膈肌膨出症是一侧膈肌的先天性缺陷最终导致的一侧膈肌的提升和功能障碍.临床诊断唯有依靠影像学上一侧膈肌的抬高表现,病因学尚且未知.有症状的膈肌膨出症和膈肌麻痹在临床表现难以区分,膈肌折叠术是治疗两种疾病情况的共同选择.微创膈肌折叠手术技术作为开胸膈肌折叠手术的有效替代方案,对于有选择的合适患者,在术后的呼吸困难和生活质量的改善上有着显著的提高.

随着微创技术的开展,近年来胸腔镜VAS手术及腹腔镜手术在成人膈肌膨出症中的应用报道也日益增多,本研究汇总了本地区多家医院近年来收治的左侧成人膈肌膨出症共16例,分别进行了左侧开胸膈肌折叠缝合术、胸腔镜下膈肌折叠缝合术、经腹腔镜左侧膈肌折叠术,通过总结不同手术方法的经验,探讨不同术式在治疗左侧成人膈肌膨出症中的优缺点.

验证使用冷沉淀在结核性包裹性脓胸行胸膜板剥脱术后止血疗效,提出建议.胸膜板剥脱术后使用冷沉淀胸腔内注射及静脉滴注,对比常规使用止血药物在术后止血效果差异.结核性包裹性脓胸行胸膜板剥脱术后冷沉淀胸腔内注射及静脉滴注止血效果明显.

Objective To investigate the protective effect of lung recruitment maneuver in rat with acute lung&nbsp;injury on pulmonary and extra-pulmonary origin .Methods 60 male and female SD rats were randomly divided into 6 groups (n=10 each):the control group (K group), the lung recruitment control group (F group), the pulmonary injury group (AN group), the lung recruitment maneuvers pulmonary injury group (RN group), the extra-pulmonary injury group ( AW group ) , and the lung recruitment maneuvers extra-pulmonary injury group ( RW group ) .The pressure sustained inflation was gradually increased .4 hours after mechanical ventilation , their lung injury was evalu-ated by Smith lung injury score , and the levels of SP-A, Fas and TNF-αin bronchoalveolar lavage fluid ( BALF) were measured by enzyme-linked immunosorbent assay ( ELISA) .Results Compared with the group AN , AW and RN, the levels of serum Fas and TNF-a decreased and serum SP-A increased in the group RN , RW and RW ( P<0.05) .Compared with the group RW and RN , Smith lung injury score increased in the group AW and AN ( P<0.05).Conclusion Lung recruitment maneuver can alleviate lung injury , increase serum SP-A concentration and decrease erum Fas and TNF-a, and it also has the protective effect for pulmonary and extra-pulmonary origin ALI , which is better for extra-pulmonary injury than that for pulmonary injury .

Objective:To evaluate the effect of Coopdech endobronchial blocker tube on blood gas concentration in the selective lobar blockade patients with ventilation. Methods:Forty patients undergoing right-sided lung resection VATS were randomly divided into double lumen endobronchial tube group (group V,n=20) in which double lumen endobronchial tube was performed for one lung ventilation,and Coopdech endobronchial blocker tube group (group C,n=20) in which the single lumen endotracheal tube and then Coopdech endobronchial blocker tube were performed for the left lung and right upper lobe of lung ventilation. Blood samples were taken from radial artery for determination of the blood gas. Results: Compared with group V, PaO2 at T1,T2 were increased in group C in which there was significant difference (P<0.05). Compared with group V ,the peak airway pressure and platforms airway pressure were reduced in which there were significant difference (P<0.05). Conclusion:Coopdech endobronchial blocker tube can improve ventilation efficiency and lung protective effect,and can improve oxygenation and reduce the airway pressure.

Objective To compare the lung protective effects of difference recruitment maneuver in rat with acute lung injury (ALI).Methods The ALI rat model were randomly divided into 4 groups (n =10 each) : control group (K group), the acute lung injury model group (ALI group)、 conventional lung recruitment maneuvers group (RM1 group), gradually increased pressure lung recruitment maneuvers group (RW group).After four hours of mechanical ventilation,lung injury was evaluated by Smith lung injury score.Surfact ant associated protein A (SP-A) and Fas levels in bronchoalveolar lavage fluid (BALF) were measured by enzyme-linked immunosorbent assay (ELISA), and blood samples were collected and blood gas analysis was performed.Results Compared with group K, serum Fas concentration and Smith lung injury score were increased, serum SP-A concentration, PaO2 was decreased and PaCO2 were increased in group ALI(P ＜ 0.05).Compared with group ALI, serum Fas concentration,Smith lung injury score、 p H、 PaCO2 were decreased and serum SP-A concentration、 PaO2 was increased in group RM1 and RM2 (P ＜0.05).Compared with group RM1 ,serum Fas concentration, Smith lung injury score were decreased and serum SP-A concentration,PaO2 was increased in group RM2 (P ＜ 0.05).pH and PaCO2 showed no significant difference between two groups (P ＞ 0.05).Conclusions Lung recruitment maneuvers has the effects of improving ventilation efficiency.It has decreasing serum Fas concentration and reducing the lung injury.The better effects are obtained the gradually increased pressure lung recruitment maneuvers than the conventional lung recruitment maneuvers.

探讨胸壁结核术后复发的主要原因及经验,为提高一次性手术治愈率,防止术后复发,提出建议.回顾分析2004-2008年5年间胸壁结核术后复发患者手术方式,对比均行肋骨切除患者复发率进行调查分析.肋骨损伤与否,均行肋骨切除+肌瓣填塞患者术后复发率明显低,一期手术治愈率高.

<正>根治性肺癌切除术后急性肺损伤(acute lung injury,ALI)的发生率是12.9%,全肺切除术后是6%,而单纯肺叶切除术后是3.7%[1]。发生ALI和急性呼吸窘迫综合症(acute respiratory distress syndrome,ARDS)的死亡率是33%~72%[1],ALI/ARDS是引起胸科手术术后病人死亡的主要原因。

目的：对冷沉淀胸腔内注射联合中心静脉导管胸腔引流和胸腔持续低负压吸引治疗难治性气胸的临床疗效及机制。方法：选用62例难治性气胸患者，在中心静脉导管胸腔闭式引流基础上使用冷沉淀胸腔注入加之低负压吸引治疗，疗效观察。结果：治愈率达93.54%（58/62），未见明显不良反应。结论：冷沉淀胸腔内注射联合中心静脉导管引流并低负压吸引治疗难治性气胸临床疗效显著，为难治性气胸临床治疗提供了有效的方法。

探讨中心静脉导管胸腔引流联合冷沉淀胸腔内注射联合治疗难治性气胸的临床疗效及机制.选选用82例难治性气胸患者,分为治疗组(62例)和对照组(20例),治疗组在中心静脉导管胸腔闭式引流基础上使用冷沉淀胸腔注入治疗;对照组行常规胸腔闭式引流治疗,观察两组病例疗效.治疗组治愈率(96％)明显优于对照组(62％),经统计学处理,有显著差异(P＜0.01).冷沉淀胸腔内注射联合中心静脉导管引流治疗难治性气胸临床效果明显,对于提高难治性气胸临床治愈率有积极的临床意义.

OBJECTIVE:To verify efficacy of moxibustion apparatus on pulmonary tuberculosis (PT) and explore adjuvant treatment method for PT. METHODS:One hundred cases of PT were randomly divided into a moxibustion group and a routine treatment group, 50 cases in each one. The regular antituberculous therapy (2HRZE/4HRE) was applied in both groups. In addition, the moxibustion apparatus was used at Bailao (EX-HN 15), Feishu (BL 13), Gaohuang (BL 43), Qihai (CV 6), Zhongfu (LU 1), Danzhong (CV 17), Guanyuan (CV 4), Zusanli (ST 36) and so on in the moxibustion group. The change of lesion area in chest radiography, degradation rate of bacte rium in the sputum, T-lymphocyte subsets and natural kill (NK) cells were observed before and after treatment in two groups. RESULTS:After the treatment for 3 months, there were 45 cases (90.0%) in the moxibustion group with more than 45% of focal absorption in chest radiography, which was obviously higher than 72.0% (36/50) in the routine treatment group (P < 0.01). The degradation rate of bacterium in the sputum in the moxibustion group was higher than that in the routine treatment group [82.0% (41/50) vs 60.0% (30/50), P < 0.01]. The CD3+, CD4+/CD8+ ratio of T-lymphocyte subsets and NK cells in the moxibustion group were significantly higher than those in the routine treatment group (P < 0.05, P < 0.01). CONCLUSION:On the basis of regular antituberculous therapy, moxibustion apparatus could significantly improve clinical effect, promote focal absorption and boost immunity, which is considered as an adjuvant treatment for PT.

Objective To investigate the effects of volatile oil of coltsfoot flower on lung function and metabolism of extracellular matrix in rats with pulmonary fibrosis.Methods Model of pulmonary fibrosis was established by injecting bleomycin in the airway.Sixty Wistar rats were divided into 6 groups(n=10 each):control group,model group,coltsfoot flower olatile oil high-,mid-and low-dose groups,dexamethasone group.Animal lung function was analyzed by animal lung function detection system,and content of hydroxyproline(Hyp) in lung tissue was assayed using spectrophotometer.Results Compared with control group,lung index,inspiratory airway resistance(RL),inspiratory total airway resistance(Re),forced expiratory time(PET) and Hyp content of lung tissue were all significantly increased(P0.05 or P0.01),and lung dynamic compliance(Cdyn),forced expiratory volume in the first 0.3 second(FEV 0.3),ratio of FEV 0.3 to forced vital capacity(FEV 0.3 /FVC),maximal mid-expiratory flow rate(MMF) as well as peak expiratory flow rate(PEF) significantly decreased in model group(P0.05 or P0.01).Compared with model group,lung index in coltsfoot flower olatile oil high-,mid-dose groups and dexamethasone group significantly decreased(P0.05 or P0.01);RL,Re,PET significantly decreased(P0.05 or P0.01);FEV 0.3,FEV 0.3 /FVC,MMF as well as PEF were significantly increased in coltsfoot flower olatile oil high-dose groups and dexamethasone group(P0.05 or P0.01).Hyp content of lung tissue significantly decreased in coltsfoot flower olatile oil high-,mid-and low-dose groups and dexamethasone group(all P0.01).Conclusions Volatile oil of coltsfoot flower could improve lung function and metabolism of extracellular matrix in pulmonary fibrosis rats.

<正>胸壁结核是一种常见的胸壁疾病,也是最常见的胸外科疾病之一,2000年3月～2010年6月我们共手术治疗98例胸壁结核患者,取得了较好的治疗效果,现报道如下。资料与方法一、临床资料本组病例男59例,女29例;年龄14～65岁,40岁以下67例(68.3%)。胸壁包块冷脓肿形成77例,脓肿最小3 cm×4 cm,最大25 cm×28 cm;冷脓肿破溃窦道形成21例;合并肺结核18例,包裹性脓胸12例。

目的总结慢性结核性渗出性胸膜炎外科治疗经验。方法回顾性分析107例慢性结核性渗出性胸膜炎患者的临床资料,行病灶清除+胸膜板剥脱术治疗。结果 107例无手术死亡,104例(97.2%)治愈,3例(2.8%)再次形成包裹,择期行二次手术;术后肺功能均有不同程度改善,随访3个月至5年,效果良好。结论外科治疗是慢性结核性渗出性胸膜炎最佳的治疗方法。

<正>肺部孤立性圆形病灶(Solid pulmonary nodule)是临床诊断的难题。由于病因甚多治疗各异,故鉴别诊断具有十分重要的意义,影像学检查是发现肺部球形病灶的手段。本组54例患者,男36例,女18例,年龄17～71岁,中位年龄44岁。

Objective To study the surgical To study the surgical operation adaption of the pulmonary tuberculosis effusion.Methods Review and analysis the treatment present condition and effect of the pulmonary tuberculosis effusion.Results The tubercle exudation of the later period in 107 pleuritis the sufferer be all obtained good effect by surgical operation treatment.Conclusion Pass the reason which turn into to the tubercle exudation pleuritis condition analysis,summary the pleuritis surgical operation of the tubercle exudation orientation certificate standard,betterly attain treatment effect.

先天性肺发育不全临床少见且诊断困难,多需手术证实.我院误诊"左侧自发气胸"患者一例,经手术明确为"先天性左肺发育不全" 患者,男,30岁,间断气短病史20年,以"左侧自发气胸"收住我院胸外科.行胸腔闭式引流无效,行手术时见左肺上叶为一30×50 cm巨大大疱取代,左肺舌叶及下叶为一3×10 cm柱状组织(图2)且肺实质质韧,通体粉红无碳沫沉积.术后该患症状缓解,带胸引管出院.

目的 探讨无创正压通气(NIPPV)在高海拔地区治疗重症社区获得性肺炎(CAP)合并呼吸衰竭的疗效.方法 将海拔高度1500～3600 m的169例社区获得性重症肺炎合并呼吸衰竭患者分为99例早期接受NIPPV治疗者为治疗组,同时对痰量较多且黏稠者应用纤维支气管镜吸除气道分泌物、肺灌洗,并取深部分泌物或灌洗液行细菌培养加药敏实验治疗.70例拒绝NIPPV治疗者为对照组,比较两组患者治疗前后呼吸频率、血气分析变化、气管插管率、病死率及住院时间.结果 治疗组治疗2 h后PaO2较治疗前升高(P<0.05);治疗组24 h后呼吸频率、PaCO2较治疗前降低,pH、PaO2较治疗前升高(P<0.01);治疗组治疗24 h后PaO2较对照组升高(P<0.01).治疗组气管插管率、病死率、住院时间明显低于对照组 (P<0.01).结果 结论在高海拔地区早期应用NIPPV联合纤维支气管镜治疗技术是治疗重症CAP合并呼吸衰竭的有效手段,可显著改善患者的预后,降低病死率,且是有效遏制重症CAP并呼吸衰竭引向多脏器功能障碍综合征(MODS)的一项重要措施,值得临床推广应用.

2002年7月5日～2002年7月8日,在我市盲聋哑学校校园发生一起细菌性咽-扁桃体炎爆发流行,现将调查结果报道如下.

AIM:To compare the accuracy of the 3 diagnosis scoring criteria for multiple organ dysfunction syndromes (MODS) in predicting the outcome of the syndrome. METHODS: By using the Lushan scoring system, Marshall scoring criterion (1995), and Lanzhou scoring criterion, three data models of 40 cases of MODS on highland (altitude 1600-3200 m) were set up to draw the receiver operating characteristic (ROC) curves, and the accuracy of the 3 diagnosis criteria was evaluated in predicting the outcome of MODS. RESULTS: The Lanzhou criterion was significantly superior to the other two criteria in the area under ROC, the sensitivity and the specificity. CONCLUSION: Lanzhou scoring system is fit for assessing the severity of MODS on highland.