Factors influencing the continuity of evidence-based practice in perioperative airway management for elderly patients with fractures:A qualitative study

BACKGROUND More and more evidence-based practices are emerging,but researchers mostly focus on short-term effects,resulting in evidence-based practices not being applied in the clinic in the long term.In this study,we took the evidence-based practice of perioperative airway management in elderly fracture patients as an example and adopted a descriptive phenomenological approach to understand the influencing factors of its sustainability to provide a reference basis for promoting the continuity of evidence-based practice in the clinic.AIM To explore factors influencing the persistence of evidence-based practice in perioperative airway management in elderly patients with fractures.METHODS This study was qualitative research.Nine nurses who implemented evidencebased practice in the orthopedic ward of a tertiary comprehensive hospital in Shanghai from September 2023 to October 2023 were selected using purposive sampling as research subjects.Semi-structured interviews were conducted with them,and the data were analyzed using the Colaizzi phenomenological analysis method based on the three dimensions and ten factors of the NHS sustainability model.RESULTS Three main themes and ten subthemes were identified:Process aspects(benefits to patients,benefits to nurses,lack of follow-up,complex processes);staff aspects(insufficient human resources,inadequate training and education,lack of leadership support);and organizational environment aspects(inadequate infrastructure,poor patient compliance,poor doctor cooperation).CONCLUSION Human resources,training and education,leadership support,infrastructure,and patient-physician collaboration are important factors influencing the sustainability of evidence-based practice for perioperative airway management in older patients with fractures.

Airway management of a patient with linear immunoglobulin A bullous dermatosis:A case report

BACKGROUND There is limited literature on managing the airway of patients with linear immunoglobulin A(IgA)bullous dermatosis,a rare mucocutaneous disorder that leads to the development of friable bullae.Careful clinical decision making is necessary when there is a risk of bleeding into the airway,and a multidisciplinary team approach may lead to decreased patient morbidity during these high-risk scenarios,especially when confronted with an unusual cause for bleeding.CASE SUMMARY A 45-year-old African American female presented to our ambulatory surgical center for right corneal transplantation due to corneal perforation after blunt trauma in the setting of cicatricial conjunctivitis and diffuse corneal neovascularization from linear IgA bullous dermatosis.The diagnosis of IgA dermatosis was recent,and the patient had been lost to follow-up.The severity of the disease and extent of airway involvement was unknown at the time of the surgery.Significant airway bleeding was noticed upon intubation and the otorhinolaryngology team had to be called to the operating room.The patient required transfer to the intensive care unit where a multidisciplinary team was involved in her case.The patient was extubated on postoperative day 4.CONCLUSION A multidisciplinary approach to treating this disease is the best course of action before a surgical procedure.In our case,key communication between the surgery,anesthesia,and dermatology teams led to the quick and safe treatment of our patient’s disease.Ambulatory surgery should not be considered for these cases unless they are in full remission and there is no mucous membrane involvement.

Is there a correlation between the changes in airway inflammation and the changes in respiratory mechanics after vaping in patients with asthma?

BACKGROUND Electronic cigarettes(ECs)have been promoted as alternatives to traditional cigarettes.To investigate ECs’effects on respiratory system,especially in patients with respiratory diseases.METHODS We randomly selected 25 smokers with stable moderate asthma and matched them with 25 healthy smokers.All were subjucted to pulmonary function tests(PFTs),impulse oscillometry(IOS),fraction exhaled Nitric Oxide(FeNO),exhaled breathe condensate(EBC)and biomarker measurements before and after vaping one nicotinecontaining EC.RESULTS The increase in FeNO 30 minutes after EC,reflecting airway inflammation,significantly correlated with increase of residual volume(RV),total lung capacity,respiratory impedance at 5 Hz(Z5Hz)and respiratory resistance at 5 and 20 Hz(R5Hz and R20Hz).No significant correlations were found between EBC biomarkers'changes and respiratory mechanics.CONCLUSION This is the first study demonstrating that the changes in airway inflammation caused by EC have direct effects in respiratory mechanics of asthmatic patients.

Clinical and pathological characteristics and expression of related molecules in patients with airway disseminated lung adenocarcinoma

Objective:Lung adenocarcinoma exhibits diverse genetic and morphological backgrounds,in addition to considerable differences in clinical pathology and molecular biological characteristics.Among these,the phenomenon of spread through air space(STAS),a distinct mode of lung cancer infiltration,has rarely been reported.Therefore,this study aimed to explore the relationship between STAS tumor cells and the clinical and molecular characteristics of patients with lung adenocarcinoma,as well as their impact on prognosis.Methods:This study included 147 patients who were diagnosed with lung adenocarcinoma at the Inner Mongolia Autonomous Region Cancer Institute between January 2014 and December 2017.Surgical resection specimens were retrospectively analyzed.Using univariate and multivariate Cox analyses,we assessed the association between STAS and the clinicopathological features and molecular characteristics of patients with lung adenocarcinoma.Furthermore,we investigated the effects on patient prognosis.In addition,we developed a column–line plot prediction model and performed internal validation.Results:Patients with positive STAS had a significantly higher proportion of tumors with a diameter≥2 cm,with infiltration around the pleura,blood vessels,and nerves,and a pathological stage>IIB than in STAS-negative patients(P<0.05).Cox multivariate survival analysis revealed that clinical stage,STAS status,tumor size,and visceral pleural invasion were independent prognostic factors influencing the 5-year progression-free survival in patients with lung adenocarcinoma.The predictive values and P values from the Hosmer-Lemeshow test were 0.8 and 0.2,respectively,indicating no statistical difference.Receiver operating characteristic curve analysis demonstrated areas under the curve of 0.884 and 0.872 for the training and validation groups,respectively.The nomogram model exhibited the best fit with a value of 192.09.Conclusions:Clinical stage,pleural invasion,vascular invasion,peripheral nerve invasion,tumor size,and necrosis are independent prognostic factors for patients with STAS-positive lung adenocarcinoma.The nomogrambased on the clinical stage,pleural invasion,vascular invasion,peripheral nerve invasion,tumor size,and necrosis showed good accuracy,differentiation,and clinical practicality.

Research on the Application of Evidence-Based Quality Control Circle to Improve the Implementation Rate of Airway Management Measures in Adult Critically Ill Patients

Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs Institute (JBI) evidence-based health care model, the best evidence of airway management in adult critically ill patients was obtained and applied to the clinic. Results: The total implementation rate of airway management measures in adult critically ill patients increased from 23.62% before the implementation of quality control circle to 88.82%, and the pulmonary infection rate in critically ill patients decreased from 42.31% to 21.74%, with statistical significance between the two groups (P 0.05). Conclusion: Evidence-based quality control circle activities can standardize the practice standards of airway management in critically ill patients, reduce the occurrence of patients’ airway related complications, and improve clinical outcomes.

Mechanism of Yanghe Pingchaun granules on airway remodeling in asthmatic rats based on IL-6/JAK2/STAT3 signaling axis

Objective: To investigate the effects of Yanghe Pingchuan Granules on airway remodeling in asthmatic rats, and to explore the mechanism of Interleukin-6/Janus kinase 2/ Signal transducing activator of transcription 3(IL-6/JAK2/STAT3) signal axis. Methods: We separated 42 healthy male SD rats into two groups, a control group (7) and a model group (35).The model group was sensitized with a combination of ovalbumin (OVA) and aluminum hydroxide for 2 weeks, while the control group was given an equal amount of physiological saline.After 2 weeks, the modeling group was randomly divided into Model group, Yanghe Pingchuan Granules high, medium and low dose groups and Dexamethasone group, each group consisted of 7 animals. After 4 weeks, OVA atomization and gavage were used for stimulation and treatment. Yanghe Pingchuan Granules high, middle and low groups were given 15.48, 7.74, 3.87 g∙kg-1 Yanghe Pingchuan Granules daily, dexamethasone group was given 0.0625 mg∙kg-1 dexamethasone daily, and the other groups were given the same amount of normal saline. HE, PAS and Masson staining were used to observe the lung histopathological changes in rats. The levels of interleukin-6, IL-23 and IL-17A were detected by ELISA. The expression levels of JAK-2, P-JAK2, STAT3 and P-STAT3 in lung tissues were detected by Western blot. Real-time quantitative polymerase chain reaction (qRT-PCR) was used to detect the mRNA expression levels of IL-6, JAK2 and STAT3 in rat lung tissue. Results: The lung tissue structure of the model group was severely damaged compared to the control group, accompanied by a great many of inflammatory cell infiltration, goblet cell hyperplasia, subepithelial collagen fiber deposition and airway epithelial thickening were more obvious. The expressions of IL-6, IL- 23 and IL-17A in serum were significantly increased (P<0.01), the protein expression levels of JAK-2, P-JAK2, STAT3 and P-STAT3 and the mRNA expression levels of IL-6, JAK2 and STAT3 in lung tissue were significantly increased (P<0.01);Compared with the model group, inflammatory cell infiltration, goblet cell proliferation, subepithelial collagen fiber deposition and airway epithelial thickening were significantly reduced in each administration group, and the expressions of IL-6, IL-23 and IL-17A in serum were significantly decreased (P< 0.01). The protein expression levels of JAK-2, P-JAK2, STAT3 and P-STAT3 and mRNA expression levels of IL-6, JAK2 and STAT3 in lung tissue were significantly decreased (P<0.01). Conclusion: Yanghe Pingchuan Granules can significantly alleviate airway remodeling in asthmatic rats, and its mechanism may be through inhibiting the IL-6/JAK2/STAT3 signal axis.

Continuous positive airway pressure for treating hypoxemia due to pulmonary vein injury:A case report

BACKGROUND Vascular injury during thoracoscopic surgery for esophageal cancer is a rare but life-threatening complication that can lead to severe hypotension and hypoxemia.Anesthesiologists need to provide rapid and effective treatment to save patients'lives.CASE SUMMARY A 54-year-old male patient was scheduled to undergo a thoracoscopic-assisted radical resection of esophageal cancer through the upper abdomen and right chest.While dissociating the esophagus from the carina through the right chest,unexpected profuse bleeding occurred from a suspected pulmonary vascular hemorrhage.While the surgeon attempted to achieve hemostasis,the patient developed severe hypoxemia.The anesthesiologist implemented continuous positive airway pressure(CPAP)using a bronchial blocker(BB),which effectively improved the patient’s oxygenation and the operation was completed success-fully.CONCLUSION CPAP using a BB can resolve severe hypoxemia caused by accidental injury of the left inferior pulmonary vein during surgery.

Airway ultrasound for patients anticipated to have a difficult airway:Perspective for personalized medicine

Airway ultrasound allows for precise airway evaluation,particularly for assessing the difficult airway and the potential for front of neck access.Many studies have shown that identification of the cricothyroid membrane by airway ultrasound is more accurate than digital palpation.However,no reports to date have provided clinical evidence that ultrasound identification of the cricothyroid membrane increases the success rate of cricothyroidotomy.This is a narrative review which describes patients with difficult airways for whom airway ultrasound may have been useful for clinical decision making.The role of airway ultrasound for the evaluation of difficult airways is summarized and an approach to the use of ultrasound for airway management is proposed.The goal of this review is to present practical applications of airway ultrasound for patients predicted to have a difficult airway and who undergo cricothyroidotomy.

Laryngeal mask airway bougie ultrasonography guided intubation in a morbidly obese patient with diffi cult airway

Airway management of morbidly obese patients is challenging due to inherent anatomical and physiological variations.[1]The frequent association of compromised hemodynamics,hypoxemia,or acidosis in an emergency department(ED)setting adds to the difficulty of the procedure.Rapid airway management position(RAMP),awake fiber-optic guided intubation,use of intubating laryngeal mask airway(ILMA),and video-laryngoscope are a few techniques that have been described to tackle difficult airways in these patients.[2]Studies have shown that the availability of fi ber-optic scopes(3%–60%),videolaryngoscopes(39%–88%),and laryngeal mask airways(LMA)(65%–83%)varies in different ED settings.[3,4]Furthermore,a lack of adequate training and the need for time-bound resuscitation make implementation of the above techniques challenging.

Difficult airway due to cervical haemorrhage caused by spontaneous rupture of a parathyroid adenoma: A case report

BACKGROUND Cervical haemorrhage due to spontaneous rupture of a parathyroid adenoma is a rare complication that may cause life-threatening acute airway compromise.CASE SUMMARY A 64-year-old woman was admitted to the hospital 1 day after the onset of right neck enlargement, local tenderness, head-turning difficulty, pharyngeal pain, and mild dyspnoea. Repeat routine blood testing showed a rapid decrease in the haemoglobin concentration, indicating active bleeding. Enhanced computed tomography images showed neck haemorrhage and a ruptured right parathyroid adenoma. The plan was to perform emergency neck exploration, haemorrhage removal, and right inferior parathyroidectomy under general anaesthesia. The patient was administered 50 mg of intravenous propofol, and the glottis was successfully visualised on video laryngoscopy. However, after the administration of a muscle relaxant, the glottis was no longer visible and the patient had a difficult airway that prevented mask ventilation and endotracheal intubation. Fortunately, an experienced anaesthesiologist successfully intubated the patient under video laryngoscopy after an emergency laryngeal mask placement. Postoperative pathology showed a parathyroid adenoma with marked bleeding and cystic changes. The patient recovered well without complications.CONCLUSION Airway management is very important in patients with cervical haemorrhage. After the administration of muscle relaxants, the loss of oropharyngeal support can cause acute airway obstruction.Therefore, muscle relaxants should be administered with caution. Anaesthesiologists should pay careful attention to airway management and have alternative airway devices and tracheotomy equipment available.

Anesthesia management in a pediatric patient with complicatedly difficult airway:A case report

BACKGROUND Reports on perioperative anesthesia management in pediatric patients with difficult airways are scarce.In addition to relatively more difficulties in the technique of endotracheal intubation,the time for manipulation is restricted compared to adults.Securing the airways safely and avoiding the occurrence of hypoxemia in these patients are of significance.CASE SUMMARY A 9-year-old boy with spastic cerebral palsy,severe malnutrition,thoracic scoliosis,thoracic and airway malformation,laryngomalacia,pneumonia,and epilepsy faced the risk of anesthesia during palliative surgery.After a thorough preoperative evaluation,a detailed scheme for anesthesia and a series of intu-bation tools were prepared by a team of anesthesiologists.Awake fiberoptic intubation is the widely accepted strategy for patients with anticipated difficult airways.Given the age and medical condition of the patient,we kept him sedated with spontaneous breathing during endotracheal intubation.The endotracheal intubation was completed on the second attempt after the failure of the first effort.Fortunately,the surgery was successful without postoperative complications.CONCLUSION Dealing with difficult airways in the pediatric population,proper sedation allows time to intubate without interrupting spontaneous breathing.The appropriate endotracheal intubation method based on the patient’s unique characteristics is the key factor in successful management of these rare cases.

Comparison of emergency surgical cricothyroidotomy and percutaneous cricothyroidotomy by experienced airway providers in an obese,in vivo porcine hemorrhage airway model

Background: Emergency front-of-neck airway(eFONA) is a life-saving procedure in “cannot intubate, cannot oxygenate”(CICO). The fastest and most reliable method of eFONA has not been determined. We compared two of the most advocated approaches: surgical cricothyroidotomy and percutaneous cricothyroidotomy, in an obese, in vivo porcine hemorrhage model, designed to introduce real-time physiological feedback, relevant and high provider stress. The primary aim was to determine the fastest method to secure airway. Secondary aims were arterial saturation and partial pressure of oxygen, proxy survival and influence of experience.Methods: Twelve pigs [(60.3±4.1) kg] were anesthetized and exposed to 25%–35% total blood volume hemorrhage before extubation and randomization to Seldinger technique “percutaneous cricothyroidotomy”(n=6) or scalpelbougie-tube technique “surgical cricothyroidotomy”(n=6). Specialists in anesthesia and intensive care in a tertiary referral hospital performed the eFONA, simulating an actual CICO-situation.Results: In surgical cricothyroidotomy vs. percutaneous cricothyroidotomy, the median(interquartile range, IQR) times to secure airway were 109(IQR 71–130) s and 298(IQR 128–360) s(P=0.0152), arterial blood saturation(SaO2) were 74.7(IQR 46.6–84.2)% and 7.9(IQR 4.1–15.6)%(P=0.0167), PaO_(2) were 7.0(IQR 4.7–7.7) kPa and 2.0(IQR 1.1–2.9) kPa(P=0.0667), and times of cardiac arrest(proxy survival) were 137–233 s, 190(IQR 143–229) s, from CICO. All six animals survived surgical cricothyroidotomy, and two of six(33%) animals survived percutaneous cricothyroidotomy. Years in anesthesia, 13.5(IQR 7.5–21.3), did not influence time to secure airway.Conclusions: eFONA by surgical cricothyroidotomy was faster and had increased oxygenation and survival, when performed under stress by board certified anesthesiologists, and may be an indication of preferred method in situations with hemorrhage and CICO, in obese patients.

Experimental study on the regulation effect of Qiaoqin Qingfei agent on cough variant asthma based on airway neurogenic inflammation

Objective:To investigate the mechanism of regulation of airway neurogenic inflammation by Qiaoqin Qingfei agent in rats with cough variant asthma(CVA).Methods:48 SD rats were randomly divided into blank group,model group,montelukast sodium group(1.05 mg/kg)and high,medium and low dose groups(26,13,6.5 g/kg),with 8 rats in each group.The rat CVA model was established by the method of ovalbumin(OVA)combined with aluminum hydroxide(Al(OH)3)sensitization and repeated stimulation.From the second day of sensitization,the rat CVA model was given by gavage for 28 days.The pathological changes of lung tissue were observed under microscope by HE staining.The content changes of nerve growth factor(NGF)and substance P(SP)in alveolar lavage fluid(BALF)were determined by double-antibody sandwich ABC-ELISA,and the protein expression levels of NGF and SP in lung tissue were detected by immunohistochemistry.Results:Pathological findings showed significant inflammatory manifestations in the model group,and the inflammatory infiltration in the high-dose,medium-dose and low-dose groups of Qiaoqin Qingfei agent and montelukast sodium groups were alleviated to varying degrees.Compared with blank group,the protein expression levels of NGF and SP in lung tissue of model group were significantly increased(P<0.01).Compared with model group,the protein expression levels of NGF and SP in lung tissue and the contents of NGF and SP in alveolar lavage fluid in high-dose,medium-dose and low-dose groups and montelukast sodium group were significantly decreased(P<0.05).Conclusion:Qiaoqin Qingfei agent may reduce airway inflammation and relieve cough variant asthma by regulating the protein expression levels of NGF and SP in airway neurogenic inflammation.

针对性气道护理对重症监护室患者舒适度与呼吸机相关性肺炎的影响

目的探讨针对性气道护理模式在重症监护室(ICU)患者中的应用效果。方法选择2021年1月—2022年12月医院120例ICU患者,按组间基线资料可比的原则将其分为对照组和观察组,每组60例。对照组予以常规护理,观察组采用针对性气道护理。观察两组患者护理干预前、护理干预5 d后的呼吸状况及舒适度,比较其康复进程、导管堵塞情况及呼吸机相关性肺炎(VAP)发生情况。结果观察组患者护理干预5 d后的PaO_(2)水平高于对照组,组间比较差异有统计学意义(P<0.05)。PaCO_(2)水平低于对照组,组间比较差异有统计学意义(P<0.05)。观察组患者护理干预5 d后的Kolcaba舒适状况量表(GCQ)评分高于对照组,差异有统计学意义(P<0.05)。观察组患者机械通气时间及ICU治疗时间分别为6.50±1.08 d和7.84±1.50 d,短于对照组的7.22±1.36 d和8.68±1.74 d,差异有统计学意义(P<0.05);观察组患者机械通气期间的导管堵塞程度较对照组轻,且VAP发生率低于对照组,差异均有统计学意义(P<0.05)。结论针对性气道护理模式可改善ICU患者呼吸状况及舒适度,缩短康复进程,并可减轻患者机械通气治疗期间导管堵塞程度,降低VAP发生率。

视频喉镜结合综合困难气道训练考核系统在急诊规范化培训住院医师气管插管培训中的应用研究

目的探讨视频喉镜结合综合困难气道训练考核系统在急诊规范化培训住院医师气管插管培训中的应用效果。方法选择2022年1月—2023年6月在首都医科大学宣武医院急诊科轮转的住院医师58人,随机分为对照组(n=28)和试验组(n=30)。对照组应用直接喉镜结合综合困难气道训练考核系统进行气管插管技能培训,试验组应用视频喉镜结合综合困难气道训练考核系统进行气管插管技能培训。培训结束后对两组住院医师进行气管插管技能考核,内容包括正常气道和困难气道的气管插管,分别比较两组住院医师气管插管时间、一次性插管成功率、喉镜对门齿的压力、气管插管位置正确率的区别。另外,分别对两组住院医师进行教学满意度问卷调查。结果普通气道气管插管中,试验组与对照组喉镜对门齿的压力和气管插管位置正确率的差异无统计学意义(P>0.05);一次性插管成功率试验组大于对照组,气管插管时间试验组小于对照组(均P<0.05)。在困难气道气管插管中,试验组的一次性插管成功率和气管插管位置正确率大于对照组(P<0.05),插管时间和喉镜对门齿的压力明显小于对照组(P<0.05)。调查问卷自评显示,试验组对气管插管自信心和学习兴趣大于对照组(P<0.05),满意度和技能评分两组差异无统计学意义(P>0.05)。结论应用视频喉镜结合综合困难气道训练考核系统对急诊规范化培训住院医师进行气管插管培训可以提高气管插管成功率,减少对门齿的损伤,提高住院医师的学习兴趣。

多索茶碱治疗COPD急性发作期的临床效果及对气道重塑和呼吸功能的影响

目的观察多索茶碱治疗慢性阻塞性肺疾病(COPD)急性发作期的临床效果及对气道重塑和呼吸功能的影响。方法选取2020年3月—2022年7月兰州市第二人民医院收治的COPD急性发作期患者70例,根据随机数字表法分为观察组和对照组,每组35例。在常规对症治疗基础上,观察组予多索茶碱治疗,对照组予氨茶碱治疗。比较2组治疗效果,治疗前后气道重塑血清指标[基质金属蛋白酶抑制因子-1(TIMP-1)、基质金属蛋白酶-3(MMP-3)、基质金属蛋白酶-9(MMP-9)、神经生长因子(NGF)]、呼吸功能指标[第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、呼气流量峰值(PEF)]、血气分析指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、动脉血氧饱和度(SaO_(2))]。结果观察组治疗总有效率为94.29%,高于对照组的71.43%(χ2=6.437,P=0.011)。治疗后,2组TIMP-1、MMP-3、MMP-9、NGF水平较治疗前降低,且观察组低于对照组(P均<0.01);2组FEV_(1)、FVC、PEF较治疗前升高,且观察组高于对照组(P<0.05或P<0.01);2组PaO_(2)、SaO_(2)水平高于对照组,PaCO_(2)水平低于对照组,且观察组变化幅度大于对照组(P均<0.01)。结论多索茶碱治疗COPD急性发作期患者疗效确切,可有效促进血气分析指标、气道重塑、呼吸功能改善。

肥大细胞在哮喘发生发展中的作用机制及中医药调控作用

哮喘在中医学中属于哮病、喘症的范畴,是以气道平滑肌收缩、免疫细胞浸润和气道重塑等为特征的气道炎症疾病。肥大细胞为非特异性免疫细胞,在哮喘的形成和发展中扮演关键角色。中医药对哮喘的防治具有独特优势,但具体机制尚不明确。通过对相关研究综述后发现,肥大细胞活化后释放的组胺、蛋白酶、细胞因子等介质在哮喘气道损伤及重塑的病理过程中起重要作用。此外,中药复方制剂、单味中药及其活性成分、中成药及中医外治法等中医药方法可通过调节肥大细胞活化,抑制多种炎症介质和细胞因子的表达,进而发挥对哮喘的治疗作用。

FeNO联合TSLP对儿童咳嗽变异性哮喘与感染后咳嗽的鉴别价值及与小气道功能的关系

目的探究呼出气一氧化氮(FeNO)联合胸腺基质淋巴细胞生成素(TSLP)对儿童咳嗽变异性哮喘(CVA)与感染后咳嗽(PIC)的鉴别价值,并分析FeNO、TSLP与CVA病情、小气道功能的关系,为临床诊疗提供有利依据。方法选取2021年6月至2023年4月郑州大学第一附属医院儿科诊治收治的90例CVA患儿作为CVA组,另选取同期90例PIC患儿作为PIC组。比较两组患儿的临床资料和FeNO、TSLP水平,绘制受试者工作特征(ROC)曲线及曲线下面积(AUC)分析FeNO联合TSLP对CVA与PIC的鉴别价值;比较CVA不同病情严重程度和病情阶段患儿的小气道功能[FEF25(%)、FEF50(%)、FEF75(%)、FEF25~75(%)]和FeNO、TSLP水平,采用Spearman和Pearson相关系数法分析FeNO、TSLP与CVA小气道功能、病情阶段、病情严重程度的相关性。结果CVA组患儿的FeNO、TSLP水平明显高于PIC组,差异均有统计学意义(P<0.05);ROC分析结果显示,FeNO联合TSLP鉴别CVA与PIC的AUC最大(0.934),敏感度、特异度为87.78%、82.22%,明显高于各指标单独诊断(P<0.05);轻度组患儿的FEF25、FEF50、FEF75和FEF25~75>中度组>重度组,差异均有统计学意义(P<0.05);轻度组患儿的FeNO、TSLP水平<中度组<重度组,差异均有统计学意义(P<0.05);临床缓解期组患儿的FEF25、FEF50、FEF75、FEF25~75明显高于急性发作期组,FeNO、TSLP水平明显低于急性发作期组,差异均有统计学意义(P<0.05);Pearson相关系数法分析结果显示,FeNO、TSLP与FEF25、FEF50、FEF75、FEF25~75均呈负相关(P<0.05);Spearman相关系数法分析结果显示,FeNO、TSLP与病情阶段、病情严重程度均呈正相关(P<0.05)。结论与PIC患儿比较,CVA患儿FeNO、TSLP水平异常升高,其联合鉴别诊断CVA与PIC具有较高价值,且FeNO、TSLP水平与患儿病情、小气道功能密切相关。

不同策略对5种品牌小儿套囊型气管插管放置深度的影响

目的了解国内小儿套囊型气管插管的设计情况,比较不同气管插管深度放置策略下5种品牌插管尖端和套囊的放置情况。方法选择2020年10月至2021年12月天津市儿童医院收治的180例年龄1~~6岁,行全身麻醉气管插管的患儿作为研究对象,通过电子支气管镜测量患儿声门下气道长度。收集5种品牌(美迪斯、柯惠、坦帕、瑞京、维力)小儿套囊型气管插管设计参数,包括:气管插管套囊长度、气管插管尖端至套囊上缘的距离、气管插管尖端至声带线下缘的距离。根据Motoyama公式计算180例患儿所需的套囊型气管插管内径(ID)型号,应用3种指导气管插管深度放置策略:①声带线指导;②管尖置于隆突上2cm;③管尖置于气道中点,根据支气管镜下测量的声带与隆突的距离,计算每例患儿3种策略下不同品牌气管插管套囊和尖端放置情况。结果5种品牌小儿套囊型气管插管设计参数存在差异。根据计算:声带线指导下,插管尖端与隆突距离<1cm的放置率为3.9%~67.8%,支气管插管发生率最高的为瑞京,可达17.8%。将插管尖端放置于隆突上2cm,5种品牌气管插管尖端和套囊均无放置不当情况。将插管尖端置于气道中点,除维力品牌外,其余4种品牌声门上和声门下区域总的套囊放置率均为100%。结论小儿套囊型气管插管不同品牌在设计上存在差异,部分设计存在导致气道并发症的风险。指导气管插管放置的策略和插管品牌都会影响气管插管的放置,1~6岁小儿将插管尖端置于隆突上2cm可实现本研究中品牌的小儿套囊型气管插管安全放置。

“肺主行水”理论在慢性阻塞性肺疾病气道黏液高分泌中的应用探讨

慢性阻塞性肺疾病是一种以持续性气流受限为主要特征的慢性气道炎症性疾病。气道黏液高分泌是慢性阻塞性肺疾病重要临床特征,主要是由于气道受到长期炎症刺激,杯状细胞产生过多,导致黏液堆积,产生咳嗽、咳痰等临床表现。气道黏液高分泌的实质是津液的代谢失常,而“肺主行水”是指肺气通过宣发和肃降推动和调节全身的津液代谢。慢性阻塞性肺疾病是肺失宣降的病理表现,气道黏液高分泌则是“肺主行水”功能异常的体现。在治疗上,西医以减少黏液分泌、抑制炎症等为主;中医以调理肺气宣降、调节水液代谢为基本治疗原则。“肺主行水”理论为慢性阻塞性肺疾病气道黏液高分泌的研究提供了新思路。