolic blood pressure and diastolic blood pressure between the two groups (both P>0.05). The incidence of microscopic bleeding in the treatment group was 48.08% (25/52), which was higher than that in the control group [0.00% (0/52)], with a statistically significant difference between the two groups ( χ2=32.911, P<0.001). Conclusions:Patients treated with bronchoscopic removal of pulmonary aspergilloma are more tense and have a high risk of hypoxemia and hemorrhage. Adopting preoperative, intraoperative, and postoperative nursing strategies, control of high-risk factors, and grasping the timing of treatment play key roles in preventing serious complications.

目的 探讨近期大咯血对支气管镜诊疗操作相关出血的影响.方法 回顾性分析2015年12月—2019年12月我院支气管镜操作导致出血超过30 mL患者的临床资料,根据近1周是否发生大咯血,分为观察组(大咯血组)和对照组(无大咯血组),比较2组间的出血量以及大出血、 血凝块、 窒息的发生率.结果 观察组的出血量以及大出血的发生率高于对照组,2组间差异有统计学意义,血凝块、 窒息的发生率两组间差异无统计学意义.结论 近期大咯血的患者支气管镜操作发生大出血的风险高.

Objective:To investigate the predictive value of thrombosis and hemostasis tests on the possible occurrence of bleeding, thrombosis, and asphyxia complications during fiberoptic bronchoscopy for diagnosis and treatment.Methods:The clinical data of fifty cases with bleeding over 30 ml during fiberoptic bronchoscopy, which were screened from 36 785 patients accepting fiberoptic bronchoscopy from January 2016 to December 2019 in Guangzhou Chest Hospital, were analyzed retrospectively. These cases were divided into asphyxia group and non-asphyxia group, or hematorrhea group (more than 100 ml of bleeding) and small hemorrhage group, or thrombosis group and non-thrombosis group. As for analysis of abnormal incidence and amount level, included thrombosis and hemostasis tests were as follows: D2 polymer (D2), prothrombin time (PT), prothrombin time ratio (PTR), prothrombin time international normalized ratio (PTINR), fibrinogen (Fbg), partial activated thromboplastin time (APTT), thrombin time (TT).Results:Abnormal incidences of D2, PTINR and level of Fbg of 14 cases with asphyxia were significantly higher those of 36 cases without asphyxia ( P values were 0.033, 0.006, and 0.006 respectively). Compared with 31 cases with small hemorrhage, 19 cases with hematorrhea had a significantly higher incidence of abnormal Fbg (χ 2=4.402, P=0.036). Abnormal incidences of PTINR and Fbg of 14 cases with thrombosis were significantly higher than those of 36 cases without thrombosis ( P values were 0.006 and 0.041 respectively); moreover, the level of Fbg was the same ( t=3.446, P=0.001). Taking the abnormal coagulation function as the exposure factor, the values of 21 odds ratios ( OR) of asphyxia vs. non-asphyxia, hematorrhea vs. small hemorrhage, and thrombosis vs. non-thrombosis were from 0.355 to 14.400, of which 16 OR were above 2.500. Conclusion:It is essential that the patients with abnormal coagulation function are paid more attention to prevent complication such as hematorrhea, thrombosis, and asphyxia during fiberoptic bronchoscopy.

目的 通过综合护理能讯速控制天疱疮病情发展,为临床护理提供经验与方法.方法 记录2组患者糜烂渗出愈合时间及效果积分、疼痛改善程度积分和护理满意度.结果 入院时2组患者糜烂渗出、疼痛等指标无差异(P均>0.05);出院时,治疗组糜烂渗出愈合时间及效果积分、疼痛改善程度积分明显好于观察组(P均<0.05);治疗组护理满意度为95.24％,高于观察组的76.32％.结论 临床护理天疱疮患者时,采用综合护理,可以提高患者的生活质量和护理满意度,值得临床推广使用.

目的 探讨研究一种更安全、有效治疗肺结核空洞继发曲菌球咯血的方法.方法 回顾性分析2015年2月至2019年4月广州市胸科医院97例肺结核空洞继发曲菌球咯血患者的临床资料,根据治疗方式将患者分为三组:介入治疗组:支气管镜下清除术联合支气管动脉栓塞术(bronchial artery emboliza?tion,BAE)29例、外科手术组34例、内科治疗组34例.比较三组治疗后不同时间段咯血复发率及并发症等情况.结果 介入组29例患者,治疗后1个月内咯血复发率为0;治疗后6个月内复发率为6.89％;治疗后12月内复发率为20.69％;均无明显并发症.外科组34例患者,术后1个月内咯血复发率为0;术后6个月内及12个月内复发率为2.94％;术后并发症的发生率为32.4％.内科组34例患者,治疗后1个月咯血复发率为44.12％,治疗后6个月内复发率为55.88％,治疗后12个月内复发率为58.82％;治疗后药物性肝损伤2例.结论 BAE能有效止血,支气管镜可有效清除曲菌球,二者同时应用可达到很好的治疗效果,可作为肺结核空洞继发曲菌球咯血非外科手术治疗的一种替代疗法.

Objective To study the effect of perioperative nursing combined with respiratory function training on the compliance and quality of life of the patients with tuberculous airway stenosis treated by balloon dilatation with fiexible bronchofiberscope.Methods 88 patients with tuberculous bronchial stenosis treated in our hospital from January 2014 to February 2016 were recruited,and randomly divided into study group and control group,44 patients in each group.All patients were treated by balloon dilation with fiexible bronchofiberscope.Both two groups were given perioperative nursing intervention,and study group was given respiratory function training on the basis.Results The total compliance rate of study group was 88.64％,and that of control group was 65.91％,with statistically significant difference between two groups (P＜0.05).The scores of physical function,psychological function,social function,and material life in study group were significantly higher than those in control group (P＜0.05).Conclusion Perioperative nursing combined with respiratory function training can improve the compliance and the quality of life of patients with tuberculous bronchial stenosis tread by balloon dilatation with fiexible bronchofiberscope,which can be widely used in clinical practice.

目的探讨气管支气管结核(TBTB)的临床特征及治疗方法。方法选取支气管结核患者320例,分析其临床特征、影像学表现、支气管镜下表现和治疗效果等。结果 320例中,男127例,女193例,中青年女性多发。胸部CT显示,阻塞性肺气肿67例,阻塞性肺叶、段不张101例,支气管管壁增厚或狭窄102例。纤维支气管镜下观察,右上支气管结核最多(85例),其次为左上支气管结核(63例);左主支气管结核发生率显著多于右主支气管(P<0.01)。炎症浸润型142例,溃疡坏死型89例,肉芽增殖型46例,瘢痕狭窄型22例,管壁软化型13例,淋巴结瘘型8例。支气管无狭窄61例,狭窄174例,阻塞85例。初治病例采用2HR(L2)ZE(S)/10HR治疗方案,复治病例采用3SHREZ/9HRE治疗方案。治疗后支气管狭窄或阻塞较治疗前改善明显(P<0.01)。结论TBTB以中青年女性多发,咳嗽、咳痰是重要临床特征,纤维支气管镜是确诊的主要手段,影像学为辅助手段。采用中华医学会结核病学分会推荐的TBTB分型标准,能更好地区分TBTB各个时期病变特征,并有助于预后判断。

目的:探讨支气管镜介入治疗结核性气道狭窄或闭锁并肺不张的疗效。方法 :对2008年1月至2011年6月我院治疗的50例结核性气道狭窄或闭锁并肺不张患者,经支气管镜高频电凝、球囊扩张治疗,观察影像学与镜下表现、治疗有效率与副作用、再狭窄率及病程对疗效的影响。结果:治疗总有效率为92.0%(46/50),其中显效78.0%(39/50),好转14.0%(7/50),无效8.0%(4/50)。治疗后气促指数改善率为100%。随访期再狭窄率为39.1%(18/46),其中治疗后3个月内再狭窄率为34.8%(16/46)。显效及好转患者病程中位数分别为1.75及3个月,而无效患者为10~20个月。结论:经支气管镜高频电凝、球囊扩张治疗结核性气道狭窄或闭锁并肺不张是一项安全、有效的治疗手段,但有一定再狭窄率。病程对疗效有明显影响,病程长者疗效较差。故对于支气管结核,尤其是呼吸困难、出现肺不张者,应把握时机,尽早介入治疗。