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Objective:To investigate the value of atropine administration before tracheal intubation under general anesthesia in the elderly patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)biopsy.Methods:This was a case-control study.A total of 87 elderly hospitalized patients receiving chest enhanced CT test suggesting the risk of lung cancer with enlargement of mediastinal lymph nodes in 7 regions were scheduled to undergo endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)biopsy under general anesthesia.The patients were randomly divided into two groups by flipping a coin: the atropine group(n=40)and the control group(n=47). The indicators for evaluating the application values of atropine included preoperative, intra-operative and postoperative systolic blood pressure(SBP), diastolic blood pressure(DBP), heart rate, oropharyngeal and airway secretion volume, oxygen saturation, operation time, positive diagnosis rate and postoperative adverse reactions.Results:SBP and DBP were lower in the atropine group than in the control group before endotracheal intubation(131.7±15.3 mmHg vs.140.7±13.7 mmHg, 79.1±7.6 mmHg vs.85.6±7.4 mmHg, t=2.885 and 4.061, P<0.05). There was no significant difference in SBP and DBP 10 min after endoscopic operation and 10 min after tracheal extubation between the atropine group versus the control group(SBP: 109.1±11.2 mmHg vs.105.0±12.2 mmHg, 136.9±23.0 mmHg vs.129.9±11.2 mmHg, DBP: 66.9±7.5 mmHg vs.68.0±8.3 mmHg, 77.6±10.9 mmHg vs.78.5±6.4 mmHg, t=-1.617, 0.687, -1.751 and 0.448, P>0.05). There was no significant difference in HR between the two groups before endotracheal intubation( t=1.416, P>0.05), while HR was higher in the atropine group than in the control group 10 min after endoscopic operation and 10 min after tracheal extubation( t=-3.323 and -2.181, P<0.01 and P<0.05). The change rates of SBP and DBP were lower in the atropine group than in the control group 10 min after endoscopic operation and 10 min after tracheal extubation( t=7.947, -6.962, -3.187 and -3.232, P<0.01). The change rate of HR was lower in the atropine group 10 min after endoscopic operation and was higher 10 min after tracheal extubation than in the control group( t=-6.467 and -4.131, P<0.01). There were significant differences in the volume of oropharyngeal and airway secretions and fingertip oxygen saturation between the two groups before endotracheal intubation and 10 min after tracheal extubation( t=-2.334, 2.759, -3.314 and -2.767, P<0.01). The endoscopic operation time was less in the atropine group than in the control group with no statistically significant difference[(25.9±5.7)min vs.(26.4±4.7)min, t=0.391, P>0.05]. There was no significant difference in postoperative adverse reactions between the atropine group versus the control group(34 patients or 85.0% vs.43 patients or 91.5%, χ2=1.247, P>0.05). Conclusions:The application of atropine before tracheal intubation under general anesthesia is beneficial to stabilizing the intraoperative blood pressure and heart rate, and can reduce the production of postoperative oropharyngeal and airway secretions in elderly patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration biopsy.
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Objective To analyze rick factors for postoperative recurrence of spontaneous pneumothorax surgery. Methods The clinic characteristics of 1128 patients who received spontaneous pneumothorax surgery in Tianjin Chest Hospital were collected from January 2009 to March 2015. The relationship between clinic characteristics and the pulmonary bullae was analyzed. Logistic regression analysis was used to assess factors affecting the postoperative relapse of spontaneous pneumothorax. Results The pulmonary bullae were found in 877 patients of 1128 during the operation. The incidence of pulmonary bullae was significantly high in patients with age below 25 years compared with patients over 25 years (P 3 d) were independent risk factors of postoperative recurrence for spontaneous pneumothorax (P<0.05). Conclusion Pulmonary bullae, pleurodesis without pleura friction and delayed drainage duration are risk factors of postoperative recurrence for spontaneous pneumothorax, which should be paid more attention in clinic.
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Objective To observe the pathological change of visceral pleura in patients with chronic obstructive pulmonary disease (COPD), and to discuss the relationship between the changes and COPD airflow limitation. Methods A total of 70 patients received the pulmonary lobectomy or partial resection because of lung tumor in Tianjin Chest Hospital from May 2014 to August 2015 were selected in this study. According to the results of pulmonary function test, the patients were divided into COPD group [forced expiratory volume in one second (FEV1)/ forced vital capacity (FVC) 0.05). The visceral pleural thickness and the proportion of elastic fibers in visceral pleural were significantly thinner in COPD group than those of control group ( P0.05). Conclusion The thinner visceral pleural and the reduction of elastic fibers in visceral pleural are one of the causes of expiratory airflow limitation in COPD patients.
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Objective To explore the association of mean platelet volume and neutrophil to lymphocyte ratio with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)in elderly patients and its clinical value for the short-term prognosis. Methods A total of 52 patients with AECOPD who had been hospitalized during the period of April 2014 to April 2015 were enrolled in this prospective observational study. Levels of mean platelet volume (MVP),C-reactive protein,complete blood count,D-dimer,fibrinogen,percent-of-predicted FEV1 and percent-of-predicted FEV1/FVC were measured at admission(acute exacerbation)and after 3 months(stable period). Fifty-two age-and sex-matched healthy individuals constituted the control group. Pearson′s correlation was used to analyze the association of MPV with WBC,NLR,CRP,DD,FIB,FEV1%,and FEV1/FVC%. Results In AECOPD,as compared with stable COPD and the control group,levels of WBC,NLR,D-dimer,fibrinogen and CRP elevated;FEV1,FVC,percent-of-predicted FEV1 and percent-of-predicted FEV1/FVC declined;and MPV level decreased obviously. As a cut-off point of MVP level of<8.35fl for predicting AECOPD,it showed a sensitivity of 84.6%and a specificity of 86.5%. A decreased MVP level was significantly correlated with an increased in white blood cell count, neutrophil to lymphocyte ratio,D-dimer,fibrinogen and C-reactive protein level(P=0.01,0.02,0.01,0.02,and 0.01 respectively). Conclusions Mean platelet volume and neutrophil to lymphocyte ratio may be inflammatory markers inAE COPD,and measurement of mean platelet volume level may be useful for identifying elderly patients at increased risks for acute exacerbation.
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Objective To analyze the clinical data of 20 young and middle-aged patients with bronchial foreign bodies who were hospitalized because of unknown lung shadow. Methods The clinical data of 20 confirmed cases, including history of aspiration, imaging examination results, bronchoscopy findings and therapeutic process were retrospectively analyzed. The outcome of bronchial foreign body granuloma in the airway was observed. Results ⑴100%of the 20 patients with an average age of (46.39±3.26) years were misdiagnosed before bronchoscope examination. (2) The results of chest CT showed that the 20 patients had bronchial stenosis or obstruction with pulmonary consolidation or atelectasis, of which 18 cases were on the right side and 2 on the left side. (3) According to the shape and size of the foreign bodies as well as the length of time of aspiration, the bronchial openings were blocked by foreign bodies in 10 patients, and the foreign bodies were taken out by foreign body forceps. The diagnosis was confirmed in 3-6 (average 4.40±0.92) months in 10 patients. Four patients were obstructed by foreign bodies and granulation tissue, which took 5-12 (average 8.25±2.86) months to diagnose, while in 6 cases, masses were found in tracheal cavity, which took 6-15 (average 10.17±2.85) months to diagnose. The latter 10 (4+6) patients were treated with endotracheal intubation to remove foreign bodies and granulation tissue. (4) After 24-72 hours of treatment, the symptoms of cough, expectoration and blood in the sputum were relieved, and no severe complications occurred in 20 patients. (5) About two weeks after bronchial foreign bodies were removed, the granulation tissue disappeared. Conclusion Foreign body aspiration on the right side is more common in the 20 young and middle-aged patients, and bronchoscope is the best means of diagnosis and treatment.
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Objective To investigate the risk factors,clinic charactertics and survival prognosis of pulmonary embolism (PE) in patients with lung cancer.Methods The clinic data of 28 lung cancer patients with PE,hospitalized in department of respiratory and critical care medicine of Tianjin Chest Hospital between June 2012 to June 2015,were retrospectively reviewed.Eleven of them were diagnosed with primary lung cancer and PE (symptomatic group),and 17 lung cancer patients were found PE accidentally (asymptomatic group).A total of 56 lung cancer patients without PE were used as control subjects (no PE group).Data of pathological types,clinical staging of lung cancer,systemic chemotherapy,white blood cell (WBC),hemoglobin (Hb),platelet (PLT),D-dimer (DD),albumin (ALB) and C-reactive protein (CRP) were analyzed by univariate analysis in the symptomatic group and asymptomatic group.Logistic regression analysis was carried out on the statistically significant indexes to observe the influencing factors.The morphology and location of the remobilization images were analyzed in lung cancer patients with PE.The median time to embolism and survival of PE patients were compared between symptomatic group and asymptomatic group.Results The proportion of adenocarcinoma,systemic chemotherapy and stage Ⅲ + Ⅳ were significantly higher in PE group than those in no PE group (P ＜ 0.01).The ratio of white blood cells (WBC)＞ 11× 109/L (hyperleukocytosis) and albumin (ALB) ＜30 g/L and D-dimer (DD)＞ 0.5 mg/L were significantly higher in PE group than those of no PE group (P ＜ 0.05).There were no statistical differences in other indicators including clinical symptoms between the two groups (P ＞ 0.05).The logistic regression analysis showed that adenocarcinoma,chemotherapy,WBC＞ 11× 109/L and DD＞0.5 mg/L were the risk factors of lung cancer with PE (P ＜ 0.05).There was higher ratio of asymptomatic PE in lung cancer patients with PE.There were no significant differences in morphology and location of the remobilization images in symptomatic group.The median time of embolization was 3.6 months (95％ CI:3.2-4.0) in the asymptomatic group,which was significantly earlier than that in the symptomatic group (10.5 months,95％ CI:8.88-12.12,P ＜ 0.01).The median survival time was 7.2 months (95％ CI:5.86-8.56) in the asymptomatic group,which was significantly longer than that of symptomatic group (2.8 months,95％ CI:2.48-3.12,P ＜ 0.05).Conclusion Lung adenocarcinom,systemic chemotherapy,hypoproteinemia and increased D-dimer are the independent risk factors in lung cancer patients with PE.PE in lung cancer is frequently asymptomatic in the early stage.Compared to symptomatic patients,asymptomatic cases have better prognosis.
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Objective To observe the hemostatic efficacy and safety of argon plasma coagulation (APC) through bron?choscope after biopsy. Methods The APC was given to patients suffered from coronary heart disease combined hyperten?sion or paroxysmal auricular fibrillation and accepted bronchoscopy biopsy with much bleeding. The hemostatic effect and changes of heart rate, blood pressure and SPO2 were observed before and after treatment. Results Sixty-two patients were treated with endoscopic hemostasis by APC. The hemostasis was successful in 60 cases. The hemostasis was performed with APC successfully in 2 patients after intubation and mechanical ventilation because of the biopsy hemorrhage. Sixty-two cas?es included 42 cases of airway tumor (26 cases in lobe bronchus and 16 in segmental bronchus), 16 cases of broadening of the trachea ridge and mucosal rough, and 4 cases of granulation tissue of lobe bronchus. There were no significant differenc?es in mean arterial pressure and heart rate before and after treatment in 60 patients (P>0.05). The oxygen saturation was sig?nificantly lower after treatment than that before treatment (0.939±0.027 vs. 0.956±0.017, P<0.05). Conclusion Hemosta?sis treatment by APC through bronchoscope has the characteristics of rapid, thorough and safe, especially for patients com?bined with cardiovascular disease. It can avoid the occurrence of cardiovascular system complications caused by convention?al hemostatic treatment.
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Objective To evaluate the positive rate, reliability and safety of thoracoscope pleural brushing for diagnosing malignant pleural effusion. Methods Seventy patients with unexplained pleural effusion were performed with medical thoracoscopy:(1) Observe the visceral and parietal pleura then use disposable cell brush to obtain specimens from suspect areas and take cytological examination. (2) Observe the parietal pleura then use biopsy forceps to forceps specimens from suspect areas and take histological examination. (3) Compare the positive rate of diagnosis, coincidence rate of pathological type and complication between two methods individual and combination in diagnosis. Results In 51 patients diagnosed as malignant pleural effusion, the diagnosis-positive rate of biopsy was 88.24%(45/51) and the diagnosis-positive rate of pleural brushing cytology was 90.20%(46/51). The diagnosis-positive rate of pleural brushing combined with biopsy was 96.08%(49/51), but there was no significant difference in diagnosis-positive rate between two methods individual and combination for malignant pleural effusion (P>0.05). In 51 patients, pathological type determination rate was 76.47%(39/51) evaluated by pleural brushing, 88.24% (45/51) by biopsy, and there was no significant difference in pathological type determination rate between two methods (P>0.05). Biopsy was performed for 168 times, more bleeding was found in 5 cases (2.98%), feeling pain in 134 cases (79.76%). Pleural brushing examination was performed for 198 times, no significant bleeding and pain were found. Conclusion Medical thoracoscopic pleural brushing under direct vision is a safe and reliable method, which can be use as an effective diagnostic method for malignant pleural effusion.
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Objective To explore the differences and infection factors of adherence of pulmonary rehabilitation (PR) in patients with different periods of chronic obstructive pulmonary disease (COPD). Methods The 304 patients were randomly distributed into two groups, stable COPD with PR group (n=178) and acute exacerbation COPD (AECOPD) with PR group (n=126). The course of PR was 12 weeks. According to the adherence definition (practical time of accompolish PR programm>70%of that planned time), patients were divided into good adherence group (n=115) and bad adherence group (n=189). The practical-perform time of PR, proportion of good adherence and PR quitting were compared between two groups. Basic data were collected and analyzed in two groups of patients. After the pulmonary rehabilitation, binary Logistic regression was used to analyse the compliance of pulmonary rehabilitation. Results The practical-perform time of PR and the proportion of good adherence were significantly higher in stable COPD with PR group than those of AECOPD with PR group (5 641.5±1 080.1 min vs. 4 426.5± 1 046.8 min,46.7%vs. 25.4%). The PR quitting proportion (10.6%, 21/199) was significantly lower in stable COPD with PR group than that of AECOPD with PR group (26.7%, 46/172). Compared with AECOPD PR group, the income level and 6 minutes walking distance (MWD) were significantly higher in stable COPD PR group, and the everage age, proportion of tabacco-exposed, MRC score and CAT score were significantly lower in stable COPD group (P<0.05). Logistic regression analysis showed that older-age, tabacco-exposed, higher MRC score and CAT score were risk factors for PR adherence, while the higher income level (≥3 000 yuan) and longer 6MWD were protective factors for PR time-adherence in patients with COPD (P<0.05). Conclusion The time adherence of COPD patients, who undergo pulmonary rehabilitation, is disappointing, especially post-exacerbation. Good adherence would be expected in younger age, non tabacco-exposed, higher income level and better health-related quality of life.
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Objective To study the predictive value of evaluation in oxygen partial pressure[p(O2)] and carbon dioxide partial pressure[p(CO2)] of pleural cavity to the closure of visceral pleura in primary spontaneous pneumothroax (PSP) pa-tients. Methods Seventy-six hospitalized pneumothroax patients were divided into two groups:closed pneumothroax group (n=40) and open pneumothroax group (n=36), according to the radiographic information.To collect the expiratory gas by the device which we designed and produced, to collect the gas in the pleural cavity by thoracentesis. To detect the p(O2)and p(CO2)respectively, and the blood gas analysis of radial artery was done at same time. Results There was significantly low-er value of p(O2)of the gas in the pleural cavity in patients of closed pneumothroax than that of open pneumothroax (P 0.05). There was significantly higher value of the expiratory gas/the pleural cavity gas p(O2) and a significantly lower value of p(CO2), in closed pneumothroax group than those of open pneumothroax group (P<0.05). Logistic regression analy-sis showed that values of the expiratory gas/the pleural cavity gas p(O2) and p(CO2) were the effective factors for the closure of visceral pleura. ROC curve showed that the areas under ROC curve (AUC) for the expiratory gas/the pleural cavity gas p(O2) and p(CO2) was 0.985 and 0.867, the sensitivities were 92.5% and 77.8%, the specificities were 100%and 85.0%and the reference values were 1.81 and 0.97. Conclusion To utilize the evaluation of gas partial pressure can predict whether the leakage of the visceral pleura is closed.