目的:分析支气管热成形术治疗重症哮喘患者围手术期的临床资料,加强围手术期护理管理.方法:分析我院完成的支气管热成形术治疗109例重症哮喘患者,共计434例次的临床资料,总结预后及术后近期不良事件发生的原因.结果:常见的不良事件包括咳嗽、痰量增加、哮喘短暂加重、痰中带血、肺炎和痰栓形成等,其发生率分别为4.84％、8.99％、6.45％、3.92％、2.07％和1.38％.仅1例需要无创通气辅助,无自发性气胸、有创机械通气和死亡病例.结论:围手术期管理需要团队的协作.术前护理主要是评估病情和积极控制合并症,术后护理重点是观察并及时处理并发症.

支气管哮喘的药物治疗,根据其在哮喘长期治疗中的地位可以分为两大类,即控制药物(又称维持性用药)和缓解药物(又称急救药物). 支气管哮喘的维持性用药 维持性用药又称为控制用药,是指需要长期、规律使用的治疗支气管哮喘的药物.这些药物主要通过稳定的抗炎作用使哮喘达到并维持临床控制,主要包括吸入性糖皮质激素(ICS)、全身用糖皮质激素、白三烯调节剂、长效β2受体激动剂(LABA)、缓释茶碱、长效吸入性抗胆碱能药物(LAMA)、色甘酸钠、抗IgE抗体、抗组胺药及其他抗炎药物.

Objective: To investigate the effects of bronchial thermoplasty (BT) on airway remodeling, asthma control and quality of life in patients with severe asthma. Methods: From January to September 2019, 11 patients with severe asthma were recruited from China Japan Friendship Hospital to receive BT treatment. The treatment was performed over three sessions separated by 3-week intervals. The right lower lobe, the left lower lobe and the bilateral upper lobes were treated respectively. In this study, patients' self-control method was used. The timepoint before the first BT treatment was defined as pre-treatment group, and the timepoint before the third treatment was defined as post-treatment group. Histological staining was used to detect the airway remodeling of the left lower lobe in two groups, including the mass of airway smooth muscle (ASM) and collagen in airway wall, and the thickness of basement membrane. The cell classification of bronchoalveolar lavage fluid (BALF) from the left lower lobe and peripheral blood, total serum IgE, asthma control test (ACT), mini asthma quality of life questionnaire (miniAQLQ) and the forced expiratory volume in 1 second expressed as percent predicted (FEV(1)%pred) were evaluated in the two groups. The correlation was analyzed between airway remodeling and asthma control and quality of life. Results: Effects of BT in post-treatment group, compared with pre-treatment group: the mass of ASM and collagen in airway wall was significantly decreased [(9.8±2.5)% vs (25.8±7.7)%, (12.9±4.0)% vs (17.4±5.6)%] (both P<0.05), while basement membrane thickness was not significantly different (P>0.05); the percentage of eosinophils in BALF and peripheral blood, and total serum IgE were not significantly different (all P>0.05); ACT score and miniAQLQ score were significantly increased [(23.1±1.8) vs (13.8±6.2) points, (5.3±1.3) vs (3.6±1.5) points] (both P<0.05), while FEV(1)% pred was not statistically different (P>0.05). The mass of ASM was negatively correlated with ACT score (r=-0.712), miniAQLQ score (r=-0.557) and FEV(1)%pred (r=-0.477), while the mass of collagen was negatively correlated with ACT score (r=-0.549) and miniAQLQ score (r=-0.639) (all P<0.05). Conclusion: BT treatment could improve airway remodeling, asthma control and quality of life in patients with severe asthma; besides, the reduction of remodeling is related to the improvements of asthma control and quality of life.

目的提高骨科治疗中医疗风险防范能力。方法分析骨科治疗中发生医疗纠纷的原因,应用临床心理学知识探讨骨科治疗时可能发生的医疗纠纷。结果找出了风险存在的因素,提出了防范骨科治疗中医疗纠纷的对策和措施。结论加强骨科治疗中医患协调沟通技巧的培训,了解患者就诊心理,是有效防范医患纠纷、保证治疗工作顺利完成的重要环节。