What Are the Different Methods of Respiratory System Examination?

Respiratory diseases

Respiratory diseases

Respiratory diseases are a common and frequently-occurring disease. The main lesions are in the trachea, bronchus, lungs and chest cavity. Those with mild lesions often have cough, chest pain, and affected breathing. In severe cases, they have difficulty breathing, hypoxia, or even respiratory failure. Mortality ranks 3rd in the city and 1st in the rural area. More attention should be paid to chronic obstructive pulmonary disease (referred to as COPD, including chronic bronchitis, emphysema, pulmonary heart disease), bronchial asthma, lung cancer, and other factors at home and abroad due to air pollution, smoking, aging of the population, and other factors. Incidence and mortality of diffuse interstitial fibrosis of the lungs and diseases such as lung infections have continued unabated.

Basic overview of respiratory diseases

Respiratory diseases

According to the statistics of death causes of the top ten major diseases in some cities and rural areas in China in 2006, respiratory diseases (excluding lung cancer) accounted for the fourth leading cause of death in urban areas (13.1%) and the third in rural areas. (16.4%). Due to air pollution, smoking, physical and chemical factors, biological factors caused by industrial economic development, and aging of the population, the incidence of respiratory diseases such as lung cancer and bronchial asthma has increased significantly in recent years, and chronic obstructive pulmonary disease remains high. (More than 8% of people over the age of 40). Although the incidence of tuberculosis has been controlled, it has been increasing in recent years. Pulmonary thromboembolism has constituted an important medical care problem, and pulmonary hypertension has received increasing attention in recent years. The incidence of diseases such as diffuse interstitial fibrosis and immunocompromised lung infections is increasing. The main cause of AIDS deaths is lung infections, especially pneumocystis carinii pneumonia. Since the end of 2002, outbreaks of infectious atypical pneumonia (Severe Acute Respiratory Syndrome, SARS) in China and worldwide have occurred in young and middle-aged people, which are highly contagious, have a high mortality rate, and lack targeted Drugs have caused panic among the masses and caused huge losses to the national economy. The mortality rate of human avian influenza in many countries is currently over 60%. The main target organ of avian influenza virus invading human body is lung. This shows that respiratory diseases are still very harmful to the Chinese people's health, and its prevention and treatment tasks are arduous.

Classification of respiratory diseases

Respiratory diseases asthma

English for asthma: Bronchial asthma, asthma for short, commonly known as "howler disease", and medicine in the motherland is called "wheezing syndrome". It is a chronic airway inflammation involving various cells, especially mast cells, eosinophils and T lymphocytes; This kind of inflammation in susceptible people can cause recurrent wheezing, shortness of breath, chest tightness, and cough, which usually occur at night or in the morning; such symptoms are often accompanied by extensive and variable expiratory flow rate limitation, but can be partially Natural relief or treatment relief; this symptom is also accompanied by increased airway response to a variety of stimulating factors. According to the authoritative institution Jinan Asthma Hospital, asthma can be classified into more than a dozen categories such as chronic bronchitis asthma, allergic asthma, medical asthma, senile asthma, cough variant asthma, chronic asthma, exercise asthma, and child asthma.

Respiratory disease tracheitis

Chronic bronchitis is caused by infectious or non-infectious factors such as inflammatory changes in the trachea and bronchial mucosa, increased secretion of mucus, and clinically characterized by long-term cough, expectoration, or wheezing. The early symptoms of this disease are relatively mild, and most of them occur in winter. They are relieved after warm spring and the course of disease is slow. When advanced disease progresses and obstructive emphysema occurs, lung function is impaired, which greatly affects health and labor. The disease is one of the most common diseases in China. Decades of clinical data show that the age of onset is more than 40 years old, smoking patients are significantly higher than non-smokers. .

Respiratory disease bronchitis

Bronchitis is a non-specific inflammation of the trachea, bronchial mucosa, and surrounding tissues. Most are caused by bacterial or viral infections. According to epidemiological investigations, they are mainly rhinovirus, syncytial virus, influenza virus and rubella virus. The more common bacteria are pneumococcus, hemolytic streptococcus, staphylococcus, influenzae, salmonella, and diphtheria. In addition, sudden temperature changes, dust, smoke and irritating gases can also cause bronchitis. Clinically, it is characterized by cough, sputum or accompanied by wheezing and recurrence. Divided into two types of chronic bronchitis and acute bronchitis . Acute bronchitis is characterized by a runny nose, fever, cough, and expectoration, with hoarseness of the throat, sore throat, and mild post-sternal friction pain. The sputum is small and sticky in the early stage and becomes purulent later. Cough can be aggravated by irritations such as smoke and cold air. Chronic bronchitis is mainly manifested by long-term cough, especially in the morning and evening. If secondary infection occurs, fever, cold, and purulent sputum. Clinical data indicate that winter is the season of high incidence of the disease.

Chronic obstructive pulmonary disease

Chronic Obstructive Pulmonary Disease ( COPD ), an irreversible chronic lung disease, includes two types: chronic bronchitis and emphysema. It is a disease that can be prevented and treated, has some obvious extrapulmonary effects, can aggravate the severity of the disease in some patients, and is characterized by incompletely reversible airflow restriction. Airflow restriction is exacerbated, and is mostly related to the lung's abnormal inflammatory response to harmful particles and gases. The characteristic lesion of COPD is restricted airflow, which is the result of the combined effect of small airway disease (obstructive bronchiolitis obliterans) and parenchymal destruction (emphysema). These two causes account for different patients. Different ratios. The natural course of COPD is variable and the course of each patient is different. A progressively worsening disease, especially when the patient is continuously exposed to a harmful environment. The effect of COPD on patients depends not only on the degree of airflow restriction, but also the severity of symptoms (especially shortness of breath and decreased mobility), systemic effects, and the presence of comorbidities.

Respiratory disease

The most common of chronic pulmonary heart disease is chronic hypoxemic pulmonary heart disease, also known as obstructive emphysema heart disease, referred to as pulmonary heart disease, which refers to the resistance to pulmonary circulation caused by chronic lesions of the lungs or the pulmonary arteries Increased, a type of heart disease that causes pulmonary hypertension and right ventricular hypertrophy, with or without right heart failure. Pulmonary heart disease is a common disease in China.

From 2000 to 2002, more than 20 million people were surveyed nationwide. The average prevalence of pulmonary heart disease was 0.4%. In 1992, more than 100,000 people were surveyed among farmers in Beijing, Hubei, and Liaoning. The average prevalence of pulmonary heart disease was 0.47%, which was basically similar to the previous one. The prevalence of people who live in plateau (such as Northeast, North China, and Northwest), southwestern China with insufficient sunlight and excessive humidity, and smoking is high, and increases with age. More than 91.2% of patients are over 41 years old. There is no significant difference between men and women. The prevalence varies with occupations in order of workers, farmers, and general urban residents. The prevalence rate can be as high as 15.7% to 49.8%. The proportion of this disease in hospitalized heart disease is 46% to 38.5%. Most regions accounted for the third and fourth place, and the composition ratio from 1980 to 1989 was only 2.49%, accounting for the eighth place, which is related to the increase in the incidence and treatment rate of coronary heart disease and myocarditis. It is the first place in the cold north and humid southwest.

Respiratory disease tuberculosis

Tuberculosis: Pulmonary tuberculosis (TB) is a chronic infectious disease caused by tubercle bacillus. It can affect multiple organs throughout the body, but tuberculosis is the most common. The pathological characteristics of this disease are tuberculous nodules and caseous necrosis, which easily form cavities. Clinically, it is a chronic process. There are often systemic symptoms such as low fever and fatigue, and respiratory system symptoms such as cough and hemoptysis.

Pathogenesis of respiratory diseases

(A) adjust the body's immune function

The onset of the respiratory system is related to the immune dysfunction caused by the disorder of the electrical activity of immune cells and the imbalance of quantum balance. Why does the benign irritant harmless to the human body also develop an immune response? This is mainly due to human immune dysfunction.

The immune surveillance system has the function of identifying aliens, eliminating aliens, and keeping the internal environment pure and stable. When immune surveillance is dysfunctional, it loses the ability to identify aliens, regardless of enemy or friend, flowers or poisonous herbs, and removes substances that are harmless to the body, which are considered to be harmful enemies, namely antigens. Therefore, the pathogenesis of bronchitis is caused by immune dysfunction. Negative oxygen ions have the functions of adjusting the immune cell's quantum balance and protein entrapment, thereby achieving normalization of functions. Adjusting the function of immune function can normalize dysfunctional immune function, eliminate allergic reactions of the body, and achieve the effect of treating respiratory diseases.

(B) regulating autonomic dysfunction

This is the second pathogenesis of the respiratory system: the vagus nerve is too excited, and the sympathetic nerve is excited. It is more appropriate to compare them to the rebels and royalists. Most drugs for treating bronchitis are achieved by changing these two forces.

(Three) improve acidic physique

The functional activities of all human cells must be performed in a suitable acid-base balance environment. The pH of normal people is weakly alkaline at pH = 7.41, and the elderly tend to become acidic due to weakened acid drainage.

Long-term stressful work and mental stress or eating too much acidic food can lead to internal environment disorders, and metabolic disorders can promote acidic constitution. In an acidic environment, mast cells can easily disrupt their stability and cause degranulation reactions. Therefore, respiratory patients should eat less meat, eat more fruits and vegetables, strengthen self-regulation to reduce psychological pressure. Patients with respiratory diseases have long-term inhaled ions to neutralize H + in the body (H + has a positive charge, while ions have a negative charge to neutralize excess H + in the body), which is an important factor in determining acidity in the body; it can also be enhanced by enhancing The respiratory system, blood system, and urinary system can improve the acidic physique due to the acid and alkali drainage function, which is beneficial to the treatment of bronchitis.

(4) Control of respiratory infections

The vagus nerve is distributed in the bronchi and alveoli. Tracheal inflammation can stimulate the vagus nerve to excite it. This is one of the causes of respiratory diseases. Ions can directly eliminate the inflammation of the trachea, reduce the stimulation of the vagus nerve, and maintain the balance between the sympathetic nerve and the vagus nerve. To sum up, the pathogenesis of bronchitis is multi-link, so it is difficult for single-agent drugs to work. Negative oxygen ions have the characteristics of "multiple diseases and the same treatment", and have unique advantages in the treatment of bronchitis. West German scholar Sulzer treated 3,000 patients with bronchitis with ions, with an effective rate of 97.4%.

Main factors related to respiratory diseases

First, the relationship between the structural function of the respiratory system and disease

The respiratory system has the most frequent contact with the external environment in various systems of the human body, and the contact area is large. Adults are at rest daily

Respiratory diseases

12000L of gas enters and exits the respiratory tract, exchanges gas with the capillaries of the pulmonary circulation in 300-750 million alveoli (total area of about 100m2), draws oxygen from the external environment, and discharges carbon dioxide to the outside. During the breathing process, organic or inorganic dust in the external environment, including various microorganisms, heteroprotein allergens, dust particles and harmful gases, can be inhaled into the lungs of the respiratory tract and cause various diseases. Among them, pulmonary infection is the least common. Viral infection is the most common primary infection. It first appears in the upper respiratory tract and can be accompanied by bacterial infection. Exogenous asthma and exogenous allergic alveolitis; inhalation and productive Pneumoconiosis caused by dust is most common in silicosis, coal silicosis, and asbestos lung; inhalation of irritating gases such as sulfur dioxide, chlorine, and ammonia with high water solubility can cause acute and chronic respiratory inflammation and pneumonia, while inhalation of low water-soluble nitrogen and oxygen Compounds, phosgene, dimethyl sulfate and other gases can damage the alveoli and pulmonary capillaries and cause acute pulmonary edema.

The lungs are supplied by two sets of blood vessels. The arterioles and veins of the pulmonary circulation are functional blood vessels for gas exchange; the bronchial arteries and veins of the systemic circulation are nutritional blood vessels such as the airway and visceral pleura. The lungs communicate with the blood and lymph circulation of all organs in the body, so the bacterial plugs of the skin and soft tissues, the thrombi of embolic phlebitis, and the tumor tumor plugs can reach the lung, causing secondary pulmonary abscess, pulmonary infarction, and metastasis, respectively. Lung cancer. Digestive system lung cancer, lung lesions can also spread throughout the body, such as lung cancer, tuberculosis spread to bones, brain, liver and other organs; the same can also spread in the lung itself.

The blood vessels of the pulmonary circulation are also narrower and smaller as the trachea-bronchus, the cross-sectional area of small arteries is larger, the area of the pulmonary capillary bed is larger, and it is easy to expand. Therefore, the lung is an organ with low pressure (pulmonary circulation blood pressure is only 1/10 of the systemic blood pressure), low resistance, and high capacity. When mitral stenosis, left heart failure, cirrhosis, nephrotic syndrome, and hypoalbuminemia of malnutrition occur, pulmonary interstitial edema, or fluid leaking from the chest, can occur.

Some immune, autoimmune, or metabolic systemic diseases such as sarcoidosis, systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, and scleroderma can all affect the lungs. The lung also has non-respiratory functions, such as the endocrine syndrome produced by the production and release of ectopic hormones in lung cancer.

Ageing of the social population

With the rapid advancement of science and medical technology, the speed of human life extension has also accelerated rapidly. It is recorded that the average lifespan two thousand years ago was second only to 20 years, increased to 30 years in the 18th century, and reached 40 years by the end of the 19th century. According to the United Nations Population Division's forecast, by 2025 the world s population over the age of 60 will increase to 1.121 billion, accounting for 13.7% of the world s population, of which 12% are in developing countries and 23% in developed countries. By the end of 1993, there were more than 2.1 million elderly people over 60 years old in Shanghai, accounting for 16% of the total population. By 2025, there will be 4 million elderly people, accounting for more than 28%. Respiratory diseases such as COPD and lung cancer increase with age, and their prevalence also increases. Due to the low immune function of the elderly, and easy to cause aspiration pneumonia, even if various new antibiotics are introduced in succession, lung infections It still ranks first in elderly infections and is often the direct cause of death.

The dangers of air pollution and smoking

Etiological studies have confirmed that the increase in respiratory diseases is closely related to air pollution and smoking. There is evidence that soot or dioxin in the air

Respiratory diseases

When sulfur sulfide exceeds 1000 ug / m3, acute episodes of chronic bronchitis significantly increase; other dusts such as carbon dioxide, coal dust, cotton dust, etc. can stimulate bronchial mucosa, reduce lung clearance and natural defense functions, creating conditions for microbial invasion. The incidence of lung cancer in industrial developed countries is higher than that in industrially backward countries, indicating that it is related to the pollution of the atmosphere by carcinogens in industrial waste gas. Smoking is a major source of pollution in small environments, and smoking is a concern with chronic bronchitis and lung cancer. In 1994, the World Health Organization proposed that smoking was the world's largest "plague" that caused death. According to surveys, in developing countries in the past half century, smoking has consumed 60 million souls, of which two-thirds are 45 to 65 years old. Smoking Died 20 years earlier than non-smokers. If the current smoking situation continues, by 2025, the world will kill 10 million people each year due to smoking, three times the current mortality rate, of which 2 million are in China. China's total tobacco consumption now ranks first in the world, and young people's smoking has increased significantly. Indeed, in the next 20 years, the number of deaths due to smoking will increase sharply.

Fourth, increased inhaled allergens

With the development of China's industrialization and economy, the types and number of allergens that can cause allergic diseases (asthma, rhinitis, etc.) have increased in urban areas. The widespread use of carpets and curtains has increased the number of indoor dust mites, and pet breeding (Birds, dogs, cats) leading to an increase in allergens of animal hair, as well as fungi of air conditioners, certain pollen spores of urban greening, organic or inorganic chemical raw materials, drugs and food additives, etc .; the presence of certain triggering factors, Such as smoking (passive smoking), nitrogen oxides emitted by cars, sulfur dioxide produced by coal combustion, bacterial and viral infections, etc. are all factors that increase the prevalence of asthma.

V. Etiology of lung infections and increased resistance

Respiratory and pulmonary infections are an important part of respiratory diseases. The number of patients with tuberculosis (mainly tuberculosis) in China ranks second in the world. There are 5 million patients with tuberculosis, of which 1.5 million are infectious, and more than 17% of patients infected with multidrug-resistant Mycobacterium tuberculosis. Since there is no effective method for preventing and treating viruses, the incidence of viral infectious diseases has not been significantly reduced; since the widespread application of antibiotics, the mortality rate of bacterial pneumonia has decreased significantly, but the mortality rate of elderly patients is still high, and the incidence of pneumonia No reduction was seen. Gram-negative bacteria dominate in hospital-acquired lung infections. Among Gram-positive cocci, methicillin-resistant bacteria have also increased significantly; community-acquired pneumonia still uses Streptococcus pneumoniae and Haemophilus influenzae as the main pathogens, as well as Legionella, Mycoplasma, Chlamydia, and viruses. The SARS outbreak in 2003 was a SARS coronavirus infection. In addition, for respiratory infections in immunocompromised or immunodeficiency patients, special pathogens such as fungi, pneumocystis, and atypical mycobacterial infections should be taken into account.

6. Advances in medical science and applied technology have increased the level of diagnosis

In recent years, advances in scientific research in various fields such as physiology, biochemistry, immunity, pharmacology, nuclear medicine, laser, ultrasound, and electronic technology have provided conditions for the diagnosis of respiratory diseases. Cell and molecular biology technologies are now used to gain a new and comprehensive understanding of the etiology, pathogenesis, and pathophysiology of some respiratory diseases, enabling the disease to be diagnosed more accurately and earlier.

Respiratory diseases have not received enough attention for a long time

Because the respiratory organs have huge reserves of physiological functions, usually only 1/20 of the lungs' respiratory function can maintain a normal life, so the pathological changes of the lungs often cannot be accurately reflected clinically; cough, sputum, hemoptysis, Symptoms such as chest pain and shortness of breath are often lacking in specificity, and are often mistaken for colds and bronchitis by people and clinicians. The diagnosis of severe pneumonia, tuberculosis, or lung cancer is delayed; or due to recurrent respiratory infections, which may develop into emphysema and lungs Heart disease, respiratory failure is only important, but it is too late, and its pathological and physiological functions are difficult to reverse. .

Diagnosis and differential diagnosis of respiratory diseases

Like other systemic diseases, a thorough and detailed medical history and physical examination are the basis for the diagnosis of respiratory diseases. X-ray chest examinations have a special important role in lung diseases. Because respiratory diseases are often a manifestation of systemic diseases, comprehensive comprehensive analysis should also be performed in conjunction with the results of routine tests and other special examinations, in order to make a diagnosis of the cause, anatomy, pathology, and function.

History of respiratory diseases

Learn about occupational and personal history of toxic substances to the lungs. If you are in contact with various inorganic, organic dust, moldy hay, and air conditioners; when you ask about smoking history, you should have a quantitative record of the number of packs per year; whether there is a history of raw food crabs or tadpoles that may be infected with lung flukes; Certain drugs that can cause lung diseases, such as bleomycin, amiodarone may cause pulmonary fibrosis, -adrenergic blockers can cause bronchospasm, and aminoglycosides can reduce respiratory muscle strength Etc .; there are also some genetic diseases, such as bronchial asthma, alveolar microlithiasis, etc. may have a family history.

Symptoms of respiratory disease

Respiratory cough, sputum, hemoptysis, shortness of breath, wheezing, chest pain and other symptoms are common to the lungs, but they still have certain characteristics, which may provide a reference for diagnosis.

(I) Irritating dry cough with acute cough is usually caused by upper respiratory tract inflammation. If accompanied by fever and hoarseness, acute viral pharynx,

Respiratory diseases

Throat, trachea, bronchitis. Chronic bronchitis, cough often occurs on cold days, and relieves when the climate warms. Sputum is exacerbated when the body is changed, which is common in lung abscesses and bronchiectasis. In the early stage of bronchial cancer, a dry cough appears. When the tumor enlarges and blocks the airway, a high-tone obstructive cough appears. Paroxysmal cough can be a manifestation of bronchial asthma. Paroxysmal cough can be seen in patients with left heart failure at night.

(2) The nature of sputum (sputum, mucus, mucopurulent, purulent), amount, and odor is helpful to the diagnosis. Slowly cough white foam or mucus sputum. Bronchiectasis and lung abscess have yellow purulent sputum and a large amount of sputum with anaerobic infection. Pulmonary edema, cough pink thin foamy sputum. Pulmonary amoebiasis is brown in color and elevated in temperature, which may be related to poor bronchial drainage. Cough green sputum is seen in green bacilli infection. The phlegm is white and sticky, and it is difficult to cough when pulled into silk. It is found in fungal infections. Cough rust-colored sputum is seen in pneumococcal pneumonia.

(3) Hemoptysis can bring blood from sputum to whole mouth of red blood. Sputum or a small amount of hemoptysis is most common in tuberculosis and bronchial lung cancer; bronchiectasis of the bronchiectasis forming small aneurysms (systemic circulation) or rupture of hollow wall aneurysms of pulmonary tuberculosis can cause repeated, massive hemoptysis, which can reach 300ml or more in 24 hours. In addition, hemoptysis should be distinguished from bleeding in the nose, throat, and upper gastrointestinal tract.

(4) Dyspnea can be divided into acute, chronic and recurrent according to the speed of its onset. Acute shortness of breath accompanied by chest pain often indicates pneumonia, pneumothorax, and pleural effusion. Pay attention to pulmonary infarction. Patients with left heart failure often experience paroxysmal dyspnea at night. Chronic progressive shortness of breath is seen in chronic obstructive pulmonary disease and diffuse pulmonary interstitial fibrosis. In the case of bronchial asthma, expiratory dyspnea occurs, accompanied by wheezing, which disappears when remission, and reappears in the next episode. There are three types of drowsiness: inspiratory, expiratory, and mixed. Such as throat edema, laryngotracheal inflammation, tumor or foreign body caused upper airway stenosis, inspiratory wheezing sound; asthma or wheezing bronchitis caused by extensive bronchospasm in the lower airway, then exhaled wheezing sound.

(5) Chest pain Lung and visceral pleura are not sensitive to pain. Chest pain occurs when pneumonia, tuberculosis, pulmonary infarction, lung abscess and other diseases involve parietal pleura. Chest pain with high fever, consider pneumonia. Lung cancer invades the pleura or bone of the thoracic wall, and there is faint pain, which continues to increase, and even cut-like pain. Attention should also be paid to distinguishing from chest pain caused by non-respiratory diseases, such as angina pectoris, mediastinum, esophagus, palate, and abdominal pain caused by disorders of the abdominal cavity.

Signs of respiratory disease

Due to the nature and extent of the lesions, signs of chest disease may be completely normal or apparently abnormal. Tracheobronchial lesions are mainly dry and wet rales; pulmonary inflammation has changes in the nature, tone and intensity of breathing sounds, such as large signs of inflammation showing signs of consolidation; pleural effusion, pneumothorax, or atelectasis may show corresponding signs May be accompanied by tracheal displacement.

Chest disease may be accompanied by extrapulmonary manifestations. Common bronchi-pulmonary and pleural purulent lesions include club-shaped fingers (toes); some bronchopulmonary joint diseases, club-shaped fingers, and other causes caused by lung cancer Paracancerous syndromes such as endocrine syndromes.

Respiratory disease examination

(A) blood test

During respiratory infections, conventional white blood cells and neutrophils increase, sometimes with toxic particles; an increase in eosinophils indicates an allergic factor or a parasite infection. 75% of exogenous asthma patients have elevated lgE, which can rule out parasitic infection. Other serological antibody tests, such as fluorescent antibodies, convection immunoelectrophoresis, and enzyme-linked immunosorbent assays, are of certain help in the diagnosis of viral, mycoplasma, and bacterial infections.

(Two) allergen test

A positive allergen skin test for asthma can help with antigen desensitization. A skin reaction that is positive for tuberculosis or fungi is only an indication of an infection and is not necessarily a disease.

The German BICOM bioresonance examination and treatment system can immediately obtain the test results in 15-20 minutes. It can detect more than 500 allergens, including almost all kinds of food, pollen, dust mites, insects, chemicals and other allergens.

(Three) sputum examination

Sputum smears in the low-power field of vision with <10 epithelial cells and white blood cells> 25 are relatively less contaminated sputum specimens. Quantitative cultures with a bacterial volume of 107cfu / ml can be determined as pathogenic bacteria. If it is sucked through the tracheal membrane puncture trachea, or through the double bronchoscope anti-pollution double cannula brush sampling, it can prevent the contamination of the larynx in the throat, which is of great value for the diagnosis of the cause of pulmonary microbial infection and the selection of drugs. Examination of exfoliated sputum cells can help diagnose lung cancer.

(Four) pleural fluid examination and pleural biopsy

Routine pleural fluid examination can determine whether effusion or leakage. Examination of lysozyme, adenosine deaminase, carcinoembryonic antigen and chromosome analysis of pleural fluid is helpful for the identification of tuberculosis and cancerous pleural fluid. Exfoliated cells and pleural pathological biopsy have diagnostic value for clear tumor or tuberculosis.

(V) Imaging inspection

Chest fluoroscopy combined with frontal and lateral chest radiographs reveals lesions obscured by the heart and palate, and enables observation of palate and cardiovascular activity. High voltage, tomography, and CT can further clarify the location, nature of the lesion, and the degree of patency of the trachea and bronchi. Magnetic resonance imaging can be of great help for mediastinal disease and pulmonary embolism. Bronchography is helpful in the diagnosis of bronchiectasis, stenosis and obstruction. Pulmonary angiography is used for pulmonary embolism and various vascular congenital or acquired lesions; bronchial arteriography and embolization have good diagnostic and therapeutic value for hemoptysis.

(6) Bronchoscope

Bronchoscopy has been replaced by bronchoscopy, and it is only used for the removal of tumors or foreign bodies in the trachea when necessary. The bronchoscopy can penetrate into the bronchus of the subsegment, and directly peek into the mucosal edema, congestion, ulcer, granuloma, new organisms, foreign bodies, etc., for brush or clamp examination of the mucosa, and histological examination; and can be used as bronchial alveoli through the bronchoscope The lavage and rinsing fluids are inspected for microorganisms, cells, immunology, biochemistry, etc., in order to clarify the pathogen and pathological diagnosis; it also removes foreign bodies, diagnoses and treats hemoptysis, and treats benign and malignant tumors by high-frequency power, laser, and microwave. Guidance through fiberoptic bronchoscopy can also be used for nasal tracheal intubation.

(7) Radionuclide scanning

Application of 133 xenon nebulization inhalation and intravenous injection of macrogranular human albumin 99m is helpful for regional pulmonary ventilation / blood flow, pulmonary thromboembolism and blood flow defects, and diagnosis of space-occupying lesions. 67 gallium has certain reference value for the diagnosis of alveolitis, sarcoidosis and lung cancer of interstitial pulmonary fibrosis.

(Eight) lung biopsy

Fibrous bronchoscopy for lung biopsy of the lesion can be repeatedly taken to facilitate diagnosis and follow-up. The lesions such as lung masses near the chest wall can be located on chest radiograph, B-mode ultrasound, or CT for transthoracic lung biopsy. Pathological examination. The disadvantage of the above two methods is that the lung tissue taken is too small; therefore, for the purpose of clarifying the diagnosis and treatment, a chest biopsy can be performed when necessary. Diagnostic artificial pneumothorax or pneumoperitoneum can identify masses in the lungs or pleura, and lesions in the iliac crest, iliac crest, or subcondyle.

Diagnostic tests for respiratory diseases

Examination of respiratory diseases can accurately evaluate lung function, and different examinations evaluate different aspects of lung function.

A set of tests called a lung function test measures lung capacity, lung inspiration, expiratory function, and lung oxygen and carbon dioxide exchange capacity. Pulmonary function tests are of greater value in determining the type and severity of lung diseases and less in determining specific causes, but they are also commonly used to diagnose certain diseases, such as asthma. Pulmonary function tests include lung volume, flow velocity measurement, flow volume measurement, muscle strength evaluation, and diffuse capacity measurement.

Measurement of lung volume and flow rate in respiratory diseases

Spirometer usage diagram

Evaluation of respiratory diseases often requires measuring the amount of air in the lungs as well as the content and flow rate of exhaled air. The spirometer used consists of a mouthpiece, a recording device, and a connection tube. During the measurement, let the subject inhale deeply, and then exhale as hard as possible through the catheter, and record the volume and time of each breath inhaled and exhaled. Lung function is usually repeated after bronchodilator application.

A simple device for detecting the expiratory flow rate is a peak velocity meter. After the patient inhales deeply, blow the air into the tachymeter as hard as possible. This inexpensive device helps asthma patients monitor the severity of the disease at home.

Lung volume measurement can reflect the stiffness or elasticity of the lungs and thorax. Some diseases, such as pulmonary fibrosis and spinal curvature (back spine, scoliosis), can cause abnormal reduction in lung capacity. Such diseases that cause lung stiffness or reduce thorax activity are called restrictive lung diseases.

The expiratory flow measurement reflects the degree of narrowing or obstruction of the airway. Patients with bronchitis, emphysema, and asthma have a reduced expiratory flow rate. These diseases are called obstructive pulmonary disease.

Respiratory disease flow velocity measurement

Most new spirometers continuously display lung volume and flow during a patient's forced exhalation. Velocity checks are particularly useful for identifying partial obstructions in the larynx and trachea.

Muscle strength evaluation

Respiratory muscle tension is measured by using a pressure gauge to inhale and exhale vigorously. Diseases that affect muscle strength, such as muscle atrophy, make breathing more difficult and lower inspiratory and expiratory pressures. This test has a certain predictive value for whether patients with mechanical ventilation can go offline.

Determination of diffuse capacity of respiratory diseases

Carbon monoxide diffusion capacity measurement can estimate the efficiency of oxygen transport from the alveoli to the blood. Because it is difficult to directly measure the diffusion function of oxygen, the subject inhaled a small amount of carbon monoxide, held his breath for 10 seconds, and then exhaled forcibly to the carbon monoxide analyzer.

Under normal circumstances, the lungs can absorb carbon monoxide in the inhaled gas well. If the measurement results indicate that the absorption of carbon monoxide is not good, it means that the oxygen exchange between the lungs and the blood flow cannot be performed normally. In patients with pulmonary fibrosis, emphysema, and pulmonary vascular injury, diffuse dysfunction has its own characteristics.

Respiratory disease sleep research

In general, breathing is autonomous and regulated by the brain's center, which regulates breathing activity based on blood oxygen and carbon dioxide levels. If the central regulation function is abnormal, the breathing may occur for a long time, especially at night, which is called sleep apnea. Sleep apnea is measured by placing one electrode on a finger or earlobe to measure blood oxygen concentration, placing the other electrode on one nostril to measure airflow, and placing an electrode on the chest to monitor breathing movements.

Arterial blood gas analysis for respiratory diseases

Arterial blood gas analysis mainly measures the oxygen and carbon dioxide concentrations in the blood and is an important indicator of lung function, because they represent the functional status of the lungs ingesting oxygen and expelling carbon dioxide.

Placing the integrated electrode on the finger or ear lobe can monitor the oxygen concentration. This method is called oximetry. If the patient is seriously ill or needs to know the level of carbon dioxide, a blood sample must be taken (usually radial blood). The laboratory can measure the oxygen, carbon dioxide concentration in the arterial blood and the pH of the blood. Such indicators cannot be measured from the venous blood sample.

Respiratory diseases chest imaging

Chest radiographs are usually taken for anterior radiographs, and sometimes for lateral radiographs. X-ray chest radiographs can show the contours of the heart and large blood vessels, severe lung diseases, and adjacent cavities and rib cages including ribs. For example, chest X-rays can clearly reflect diseases such as pneumonia, lung tumors, pneumothorax, pleural effusion, and emphysema. Although X-ray chest radiographs do not provide the exact cause of chest lesions, they can help physicians choose diagnostic methods with diagnostic value.

Compared with X-ray chest radiography, computed tomography (CT) scans of the chest can show the details of the lesions. During a CT scan, the computer analyzes a series of X-ray images and then provides several cross-sectional images. During the CT scan, dyes can be injected orally or through blood vessels to make some chest lesions more visible.

Magnetic resonance imaging (MRI) can also provide high-resolution images, especially for those with abnormal blood vessels in the chest, such as aortic aneurysms. Unlike CT scans, MRI does not use radiation and only records the magnetic characteristics of atoms in the body.

Ultrasound scans produce images based on the reflection of ultrasound waves in the body. Ultrasound is often used to detect fluid accumulation in the pleural cavity (the space between the two layers of pleura covering the surface of the lungs). Ultrasound can also be used as a mediator when performing thoracentesis.

Lung radionuclide scans use trace amounts of short-lived radioactive material to show the flow of gas and blood in the lungs. The examination is usually divided into the following two stages: the first stage the subject inhales the radioactive gas and uses a scanner to detect the distribution of the gas throughout the airway and the alveoli; the second stage injects radioactive substances into the vein and the scanner detects Its distribution in the pulmonary blood vessels. This test is of great value for detecting the presence or absence of pulmonary embolism, and can also be used for preoperative evaluation of lung cancer patients.

Angiography can accurately show the blood supply to the lungs. An X-ray-detectable dye is injected into a blood vessel, and an image is produced when it flows through arteriovenous veins in the lungs. Angiography is most commonly used in patients with suspected pulmonary embolism, and can often indicate abnormal lung scan results. Pulmonary angiography is considered the definitive method (gold standard) for the diagnosis and exclusion of pulmonary embolism.

Respiratory system thoracentesis

During thoracentesis, pleural effusion (abnormally accumulated fluid in the thoracic cavity) can be drawn out with a syringe and used for analysis and detection. The two main reasons for performing thoracentesis are to alleviate dyspnea caused by compressed lung tissue and to obtain a pleural fluid sample for diagnostic puncture.

During the operation, the patient took a comfortable sitting position, leaning forward slightly, with both upper limbs as support. Disinfect local back skin and perform local anesthesia. Then insert a puncture needle between the two ribs, and withdraw the fluid with an empty needle. Sometimes a thoracentesis is performed under ultrasound guidance. The collected pleural fluid is used for chemical composition determination, and sent to bacteriological and cancer cell examinations as appropriate.

If a large amount of fluid accumulates in the chest cavity, it can cause difficulty breathing. Extracting too much fluid can expand the lungs and improve breathing difficulties. During thoracentesis, drugs can also be injected into the thorax to prevent fluid from accumulating again.

After the puncture is completed, a chest X-ray examination is required to confirm the amount of fluid being withdrawn, to understand the lung field that was originally covered by the fluid, and to determine whether there are complications of puncture.

The risk during and after thoracentesis is minimal. Pain occasionally occurs as the lungs expand to the chest wall. In addition, sometimes patients feel a slight headache and difficulty breathing. Other possible complications include pneumothorax, bleeding from the chest or chest wall, syncope, infections, stab wounds to the liver and spleen, and accidental entry of gas into the blood stream (air embolism) are extremely rare complications.

Pleural acupuncture biopsy

A pleural needle biopsy is required when the cause of pleural effusion cannot be identified by thoracic puncture or a tissue sample is suspected of a tumor. As with thoracentesis, first anaesthetize the local skin, use a large-aperture puncture needle, collect a small amount of pleural tissue, and send it to the real laboratory for tumor and tuberculosis examinations. The accuracy of pleural biopsy for the diagnosis of the above diseases is about 85% to 90%. The complications are similar to those of thoracentesis.

Respiratory disease bronchoscopy

Bronchoscopy is a method of directly observing the pharynx and airways with a bronchoscope. The light source at the end of the bronchoscope allows the doctor to observe the bronchus in the lungs.

Bronchoscopy

Bronchoscopy can greatly help doctors diagnose and treat certain diseases. Flexible bronchoscope can be used to remove secretions, blood, pus and foreign bodies, inject medicine into selected bronchial tubes, and find bleeding sites. For patients with suspected lung cancer, bronchoscopy can be used to examine the airway and take lesions. For patients with pneumonia, bronchoscopy can also be performed when it is difficult to obtain specimens and detect pathogens by other methods. It is particularly useful for obtaining respiratory specimens from AIDS and other immunodeficiency patients. For patients who have burns or smoke, bronchoscopy can help assess damage to the pharynx and airways.

Before bronchoscopy, the patient should fast for at least 4 hours, give a proper amount of sedatives to eliminate tension, and use atropine to reduce the risk of laryngeal spasm and heart rate slowdown during the procedure. After anaesthetizing the nasal cavity and throat with anesthetic spray, a flexible bronchoscope is sent through the nasal cavity to the bronchus in the lungs for examination.

Bronchoalveolar lavage is an examination method for collecting small airway specimens that cannot be seen by bronchoscope. After the bronchoscope is inserted into the small airway, physiological saline is injected through the bronchoscopy channel, and then the bronchoscope is used to draw back a liquid mixed with cells and bacteria. The obtained liquid is used for microscopy to help diagnose lung cancer and infectious diseases; culturing with this liquid has greater diagnostic value for patients with infectious diseases. Bronchoalveolar lavage can also be used to treat alveolar proteinosis and other diseases.

Transbronchial lung biopsy is a method of obtaining lung tissue specimens by using biopsy forceps through the bronchial wall. During the operation, the biopsy forceps were delivered through the bronchoscopic orifice, and then passed through the small airway tube wall to enter the lung lesions to collect tissue specimens. In order to accurately penetrate the lung lesions, X-ray fluoroscopy can be used to reduce the risk of lung injury and pneumothorax. Although transbronchial lung biopsy can increase the incidence of complications, it can often provide important diagnostic evidence and assess whether patients can be treated with surgery.

After bronchoscopy, the subject should be observed for several hours, and chest X-rays should be performed for those undergoing biopsy to see if there are complications.

Respiratory diseases thoracoscopy

Thoracoscopy is a method of inspecting the surface of the lungs and pleura with a peepable tube (thoracoscopy). This method can also be used to treat pleural effusion.

During the examination, general anesthesia is usually used, then three small incisions are made on the chest wall, and the thoracoscopy is performed into the pleural cavity. The air then enters the chest cavity, causing the lung tissue to collapse. In addition to observing the surface of the lungs and pleura, tissue specimens can also be taken for microscopy or thoracoscopic injection of drugs into the chest to prevent recurrence of pleural effusion. After removing the thoracoscopy, a chest drainage tube should be placed to discharge the gas that enters the chest cavity during the examination to restore the collapsed lung tissue.

The complications of thoracoscopy are similar to those of thoracentesis and pleural needle biopsy. But the method is more traumatic, leaves a small scar, and requires hospitalization and general anesthesia.

Respiratory disease mediastinoscopy

Mediastinoscopy is a direct observation of the chest tissue (mediastinum) between the lungs using a mediastinoscopy. The mediastinum contains tissues such as the heart, trachea, esophagus, thymus, and lymph nodes. The purpose of almost all mediastinoscopy is to evaluate the cause of lymphadenopathy or to assess the extent of metastasis in lung cancer patients before chest surgery (thoracotomy).

Mediastinoscopy should be performed in the operating room after the patient is under general anesthesia. Make a small incision on the sternum, send it into the mediastinum to the chest, observe the organs and tissues inside the mediastinum, and collect the diseased tissue for necessary examination.

Respiratory system thoracotomy

A thoracotomy is a surgical approach to open the chest cavity, expose internal organs, collect specimens for laboratory examination, or treat lung, heart, and macrovascular disease.

Although thoracotomy is the best method for evaluating lung disease, it is less commonly used than other methods because it is a major operation. Laparotomy is usually used for patients who cannot be diagnosed, such as transthoracic puncture, bronchoscopy, or mediastinoscopy. Due to the direct observation and selective collection of specimens and the use of larger tissue specimens, the diagnosis of lung diseases by thoracotomy is more than 90%.

A thoracotomy is performed after the patient is under general anesthesia in the operating room. All mouths are made on the chest wall, and lung tissue specimens are taken for microscopic examination. If specimens are collected from both lungs, the sternum is often cut. If necessary, lung segment, lobe, or pneumonectomy can be performed.

After thoracotomy, a thoracic drainage tube should be left for 24 to 48 hours. Patients often need to be hospitalized for several days.

Respiratory disease suction

Aspiration can be used to obtain secretions and cells in the trachea and large bronchi. Aspiration is often used to obtain specimens required for microscopy or to help patients with weak cough remove respiratory secretions.

During operation, one end of a long and soft sterilized plastic tube is connected to the suction pump, and the other end is inserted into the trachea through the nasal cavity or oral cavity. When the front end reaches a suitable site, intermittent suction is performed for a duration of 2 to 5 second. For those who have established an artificial airway (tracheotomy), the suction tube can be inserted directly into the trachea through the artificial airway.

Prospects for prevention and treatment of respiratory diseases

Chronic obstructive pulmonary disease, lung cancer and occupational lung disease are diseases closely related to atmospheric (indoor) air pollution. Tobacco control and reduction of air pollution are the keys to preventing the development of these diseases. China's tobacco production ranks first in the world, and the number of smokers in the population is one of the highest in the world. Publicizing smoking is harmful, banning tobacco advertisements across the country, and taking effective measures to quit smoking are important tasks at the same time. At the same time, due to severe air pollution in most cities in China (including sulfur dioxide, dustfall, and nitrogen oxide levels far exceeding standards), it must be strict Implementation of air pollution tolerance standards formulated by the national environmental protection department. Transform industrial and household fuels to reduce industrial waste gas and indoor air pollution to standards (or below) set by the United Nations World Health Organization. For acute respiratory infectious diseases such as SARS and avian influenza, they must be managed in accordance with the legal infectious diseases of the Law of the People's Republic of China on the Prevention and Treatment of Infectious Diseases, and the source of transmission, the route of transmission, and the susceptible population must be managed. Comprehensive prevention measures based on prevention and control of transmission in hospitals.

Systemic diseases often develop into the middle and late stages when obvious symptoms appear, and early prevention and treatment of the disease is more effective. Early diagnosis is very important, especially when no symptoms appear.

Radiologically, regular chest x-rays are valuable for the discovery of some early peripheral lung cancer. With the widespread use of high-resolution spiral CT, the detection and diagnosis of small lung lesions are more accurate. CT pulmonary angiography (CTPA) has become the first-line diagnostic method for pulmonary thromboembolism. PET provides a more accurate method for characterizing small shadow lesions in the lungs and mediastinal lymph nodes.

From a functional point of view, regular pulmonary ventilation tests will help diagnose early chronic obstructive pulmonary disease, especially for people who smoke. The plethysmograph can more fully detect changes in lung function. , FoT) is more suitable for lung function measurement in young children and the elderly.

From the perspective of molecular biology, the application of polymerase chain reaction (PCR) technology has certain value in the diagnosis of tuberculosis, legionella pneumonia, mycoplasma, pneumocystis, and viral infections. Molecular genetic analysis can determine hereditary a, primary antitrypsin deficiency, pulmonary cystic fibrosis, and so on.

At present, China has formulated guidelines for the prevention and treatment of chronic obstructive pulmonary disease, bronchial asthma, pulmonary thromboembolism, interstitial lung disease, hospital and community-acquired pneumonia, and diagnostic and treatment plans for infectious atypical pneumonia (SARS). Prevention of the above diseases.

The development of molecular biology technology has provided broad prospects for the treatment of respiratory diseases, such as the replacement of missing genes, gene transfection, human recombinant antibodies, and antisense oligonucleotide (or nucleic acid) technology to inhibit proto-oncogenes and cause inflammation. Factor synthesis and activity, enhance the activity of tumor suppressor genes, anti-inflammatory factors or accelerate cell apoptosis.

In clinical treatment, due to the innovation of respiratory physiology and intensive care medicine including equipment, and the establishment of the intensive care unit (ICU) organization and management system, especially the development and improvement of respiratory support technology, it has greatly enriched the respiratory failure of critically ill patients. The theory and practice of rescue have reduced the case fatality rate. A full set of clinical physiological monitoring of sleep state and non-invasive positive pressure ventilation provide comprehensive technical means for the diagnosis and treatment of sleep disordered breathing. The new generation of various antibiotics (such as fourth-generation cephalosporins, new-generation quinolones, carbapenems, etc.) has a stronger therapeutic effect on negative bacilli that produce extended-spectrum p-lactamase (ESBI, s). New umazolidone (such as linezolid) and glycopeptide (such as teicoplanin) antibiotics are similar to vancomycin in methicillin-resistant Staphylococcus, with fewer side effects. A new generation of antifungal drugs (such as amphotericin B liposomes, voriconazole, caspofungin, etc.) has better efficacy and fewer side effects on various fungal infections.

The use of minimally invasive techniques (such as thoracoscopy) can perform lung surgery on some patients with poor lung function, and the improvement of various ventilation modes can provide targeted treatment for respiratory failure caused by different causes. The promotion of non-invasive facial (nasal) mask ventilation will prevent some patients (such as chronic obstructive pulmonary disease, neuromuscular disease) from developing respiratory failure, and avoid tracheal intubation or incision in some patients. The development of lung transplantation will become an important treatment for decompensated respiratory insufficiency.