Objective:To study the improving effect of sputum aspiration combined with bronchoalveolar lavage by fiber bronchoscope on the condition and inflammation in lung cancer patients with postoperative pulmonary infection....Objective:To study the improving effect of sputum aspiration combined with bronchoalveolar lavage by fiber bronchoscope on the condition and inflammation in lung cancer patients with postoperative pulmonary infection.Methods:A total of 78 patients with lung cancer who received surgical treatment in our hospital between August 2013 and January 2015 and were with postoperative infection were selected as the research subjects and randomly divided into two groups, control group received mechanical ventilation therapy, observation group received bronchoalveolar lavage by bronchoscope combined with mechanical ventilation, and the inflammatory factor levels, RAAS system activity and respiratory mechanics indexes of two groups were determined after treatment.Results:3 d after treatment, serum hs-CRP, TNF-α, IL-8, PCT, renin, angiotensin II and aldosterone levels of observation group were lower than those of control group, and PIP, Raw and WOB values were lower than those of control group while Cdyn value was higher than that of control group.Conclusion:For lung cancer patients with postoperative pulmonary infection, bronchoalveolar lavage by bronchoscope combined with mechanical ventilation can optimize patients' condition, relieve systemic inflammatory response and improve respiratory function, and it has positive clinical significance.展开更多
Objective: To discuss the effect of lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation on the blood gas results and systemic state of patients with COPD complicated by severe p...Objective: To discuss the effect of lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation on the blood gas results and systemic state of patients with COPD complicated by severe pneumonia. Methods: A total of 68 patients with COPD complicated by severe pneumonia who were treated in the hospital between November 2015 and April 2017 were collected, retrospectively analyzed and then divided into the group A (n=35) who received noninvasive positive pressure ventilation and the group B (n=33) who received lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation. The differences in arterial blood gas and serum index levels were compared between the two groups before and after treatment. Results: Before treatment, there was no statistically significant difference in arterial blood gas index levels as well as serum contents of inflammatory mediators, stress hormones and myocardial enzyme spectrum indexes between the two groups. After treatment, arterial blood gas indexes PH and PaO2 levels of group B were higher than those of group A;serum inflammatory mediators HMGB1, PCT and hs-CRP contents were lower than those of group A;serum stress hormones Cor, AngⅠ and AngⅡcontents were lower than those of group A;serum myocardial enzyme spectrum indexesα-HBDH and cTn-Ⅰ contents were lower than those of group A. Conclusion: Lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation can effectively optimize the arterial blood gas levels, reduce systemic inflammatory stress state and protect the myocardial function of patients with COPD complicated by severe pneumonia.展开更多
Objective To evaluate the value of autofluorescence bronchoscope (AFB) in airway examination in central type lung cancer. Methods From Sep 2009 to Mar 2010,29 patients (23 men,6 women,median age 62. 2 years,range from...Objective To evaluate the value of autofluorescence bronchoscope (AFB) in airway examination in central type lung cancer. Methods From Sep 2009 to Mar 2010,29 patients (23 men,6 women,median age 62. 2 years,range from 34 to 81 years) underwent AFB procedure. There were 3 lesions located at trachea,1 at展开更多
BACKGROUND The advent of molecular targeted agents and immune checkpoint inhibitors has greatly improved the treatment of advanced renal cell carcinoma(RCC), thus significantly improving patient survival. The incidenc...BACKGROUND The advent of molecular targeted agents and immune checkpoint inhibitors has greatly improved the treatment of advanced renal cell carcinoma(RCC), thus significantly improving patient survival. The incidence of rare drug-related adverse events has gained increased attention.CASE SUMMARY We report a patient with advanced RCC treated with multiple lines of molecular targeted agents and immune checkpoint inhibitors, who developed a pulmonary infection after treatment with everolimus in combination with lenvatinib. Determining the pathogenic organism was difficult, but it was eventually identified as Pneumocystis jirovecii by next-generation sequencing(NGS) of bronchoscopic alveolar lavage fluid(BALF) and successfully treated with trimethoprim-sulfamethoxazole.CONCLUSION Rare pulmonary infections caused by molecular targeted agents are not uncommon in clinical practice, but their diagnosis is difficult. Evaluating BALF with NGS is a good method for rapid diagnosis of such infections.展开更多
Pneumonia caused by severe acute respiratory syndrome coronavirus 2 occasionally becomes severe and requires endotracheal intubation.Endotracheal intubation is usually performed using a laryngoscope;however,the operat...Pneumonia caused by severe acute respiratory syndrome coronavirus 2 occasionally becomes severe and requires endotracheal intubation.Endotracheal intubation is usually performed using a laryngoscope;however,the operator needs to be in close proximity to the patient’s face during the procedure,which increases the risk of droplet exposure.Therefore,we simulated fiberoptic endotracheal intubation on a mannequin representing the patient,using an ultrathin flexible gastrointestinal endoscope as an alternative to the bronchoscope,in order to maintain distance from the patient during the procedure.We performed this procedure 10 times and measured the time required;the median procedure time was 6.4 s(interquartile range,5.7-8.1 s).The advantage of this method is the short procedure time and distance maintained from the patients.The flexible tip-steerable control and length of the gastrointestinal endoscope contributed to shortening the procedure time and maintaining distance from the patients.In addition,this method can handle difficult airways without risk of misplacement of the endotracheal tube.However,it is necessary to consider the risk of aerosol generation associated with this procedure.In the pandemic setting of coronavirus disease 2019,this approach may be useful when a gastrointestinal endoscopist is in charge of endotracheal intubation of patients with coronavirus disease 2019.展开更多
Objective To evaluate the diagnostic value of transbronchial lung biopsy(TBLB)via bronchoscope for lung diffuse lesions and peripheral pulmonary lesions.Methods The results of TBLB were retrospectively analyzed from 2...Objective To evaluate the diagnostic value of transbronchial lung biopsy(TBLB)via bronchoscope for lung diffuse lesions and peripheral pulmonary lesions.Methods The results of TBLB were retrospectively analyzed from 256 diagnoses of unknown patients with lung diffuse lesions or peripheral lung lesions.Results Eighty-nine final diagnosis cases via TBLB only once,the diagnostic rate of double lung diffuse lesions was the highest,[51.06%(24/47)],local non-nodule lesions,nodule lesions,cavity lesions were 33.33%(23/69),29.91%(35/117),and 28.57%(4/14),respectively.Among 24 diagnostic cases of double lung diffuse lesions,there were 6 cases of pneumonia of pulmonary tuberculosis,9 cases of lung carcinoma,7 cases of adenocarcinoma;6 cases of pneumonia,2 cases of fungous infection,and 1 case of lung hemosiderosis.The diagnostic yield about 58 cases of local lesions was low,among which non-nodule lesions accounted for 33.33% and nodule lesions accounted for 29.91%.In 89 cases of peripheral lung lesions with histological diagnosis,lung carcinoma and pulmonary tuberculosis were frequent diseases,which accounted for 86.52%.Conclusion TBLB is a reliable,safe,effective and repeatable operation method in diagnosis of lung diffuse lesions and peripheral pulmonary lesions.展开更多
BACKGROUND Takotsubo cardiomyopathy(TTC),a syndrome of acute left ventricular(LV)dysfunction,is characterized by transitory hypokinesis of LV apices with compensatory hyperkinesis of the LV basal region.The symptoms o...BACKGROUND Takotsubo cardiomyopathy(TTC),a syndrome of acute left ventricular(LV)dysfunction,is characterized by transitory hypokinesis of LV apices with compensatory hyperkinesis of the LV basal region.The symptoms of TTC mimic acute myocardial infarction,without significant coronary stenoses on coronary angiography.Echocardiogram plays a key role in the diagnosis and prognosis of TTC.New indicators from echocardiograms may be helpful in disease evaluation.CASE SUMMARY A 67-year-old man with a 10-year history of non-small cell lung cancer was admitted to our hospital for emerging facial edema and dry cough.Bronchoscopic lavage,brushing,and biopsy were performed to evaluate tumor progression.During this procedure,he complained of left chest pain,nausea,and vomiting,with elevated troponin levels.Electrocardiogram showed sinus bradycardia with ST-segment elevation in I,AVL,and V4 to V6 leads.Coronary angiography revealed mild stenosis in the right coronary artery.Echocardiography showed hypokinesis of LV apices with compensatory hyperkinesis of the LV basal region.At the 7-d follow-up,echocardiographic pressure-strain analysis showed a normal LV ejection fraction,but partial recovery of LV myocardial work,which fully recovered 5 mo later.CONCLUSION This is a case of TTC caused by bronchoscopic operation.We strongly recommend noninvasive myocardial work measured by echocardiographic pressure-strain analysis as a necessary supplementary test for the long-term follow-up of TTC.展开更多
Objective: To investigate the effect of mucosolvan combined with fiberoptic bronchoscopy on respiratory function, inflammatory response and stress state in patients with severe pneumonia. Methods: From January 2017 to...Objective: To investigate the effect of mucosolvan combined with fiberoptic bronchoscopy on respiratory function, inflammatory response and stress state in patients with severe pneumonia. Methods: From January 2017 to June 2018, 82 patients with severe pneumonia were randomly divided into observation group and control group (all 41 cases). Patients in the control group received conventional anti-infective treatment, and the observation group was treated with fiberoptic bronchoscopy combined with mucosolvan on the basis of the control group. Respiratory function, inflammatory response and stress status were compared between the two groups. Results: Before treatment, there was no significant difference in Cdyn, WOB and PaO2/FiO2 between the two groups. After treatment, Cdyn and PaO2/FiO2 in the observation group were (36.28±4.28) mL/cmH2O and (376.23±24.21) mmHg respectively, while those in the control group were (26.89±3.76) mL/cmH2O and (322.12±23.16) mmHg, respectively. The levels of Cdyn and PaO2/FiO2 in the observation group were higher than those in the control group. After treatment, the WOB in the observation group was (7.81±0.72) J/L, and the WOB in the control group was (8.33±1.23) J/L. WOB of both groups was lower than that before treatment, and in observation group WOB was lower than that of control group, the difference was statistically significant. In CRP, PCT and sTREM-1 levels, there was no significant difference between the two groups before treatment. After treatment, CRP, PCT and sTREM-1 in the observation group were (39.10±6.03) mg/L, (14.57±2.05) ng/L, (15.02±3.02) ng/L respectively, while those in the control group were (59.72±8.81) mg/L, (20.03±3.09) ng/L, (34.21±5.28) ng/L, respectively. CRP, PCT, sTREM-1 in both groups were lower than those before treatment, and CRP, PCT, sTREM-1 in observation group were lower than those in control group. Before treatment, there was no significant difference with Cor, Ang-I and Ang-II in two groups. After treatment, the levels of Cor, Ang-I and Ang-II in the observation group were (114.76±15.85) ng/mL, (6.72±0.64) ng/mL, (27.28±3.43) ng/mL respectively, while those in the control group were (193.15±22.64) ng/mL, (12.10±1.68) ng/mL, (43.02±5.57) ng/mL, respectively. In the observation group, the levels of Cor, Ang-I and Ang-II were lower than those in the control group. Conclusion: Mucosolvan combined with fiberoptic bronchoscopy can effectively improve the respiratory function of patients with severe pneumonia, and reduce inflammation and stress state of the body.展开更多
Self-expanding metallic stents are sometimes placed for the management of obstructing airway lesions or conditions such as airway wall malacia or tracheal stenosis. However, endoscopic removal of these devices from th...Self-expanding metallic stents are sometimes placed for the management of obstructing airway lesions or conditions such as airway wall malacia or tracheal stenosis. However, endoscopic removal of these devices from the airway can pose extreme challenges for both clinical airway management as well as for the administration of general anesthesia. We report on a 61-yearold man with a complex cardiac history presenting for endoscopic stent removal necessitated by the formation of extensive granulation tissue. Comorbidities included a history of myocardial infarction, an ischemic cardiomyopathy with severe left heart failure(ejection fraction of 25%), mild right heart failure, 2+ tricuspid regurgitation status post tricuspid valve repair, and atrial fibrillation. An automatic external(wearable) cardiac defibrillator(Zoll Life Vest) was also in place. Induction of anesthesia was carried out using etomidate, with maintenance of anesthesia carried out with a propofol infusion(total intravenous anesthesia). Rocuronium was used for neuromuscular blockade. A size 4 i Gel supraglottic airway and, later, rigid bronchoscopy formed the basis for airway management. Stable conditions were met through the 2-h procedure, and the patient recovered uneventfully. Our successful experience in this case leads us to propose further use of a supraglottic airway in conjunction with total intravenous anesthesia for these procedures.展开更多
Objective:To study the effect of remifentanil combined with etomidate on systemic stress reaction during painless fiberoptic bronchoscopy.Methods:A total of 84 patients who received painless fiberoptic bronchoscopy in...Objective:To study the effect of remifentanil combined with etomidate on systemic stress reaction during painless fiberoptic bronchoscopy.Methods:A total of 84 patients who received painless fiberoptic bronchoscopy in outpatient and ward of our hospital between May 2014 and October 2016 were selected as the research subjects and randomly divided into two groups, observation group of patients accepted remifentanil combined with etomidate anesthesia, control group of patients received surface anesthesia, and in various time periods of inspection (before, during and after inspection), serum was collected respectively to test stress indexes.Results:Before inspection, serum NE, E, ACTH, Cor, PRA, AT-II, ALD, CRP, TNF-α, IL-6 and MCP-1 contents were not significantly different between two groups of patients;during and after inspection, serum NE, E, ACTH, Cor, PRA, AT-II, ALD, CRP, TNF-α, IL-6 and MCP-1 contents of both groups of patients were significantly higher than those before inspection, and serum NE, E, ACTH, Cor, PRA, AT-II, ALD, CRP, TNF-α, IL-6 and MCP-1 contents of observation group were significantly lower than those of control group. Conclusion:Remifentanil combined with etomidate can significantly inhibit the activation of systemic stress reaction and the release of stress hormones during painless fiberoptic bronchoscopy.展开更多
Objective:To study the effect of bronchoscopic ambroxol lavage on inflammatory factors in lavage fluid of patients with bronchiectasis complicated by infection.Methods:100 patients with bronchiectasis complicated by i...Objective:To study the effect of bronchoscopic ambroxol lavage on inflammatory factors in lavage fluid of patients with bronchiectasis complicated by infection.Methods:100 patients with bronchiectasis complicated by infection who were treated in our hospital between May 2012 and January 2016 were divided into the control group (n=54) who received conventional treatment and the observation group (n=46) who received intravenous anti-infection combined with bronchoscopic ambroxol lavage after the therapies were reviewed. The contents of inflammatory factors, adhesion molecules and acute phase proteins in lavage fluid were compared between the two groups.Results: Before treatment, the differences in contents of inflammatory factors, adhesion molecules and acute phase proteins in lavage fluid were not statistically significant between two groups of patients. After treatment, inflammatory factors IL-4, IL-6, IL-10 and TNF-α contents in lavage fluid of observation group were lower than those of control group;adhesion molecules sICAM-1 and VCAM-1 contents in lavage fluid were lower than those of control group;acute phase proteins CRP, AAG, HPT and CER contents in lavage fluid were lower than those of control group.Conclusion:Bronchoscopic ambroxol lavage can reduce airway inflammation in patients with bronchiectasis complicated by infection.展开更多
Objective:Fluoroscopy guidance is generally required for endobronchial ultrasonography with guide sheath(EBUS-GS)in peripheral pulmonary lesions(PPLs).Virtual bronchoscopic navigation(VBN)can guide the bronchoscope by...Objective:Fluoroscopy guidance is generally required for endobronchial ultrasonography with guide sheath(EBUS-GS)in peripheral pulmonary lesions(PPLs).Virtual bronchoscopic navigation(VBN)can guide the bronchoscope by creating virtual images of the bronchial route to the lesion.The diagnostic yield and safety profiles of VBN without fluoroscopy for PPLs have not been evaluated in inexperienced pulmonologist performing EBUS-GS.Methods:Between January 2016 and June 2017,consecutive patients with PPLs referred for EBUS-GS at a single cancer center were enrolled.The diagnostic yield as well as safety profiles was retrospectively analyzed,and our preliminary experience was shared.Results:A total of 109 patients with 109 lesions were included,99(90.8%)lesions were visible on EBUS imaging.According to the procedure time needed to locate the lesion on EBUS,24.8%(27/109)were deemed technically difficult procedures;however,no significant relationships were identified between candidate parameters and technically difficult procedures.The overall diagnosis yield was 74.3%(81/109),and the diagnostic yield of malignancy was 83.7%(77/92).Lesions larger than 20 mm[odds ratio(OR),2.758;95%confidence interval(95%CI),1.077-7.062;P=0.034]and probe of within type(OR,3.174;95%CI,1.151-8.757,P=0.026)were independent factors leading to a better diagnostic yield in multivariate analysis.About 30 practice procedures were needed to achieve a stable diagnostic yield,and the proportion of technically difficult procedures decreased and stabilized after 70 practice procedures.Regarding complications,one patient(0.9%)had intraoperative hemorrhage(100 mL)which was managed under endoscopy.Conclusions:VBN without fluoroscopy guidance is still useful and safe for PPLs diagnosis,especially for malignant diseases when performed by pulmonologist without previous experience of EBUS-GS.VBN may simplify the process of lesion positioning and further multi-center randomized studies are warranted.展开更多
Objective: Exploration for chronic obstructive pulmonary disease with branched air lumen hamartoma by bronchoscoptic treatment. Material and Method: An old man was referred to our hospital with shortness of breath for...Objective: Exploration for chronic obstructive pulmonary disease with branched air lumen hamartoma by bronchoscoptic treatment. Material and Method: An old man was referred to our hospital with shortness of breath for many years. Clinical evidence emphysema on respiratory examination, lung function and chest X-ray gave rise to concern. He was diagnosed as COPD and treated with ICS + LABA. But the shortness of breath is still existed. Initial assessment by CT suggested a left lower lobe collapse. Then bronchoscope identified a solid abnormality in main left bronchus. The pathology showed a benign neoplasm. Because of intolerance of operation, the patient was treated by brochoscopic intervention. The endoscopic intervention included resection by electrosurgical snare, electrocautery, argon plasma coagulation (APC). Result: After intervention, the neoplasm was partly removed and the pathological result was endobrochial hematoma. After treatment, the patient’s panting had taken a turn for the better. After one month later, the patient’s lung function improved a lot. Conclusion: In conclusion, endobronchial hamartomas are one of benign neoplasms. It can cause persistent bronchial obstruction and recurrent pneumonias. In this case, invasive endoscopic treatment provides an excellent outcome.展开更多
BACKGROUND Primary tracheobronchial mucoepidermoid carcinoma(MEC),derived from salivary mucus glands,is an uncommon neoplasm in adults.At present,surgery is still the preferred treatment for adult bronchial MEC,althou...BACKGROUND Primary tracheobronchial mucoepidermoid carcinoma(MEC),derived from salivary mucus glands,is an uncommon neoplasm in adults.At present,surgery is still the preferred treatment for adult bronchial MEC,although it may cause significant trauma and loss of lung function.Here,we report a patient with endobronchial MEC who received the interventional bronchoscopic therapy to remove the neoplasm and no recurrence occurred during follow-up.CASE SUMMARY A 28-year-old man was admitted to our unit with mild hemoptysis for 3 d.Physical examination did not show any abnormal signs,and the serological indexes were all in the normal range.Chest computed tomography(CT)indicated an intraluminal nodule in the bronchus intermedius with homogeneous density and a well-defined margin.Upon fiberoptic bronchoscopy,an endobronchial pedunculated polypoid was discovered without submucosal involvement.As the neoplasm was confined to the bronchus,interventional bronchoscopy was performed to remove the mass by high-frequency electric knife and laser resection.Tissue was sampled and histopathological examination confirmed the diagnosis of low-grade MEC.As the proliferation index was low,no further treatment was given.During 2 years of follow-up,the patient’s condition was good and no relapse was discovered under fluorescence bronchoscopy or CT scan.CONCLUSION Interventional bronchoscopy can be considered for treatment of low-grade bronchial MEC,with few complications and preserved lung function.展开更多
BACKGROUND End-stage chronic obstructive pulmonary disease(COPD)is one of the common lung diseases referred for lung transplantation.According to the international society of heart and lung transplantation,30%of all l...BACKGROUND End-stage chronic obstructive pulmonary disease(COPD)is one of the common lung diseases referred for lung transplantation.According to the international society of heart and lung transplantation,30%of all lung transplantations are carried out for COPD alone.When compared to bilateral lung transplant,singlelung transplant(SLT)has similar short-term and medium-term results for COPD.For patients with severe upper lobe predominant emphysema,lung volume reduction surgery is an excellent alternative which results in improvement in functional status and long-term mortality.In 2018,endobronchial valves were approved by the Food and Drug Administration for severe upper lobe predominant emphysema as they demonstrated improvement in lung function,exercise capacity,and quality of life.However,the role of endobronchial valves in native lung emphysema in SLT patients has not been studied.CASE SUMMARY We describe an unusual case of severe emphysema who underwent a successful SLT 15 years ago and had gradual worsening of lung function suggestive of chronic lung allograft dysfunction.However,her lung function improved significantly after a spontaneous pneumothorax of the native lung resulting in auto-deflation of large bullae.CONCLUSION This case highlights the clinical significance of native lung hyperinflation in single lung transplant recipient and how spontaneous decompression due to pneumothorax led to clinical improvement in our patient.展开更多
Objective:To observe whether wrist-ankle acupuncture can reduce propofol dosage in painless bronchoscopy of elderly patients or not and its potential effect mechanism.Methods:A total of 60 patients undergoing painless...Objective:To observe whether wrist-ankle acupuncture can reduce propofol dosage in painless bronchoscopy of elderly patients or not and its potential effect mechanism.Methods:A total of 60 patients undergoing painless bronchoscopy were randomized into a wrist-ankle acupuncture group and a control group,30 cases in each one.In the wrist-ankle acupuncture group,wrist-ankle acupuncture was received and the needles were retained for 30 min before entering to the operating room.In the control group,no any intervention was provided.The patients in two groups all received venous administration of midazolam,nalorphine and lidocaine and target controlled infusion of propofol.When the patient’s consciousness was lost and the eyelash reflex disappeared,bronchoscopy was performed and the propofol dosage was increased accordingly during operation.Propofol dosage,vital signs and occurrence of adverse reactions,bronchoscopist satisfaction,operation time and recovering time were recorded in the patients of two groups.Results:Propofol dosage in induction period and the total dosage of propofol in the wrist-ankle acupuncture group were lower than those in the control group,indicating the statistical differences(both P<0.05).The vital signs were stable during bronchoscopy in patients of two groups.The occurrence rates of hypoxemia and choking in the wrist-ankle acupuncture groups were lower than those in the control group,indicating the statistical differences(both P <0.05).Bronchoscopist satisfaction in the wrist-ankle acupuncture group was higher than that of the control group,and the operation time and recovering time were lower than the control group,indicating the statistical differences(all P<0.05).Conclusion:In painless bronchoscopy,wrist-ankle acupuncture may effectively reduce propofol dosage,alleviate respiratory suppression,reduce adverse reaction and shorten the recovering time in elderly patients.展开更多
Importance Pediatric hypervascular primary airway tumors are progressive,fatal lesions with a low incidence,and the disease is often more serious than that in adults.Objective To evaluate the clinical efficacy and saf...Importance Pediatric hypervascular primary airway tumors are progressive,fatal lesions with a low incidence,and the disease is often more serious than that in adults.Objective To evaluate the clinical efficacy and safety of interventional therapeutic bronchoscopy combined with conservative treatment and bronchial arterial embolization in children with primary airway tumors.Methods We retrospectively analyzed the clinical data of four pediatric patients with hypervascular primary airway tumor between 2017 and 2019 at Beijing Children’s Hospital.Results Two patients were low-grade bronchial mucoepidermoid carcinoma,one patient was pleomorphic adenoma,and one was bronchial leiomyoma.Interventional therapeutic bronchoscopy combined with bronchial arterial embolization was used for treatment(all four patients received general anesthesia).The tumors were safely resected in all patients via interventional bronchoscopy.There were no severe complications related to the procedures.All patients were followed up for 5–12 months,and one low-grade bronchial mucoepidermoid carcinoma recurred.Interpretation Interventional therapeutic bronchoscopy combined with bronchial arterial embolization appears to be a safe and efficient therapeutic method associated with less trauma and fewer complications,including no serious adverse events,in children with hypervascular primary airway tumors without bronchus wall infiltration.展开更多
文摘Objective:To study the improving effect of sputum aspiration combined with bronchoalveolar lavage by fiber bronchoscope on the condition and inflammation in lung cancer patients with postoperative pulmonary infection.Methods:A total of 78 patients with lung cancer who received surgical treatment in our hospital between August 2013 and January 2015 and were with postoperative infection were selected as the research subjects and randomly divided into two groups, control group received mechanical ventilation therapy, observation group received bronchoalveolar lavage by bronchoscope combined with mechanical ventilation, and the inflammatory factor levels, RAAS system activity and respiratory mechanics indexes of two groups were determined after treatment.Results:3 d after treatment, serum hs-CRP, TNF-α, IL-8, PCT, renin, angiotensin II and aldosterone levels of observation group were lower than those of control group, and PIP, Raw and WOB values were lower than those of control group while Cdyn value was higher than that of control group.Conclusion:For lung cancer patients with postoperative pulmonary infection, bronchoalveolar lavage by bronchoscope combined with mechanical ventilation can optimize patients' condition, relieve systemic inflammatory response and improve respiratory function, and it has positive clinical significance.
文摘Objective: To discuss the effect of lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation on the blood gas results and systemic state of patients with COPD complicated by severe pneumonia. Methods: A total of 68 patients with COPD complicated by severe pneumonia who were treated in the hospital between November 2015 and April 2017 were collected, retrospectively analyzed and then divided into the group A (n=35) who received noninvasive positive pressure ventilation and the group B (n=33) who received lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation. The differences in arterial blood gas and serum index levels were compared between the two groups before and after treatment. Results: Before treatment, there was no statistically significant difference in arterial blood gas index levels as well as serum contents of inflammatory mediators, stress hormones and myocardial enzyme spectrum indexes between the two groups. After treatment, arterial blood gas indexes PH and PaO2 levels of group B were higher than those of group A;serum inflammatory mediators HMGB1, PCT and hs-CRP contents were lower than those of group A;serum stress hormones Cor, AngⅠ and AngⅡcontents were lower than those of group A;serum myocardial enzyme spectrum indexesα-HBDH and cTn-Ⅰ contents were lower than those of group A. Conclusion: Lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation can effectively optimize the arterial blood gas levels, reduce systemic inflammatory stress state and protect the myocardial function of patients with COPD complicated by severe pneumonia.
文摘Objective To evaluate the value of autofluorescence bronchoscope (AFB) in airway examination in central type lung cancer. Methods From Sep 2009 to Mar 2010,29 patients (23 men,6 women,median age 62. 2 years,range from 34 to 81 years) underwent AFB procedure. There were 3 lesions located at trachea,1 at
文摘BACKGROUND The advent of molecular targeted agents and immune checkpoint inhibitors has greatly improved the treatment of advanced renal cell carcinoma(RCC), thus significantly improving patient survival. The incidence of rare drug-related adverse events has gained increased attention.CASE SUMMARY We report a patient with advanced RCC treated with multiple lines of molecular targeted agents and immune checkpoint inhibitors, who developed a pulmonary infection after treatment with everolimus in combination with lenvatinib. Determining the pathogenic organism was difficult, but it was eventually identified as Pneumocystis jirovecii by next-generation sequencing(NGS) of bronchoscopic alveolar lavage fluid(BALF) and successfully treated with trimethoprim-sulfamethoxazole.CONCLUSION Rare pulmonary infections caused by molecular targeted agents are not uncommon in clinical practice, but their diagnosis is difficult. Evaluating BALF with NGS is a good method for rapid diagnosis of such infections.
文摘Pneumonia caused by severe acute respiratory syndrome coronavirus 2 occasionally becomes severe and requires endotracheal intubation.Endotracheal intubation is usually performed using a laryngoscope;however,the operator needs to be in close proximity to the patient’s face during the procedure,which increases the risk of droplet exposure.Therefore,we simulated fiberoptic endotracheal intubation on a mannequin representing the patient,using an ultrathin flexible gastrointestinal endoscope as an alternative to the bronchoscope,in order to maintain distance from the patient during the procedure.We performed this procedure 10 times and measured the time required;the median procedure time was 6.4 s(interquartile range,5.7-8.1 s).The advantage of this method is the short procedure time and distance maintained from the patients.The flexible tip-steerable control and length of the gastrointestinal endoscope contributed to shortening the procedure time and maintaining distance from the patients.In addition,this method can handle difficult airways without risk of misplacement of the endotracheal tube.However,it is necessary to consider the risk of aerosol generation associated with this procedure.In the pandemic setting of coronavirus disease 2019,this approach may be useful when a gastrointestinal endoscopist is in charge of endotracheal intubation of patients with coronavirus disease 2019.
文摘Objective To evaluate the diagnostic value of transbronchial lung biopsy(TBLB)via bronchoscope for lung diffuse lesions and peripheral pulmonary lesions.Methods The results of TBLB were retrospectively analyzed from 256 diagnoses of unknown patients with lung diffuse lesions or peripheral lung lesions.Results Eighty-nine final diagnosis cases via TBLB only once,the diagnostic rate of double lung diffuse lesions was the highest,[51.06%(24/47)],local non-nodule lesions,nodule lesions,cavity lesions were 33.33%(23/69),29.91%(35/117),and 28.57%(4/14),respectively.Among 24 diagnostic cases of double lung diffuse lesions,there were 6 cases of pneumonia of pulmonary tuberculosis,9 cases of lung carcinoma,7 cases of adenocarcinoma;6 cases of pneumonia,2 cases of fungous infection,and 1 case of lung hemosiderosis.The diagnostic yield about 58 cases of local lesions was low,among which non-nodule lesions accounted for 33.33% and nodule lesions accounted for 29.91%.In 89 cases of peripheral lung lesions with histological diagnosis,lung carcinoma and pulmonary tuberculosis were frequent diseases,which accounted for 86.52%.Conclusion TBLB is a reliable,safe,effective and repeatable operation method in diagnosis of lung diffuse lesions and peripheral pulmonary lesions.
文摘BACKGROUND Takotsubo cardiomyopathy(TTC),a syndrome of acute left ventricular(LV)dysfunction,is characterized by transitory hypokinesis of LV apices with compensatory hyperkinesis of the LV basal region.The symptoms of TTC mimic acute myocardial infarction,without significant coronary stenoses on coronary angiography.Echocardiogram plays a key role in the diagnosis and prognosis of TTC.New indicators from echocardiograms may be helpful in disease evaluation.CASE SUMMARY A 67-year-old man with a 10-year history of non-small cell lung cancer was admitted to our hospital for emerging facial edema and dry cough.Bronchoscopic lavage,brushing,and biopsy were performed to evaluate tumor progression.During this procedure,he complained of left chest pain,nausea,and vomiting,with elevated troponin levels.Electrocardiogram showed sinus bradycardia with ST-segment elevation in I,AVL,and V4 to V6 leads.Coronary angiography revealed mild stenosis in the right coronary artery.Echocardiography showed hypokinesis of LV apices with compensatory hyperkinesis of the LV basal region.At the 7-d follow-up,echocardiographic pressure-strain analysis showed a normal LV ejection fraction,but partial recovery of LV myocardial work,which fully recovered 5 mo later.CONCLUSION This is a case of TTC caused by bronchoscopic operation.We strongly recommend noninvasive myocardial work measured by echocardiographic pressure-strain analysis as a necessary supplementary test for the long-term follow-up of TTC.
文摘Objective: To investigate the effect of mucosolvan combined with fiberoptic bronchoscopy on respiratory function, inflammatory response and stress state in patients with severe pneumonia. Methods: From January 2017 to June 2018, 82 patients with severe pneumonia were randomly divided into observation group and control group (all 41 cases). Patients in the control group received conventional anti-infective treatment, and the observation group was treated with fiberoptic bronchoscopy combined with mucosolvan on the basis of the control group. Respiratory function, inflammatory response and stress status were compared between the two groups. Results: Before treatment, there was no significant difference in Cdyn, WOB and PaO2/FiO2 between the two groups. After treatment, Cdyn and PaO2/FiO2 in the observation group were (36.28±4.28) mL/cmH2O and (376.23±24.21) mmHg respectively, while those in the control group were (26.89±3.76) mL/cmH2O and (322.12±23.16) mmHg, respectively. The levels of Cdyn and PaO2/FiO2 in the observation group were higher than those in the control group. After treatment, the WOB in the observation group was (7.81±0.72) J/L, and the WOB in the control group was (8.33±1.23) J/L. WOB of both groups was lower than that before treatment, and in observation group WOB was lower than that of control group, the difference was statistically significant. In CRP, PCT and sTREM-1 levels, there was no significant difference between the two groups before treatment. After treatment, CRP, PCT and sTREM-1 in the observation group were (39.10±6.03) mg/L, (14.57±2.05) ng/L, (15.02±3.02) ng/L respectively, while those in the control group were (59.72±8.81) mg/L, (20.03±3.09) ng/L, (34.21±5.28) ng/L, respectively. CRP, PCT, sTREM-1 in both groups were lower than those before treatment, and CRP, PCT, sTREM-1 in observation group were lower than those in control group. Before treatment, there was no significant difference with Cor, Ang-I and Ang-II in two groups. After treatment, the levels of Cor, Ang-I and Ang-II in the observation group were (114.76±15.85) ng/mL, (6.72±0.64) ng/mL, (27.28±3.43) ng/mL respectively, while those in the control group were (193.15±22.64) ng/mL, (12.10±1.68) ng/mL, (43.02±5.57) ng/mL, respectively. In the observation group, the levels of Cor, Ang-I and Ang-II were lower than those in the control group. Conclusion: Mucosolvan combined with fiberoptic bronchoscopy can effectively improve the respiratory function of patients with severe pneumonia, and reduce inflammation and stress state of the body.
文摘Self-expanding metallic stents are sometimes placed for the management of obstructing airway lesions or conditions such as airway wall malacia or tracheal stenosis. However, endoscopic removal of these devices from the airway can pose extreme challenges for both clinical airway management as well as for the administration of general anesthesia. We report on a 61-yearold man with a complex cardiac history presenting for endoscopic stent removal necessitated by the formation of extensive granulation tissue. Comorbidities included a history of myocardial infarction, an ischemic cardiomyopathy with severe left heart failure(ejection fraction of 25%), mild right heart failure, 2+ tricuspid regurgitation status post tricuspid valve repair, and atrial fibrillation. An automatic external(wearable) cardiac defibrillator(Zoll Life Vest) was also in place. Induction of anesthesia was carried out using etomidate, with maintenance of anesthesia carried out with a propofol infusion(total intravenous anesthesia). Rocuronium was used for neuromuscular blockade. A size 4 i Gel supraglottic airway and, later, rigid bronchoscopy formed the basis for airway management. Stable conditions were met through the 2-h procedure, and the patient recovered uneventfully. Our successful experience in this case leads us to propose further use of a supraglottic airway in conjunction with total intravenous anesthesia for these procedures.
文摘Objective:To study the effect of remifentanil combined with etomidate on systemic stress reaction during painless fiberoptic bronchoscopy.Methods:A total of 84 patients who received painless fiberoptic bronchoscopy in outpatient and ward of our hospital between May 2014 and October 2016 were selected as the research subjects and randomly divided into two groups, observation group of patients accepted remifentanil combined with etomidate anesthesia, control group of patients received surface anesthesia, and in various time periods of inspection (before, during and after inspection), serum was collected respectively to test stress indexes.Results:Before inspection, serum NE, E, ACTH, Cor, PRA, AT-II, ALD, CRP, TNF-α, IL-6 and MCP-1 contents were not significantly different between two groups of patients;during and after inspection, serum NE, E, ACTH, Cor, PRA, AT-II, ALD, CRP, TNF-α, IL-6 and MCP-1 contents of both groups of patients were significantly higher than those before inspection, and serum NE, E, ACTH, Cor, PRA, AT-II, ALD, CRP, TNF-α, IL-6 and MCP-1 contents of observation group were significantly lower than those of control group. Conclusion:Remifentanil combined with etomidate can significantly inhibit the activation of systemic stress reaction and the release of stress hormones during painless fiberoptic bronchoscopy.
文摘Objective:To study the effect of bronchoscopic ambroxol lavage on inflammatory factors in lavage fluid of patients with bronchiectasis complicated by infection.Methods:100 patients with bronchiectasis complicated by infection who were treated in our hospital between May 2012 and January 2016 were divided into the control group (n=54) who received conventional treatment and the observation group (n=46) who received intravenous anti-infection combined with bronchoscopic ambroxol lavage after the therapies were reviewed. The contents of inflammatory factors, adhesion molecules and acute phase proteins in lavage fluid were compared between the two groups.Results: Before treatment, the differences in contents of inflammatory factors, adhesion molecules and acute phase proteins in lavage fluid were not statistically significant between two groups of patients. After treatment, inflammatory factors IL-4, IL-6, IL-10 and TNF-α contents in lavage fluid of observation group were lower than those of control group;adhesion molecules sICAM-1 and VCAM-1 contents in lavage fluid were lower than those of control group;acute phase proteins CRP, AAG, HPT and CER contents in lavage fluid were lower than those of control group.Conclusion:Bronchoscopic ambroxol lavage can reduce airway inflammation in patients with bronchiectasis complicated by infection.
基金This study was supported by Beijing Municipal Hospital Scientific Research Cultivation Program(No.PX2016057).We thank Xiaoping Kang for her help in data analysis.
文摘Objective:Fluoroscopy guidance is generally required for endobronchial ultrasonography with guide sheath(EBUS-GS)in peripheral pulmonary lesions(PPLs).Virtual bronchoscopic navigation(VBN)can guide the bronchoscope by creating virtual images of the bronchial route to the lesion.The diagnostic yield and safety profiles of VBN without fluoroscopy for PPLs have not been evaluated in inexperienced pulmonologist performing EBUS-GS.Methods:Between January 2016 and June 2017,consecutive patients with PPLs referred for EBUS-GS at a single cancer center were enrolled.The diagnostic yield as well as safety profiles was retrospectively analyzed,and our preliminary experience was shared.Results:A total of 109 patients with 109 lesions were included,99(90.8%)lesions were visible on EBUS imaging.According to the procedure time needed to locate the lesion on EBUS,24.8%(27/109)were deemed technically difficult procedures;however,no significant relationships were identified between candidate parameters and technically difficult procedures.The overall diagnosis yield was 74.3%(81/109),and the diagnostic yield of malignancy was 83.7%(77/92).Lesions larger than 20 mm[odds ratio(OR),2.758;95%confidence interval(95%CI),1.077-7.062;P=0.034]and probe of within type(OR,3.174;95%CI,1.151-8.757,P=0.026)were independent factors leading to a better diagnostic yield in multivariate analysis.About 30 practice procedures were needed to achieve a stable diagnostic yield,and the proportion of technically difficult procedures decreased and stabilized after 70 practice procedures.Regarding complications,one patient(0.9%)had intraoperative hemorrhage(100 mL)which was managed under endoscopy.Conclusions:VBN without fluoroscopy guidance is still useful and safe for PPLs diagnosis,especially for malignant diseases when performed by pulmonologist without previous experience of EBUS-GS.VBN may simplify the process of lesion positioning and further multi-center randomized studies are warranted.
文摘Objective: Exploration for chronic obstructive pulmonary disease with branched air lumen hamartoma by bronchoscoptic treatment. Material and Method: An old man was referred to our hospital with shortness of breath for many years. Clinical evidence emphysema on respiratory examination, lung function and chest X-ray gave rise to concern. He was diagnosed as COPD and treated with ICS + LABA. But the shortness of breath is still existed. Initial assessment by CT suggested a left lower lobe collapse. Then bronchoscope identified a solid abnormality in main left bronchus. The pathology showed a benign neoplasm. Because of intolerance of operation, the patient was treated by brochoscopic intervention. The endoscopic intervention included resection by electrosurgical snare, electrocautery, argon plasma coagulation (APC). Result: After intervention, the neoplasm was partly removed and the pathological result was endobrochial hematoma. After treatment, the patient’s panting had taken a turn for the better. After one month later, the patient’s lung function improved a lot. Conclusion: In conclusion, endobronchial hamartomas are one of benign neoplasms. It can cause persistent bronchial obstruction and recurrent pneumonias. In this case, invasive endoscopic treatment provides an excellent outcome.
基金Supported by the National Natural Science Foundation of China,No.81870018.
文摘BACKGROUND Primary tracheobronchial mucoepidermoid carcinoma(MEC),derived from salivary mucus glands,is an uncommon neoplasm in adults.At present,surgery is still the preferred treatment for adult bronchial MEC,although it may cause significant trauma and loss of lung function.Here,we report a patient with endobronchial MEC who received the interventional bronchoscopic therapy to remove the neoplasm and no recurrence occurred during follow-up.CASE SUMMARY A 28-year-old man was admitted to our unit with mild hemoptysis for 3 d.Physical examination did not show any abnormal signs,and the serological indexes were all in the normal range.Chest computed tomography(CT)indicated an intraluminal nodule in the bronchus intermedius with homogeneous density and a well-defined margin.Upon fiberoptic bronchoscopy,an endobronchial pedunculated polypoid was discovered without submucosal involvement.As the neoplasm was confined to the bronchus,interventional bronchoscopy was performed to remove the mass by high-frequency electric knife and laser resection.Tissue was sampled and histopathological examination confirmed the diagnosis of low-grade MEC.As the proliferation index was low,no further treatment was given.During 2 years of follow-up,the patient’s condition was good and no relapse was discovered under fluorescence bronchoscopy or CT scan.CONCLUSION Interventional bronchoscopy can be considered for treatment of low-grade bronchial MEC,with few complications and preserved lung function.
文摘BACKGROUND End-stage chronic obstructive pulmonary disease(COPD)is one of the common lung diseases referred for lung transplantation.According to the international society of heart and lung transplantation,30%of all lung transplantations are carried out for COPD alone.When compared to bilateral lung transplant,singlelung transplant(SLT)has similar short-term and medium-term results for COPD.For patients with severe upper lobe predominant emphysema,lung volume reduction surgery is an excellent alternative which results in improvement in functional status and long-term mortality.In 2018,endobronchial valves were approved by the Food and Drug Administration for severe upper lobe predominant emphysema as they demonstrated improvement in lung function,exercise capacity,and quality of life.However,the role of endobronchial valves in native lung emphysema in SLT patients has not been studied.CASE SUMMARY We describe an unusual case of severe emphysema who underwent a successful SLT 15 years ago and had gradual worsening of lung function suggestive of chronic lung allograft dysfunction.However,her lung function improved significantly after a spontaneous pneumothorax of the native lung resulting in auto-deflation of large bullae.CONCLUSION This case highlights the clinical significance of native lung hyperinflation in single lung transplant recipient and how spontaneous decompression due to pneumothorax led to clinical improvement in our patient.
基金Supported by Scientific Research Program of Hebei Administration of Traditional Chinese Medicine:2020006。
文摘Objective:To observe whether wrist-ankle acupuncture can reduce propofol dosage in painless bronchoscopy of elderly patients or not and its potential effect mechanism.Methods:A total of 60 patients undergoing painless bronchoscopy were randomized into a wrist-ankle acupuncture group and a control group,30 cases in each one.In the wrist-ankle acupuncture group,wrist-ankle acupuncture was received and the needles were retained for 30 min before entering to the operating room.In the control group,no any intervention was provided.The patients in two groups all received venous administration of midazolam,nalorphine and lidocaine and target controlled infusion of propofol.When the patient’s consciousness was lost and the eyelash reflex disappeared,bronchoscopy was performed and the propofol dosage was increased accordingly during operation.Propofol dosage,vital signs and occurrence of adverse reactions,bronchoscopist satisfaction,operation time and recovering time were recorded in the patients of two groups.Results:Propofol dosage in induction period and the total dosage of propofol in the wrist-ankle acupuncture group were lower than those in the control group,indicating the statistical differences(both P<0.05).The vital signs were stable during bronchoscopy in patients of two groups.The occurrence rates of hypoxemia and choking in the wrist-ankle acupuncture groups were lower than those in the control group,indicating the statistical differences(both P <0.05).Bronchoscopist satisfaction in the wrist-ankle acupuncture group was higher than that of the control group,and the operation time and recovering time were lower than the control group,indicating the statistical differences(all P<0.05).Conclusion:In painless bronchoscopy,wrist-ankle acupuncture may effectively reduce propofol dosage,alleviate respiratory suppression,reduce adverse reaction and shorten the recovering time in elderly patients.
文摘Importance Pediatric hypervascular primary airway tumors are progressive,fatal lesions with a low incidence,and the disease is often more serious than that in adults.Objective To evaluate the clinical efficacy and safety of interventional therapeutic bronchoscopy combined with conservative treatment and bronchial arterial embolization in children with primary airway tumors.Methods We retrospectively analyzed the clinical data of four pediatric patients with hypervascular primary airway tumor between 2017 and 2019 at Beijing Children’s Hospital.Results Two patients were low-grade bronchial mucoepidermoid carcinoma,one patient was pleomorphic adenoma,and one was bronchial leiomyoma.Interventional therapeutic bronchoscopy combined with bronchial arterial embolization was used for treatment(all four patients received general anesthesia).The tumors were safely resected in all patients via interventional bronchoscopy.There were no severe complications related to the procedures.All patients were followed up for 5–12 months,and one low-grade bronchial mucoepidermoid carcinoma recurred.Interpretation Interventional therapeutic bronchoscopy combined with bronchial arterial embolization appears to be a safe and efficient therapeutic method associated with less trauma and fewer complications,including no serious adverse events,in children with hypervascular primary airway tumors without bronchus wall infiltration.
