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目的 观察掺钕饱钇铝石榴石(Nd:YAG)激光在老年患者癌性气道内阻塞治疗中的应用价值。方法 广东省人民医院于1998-06~2004-12对41例老年患者癌性气道内阻塞患者经纤维支气管镜应用Nd:YAG激光进行消融,观察其疗效及并发症。结果 41例患者均良好耐受激光治疗,激光治疗后气道直径均有所扩大,扩大(6 .12±1 .12)mm;气促分级减少,减少(1. 8±0. 57)级; 1秒用力呼气容积(FEV1 )增加(0. 62±0 .16)L;动脉血氧分压(PaO2 )上升(2 .8±1 .4)kPa。激光治疗过程中有39例患者出现短暂性低氧血症, 16例出现出血,术后有13例出现早期呼吸困难, 5例出现发热,心肌梗死及急性心功能不全各1例。所有并发症经积极处理后病情均保持稳定。结论 Nd:YAG激光对老年人癌性气道内阻塞的治疗安全、有效。对肺功能暂时不能耐受放化疗伴癌性气道阻塞的老年肺癌患者,可以首先选择气道内Nd:YAG激光治疗,打通气道,改善肺功能及一般情况后,再选择性地进一步其它治疗。
Objective To observe the value of neodymium-doped yttrium aluminum garnet (Nd: YAG) laser in the treatment of obstructive airway obstruction in elderly patients. Methods Guangdong Provincial People’s Hospital in 1998-06 ~ 2004-12 41 elderly patients with airway obstruction by bronchoscopy using Nd: YAG laser ablation to observe its efficacy and complications. Results All the 41 patients were well tolerated by laser. The diameters of the airways after laser treatment were both enlarged and enlarged (6.12 ± 1.12) mm. ; FEV1 increased (0.62 ± 0.16) L in 1 second; PaO2 increased (2 .8 ± 1. 4) kPa. During the laser treatment, 39 patients had transient hypoxemia, 16 had hemorrhage, 13 had early dyspnea, and 5 had fever, myocardial infarction and acute cardiac insufficiency in 1 patient. All the complications were stable after treatment. Conclusion Nd: YAG laser is safe and effective for the treatment of elderly patients with malignant airway obstruction. Elderly patients with lung function who are temporarily unable to tolerate chemoradiotherapy and cancer with airway obstruction may be treated with Nd: YAG laser in the airway first, then the airway is ventilated, their lung function and general condition are improved, and then further other treatments are optional .