肺下的

Discussion and Conclusion: Our walking exercise program can decrease the resting dyspnea, improve breathing patterns and improve exercise capacity. Supplementing oxygen during walking may not result in a further improvement.

讨论及结论：对中重度慢性阻塞性肺疾病患而言，在肺功能受损且改善有限的情形下，适当的运动介入仍能有助於增进运动能力，改善其动态之呼吸形式及呼吸困难的困扰，至於氧气辅助的附加效益，是否受限於介入的方式、浓度或时机等因素，仍须更进一步的研究。

objective to discuss perioperative complication and management of patient with high risk copd following esophagectomy.methods 45 patients with high risk copd underwent esophagectomy with epidural block combined with general anesthesia.perioperative treatment included smoking cessation,chest physiotherapy,prevention and control of infection of air way and appropriate bronchodilators of air way,breathing exercises,nutrition support and oxygen therapy.painkiller was instilled after surgery,early exercises,ensuring unobstruction of the air way,mechanical ventilation was applied when needed.results 3 had hypoxaemia in operation.after surgery,all patients had spo2 somewhat declined.6 had lung infection.6 were removed of bronchial secretion by bronchoscope.2 were supported by ventilator by using intubation.2 underwent tracheotomy.1 had disturbances of acid base balance and treated by using hydrochloric acid muriatic acid.all patients recovered rather smoothly and discharged from hospital.conclusion high risk copd is not the absolute contraindication of esophagectomy.active management before and after surgery ensures the safety and recovery of patients.

目的 探讨重度慢性阻塞性肺疾病简称慢阻肺病人食管切除术围手术期常见并发症及其处理。方法 45例重度慢阻肺的病人在全麻联合硬膜外阻滞下进行开胸食管切除手术，围手术期处理包括术前戒烟、胸部理疗、预防和控制呼吸道感染、解痉化痰、呼吸功能锻炼、营养支持和氧疗；术后硬膜外镇痛、早期锻炼、保持呼吸道通畅，部分病人予以呼吸支持。结果术中3例出现低氧血症。术后所有病人pao2均有不同程度的下降，6例出现肺部感染，6例行纤维支气管镜吸痰，2例通过气管插管给予呼吸机支持，2例行气管切开术，1例酸碱平衡紊乱使用盐酸精氨酸治疗。所有病人均痊愈出院。结论重度慢阻肺病人并非开胸食管切除手术的绝对禁忌证，积极的术前准备和严格的术后管理可减少和控制术后急性发作，有助于确保此类病人的围手术期安全和康复。

The superficial microvascular networks were sparser, while the subpleural microvascular networks were denser. The superficial blood vessels and the interlobular blood vessels were mutual transitional, and the anastomosing between the superficial blood vessels with the subpleural vessels. According to the branching sequence of the subpleural arteriole, it could be divided into the arteriole, terminal arteriole, precapillary arteriole and capillary in turn. The subpleural capillary networks were mainly web-like, while small holes were also found on the cast. The honeycomb vascular networks were various in size and form at a low magnification. The outline of alveolus, alveolar sac, alveolar duct and respiratory bronchiole and terminal bronchiole, made of microvascular networks, could be found in the cut surface.

胸膜面浅层的微血管网稀疏，深层的胸膜下微血管网致密；胸膜面浅层的微血管与小叶间隔的微血管之间相互移行，与胸膜下微血管之间形成吻合连接；根据胸膜下微动脉连续分支的顺序，常可将其分为微动脉、终末微动脉、毛细血管前微动脉和毛细血管四级；胸膜下毛细血管网主要以网络状的形式存在，但在铸型上均可见数量不等的"小孔状"结构；低倍镜下肺实质内微血管网呈现大小不等、形态各异的蜂窝状结构，可以见到由微血管网构成了肺泡、肺泡囊、肺泡管和呼吸性细支气管以及终末细支气管等结构的轮廓。

Clinical pulmonary ventilation function test, Pulmo CT measurement of vital capacity, and spiral CT scan under the control of spirometer were performed in 40 patients and 20 health adults in order to assess the accuracy of spirometrically controlled CT and to analyze CT quantitative data in correspondence with clinical pulmonary ventilation function.

为检测呼吸门控的准确性、了解定量的CT资料与肺通气功能的相关性，对患者组40例和对照组20例行临床肺通气功能检查、Pulmo CT肺活量检测和呼吸门控下螺旋CT扫描。

The pleural superficial blood vessels were smooth, while the constrictions of smooth muscle cells and round imprints of endothelial nuclei occurred on the surface of the subpleural and parenchymal arteriole and venule.

肺胸膜面浅层微血管的铸型表面光滑，胸膜下和肺实质内微动脉和微静脉的铸型表面可见平滑肌细胞形成的缩窄，以及圆形内皮细胞核的压痕。

Admission examination: the spirit of soft, clear consciousness, nutrition, poor growth, weight loss significantly, weight 23kg, moderate anemia appearance, and the lungs have not heard a clear wet and dry rale, abdomen soft, upper abdominal tenderness under Xiphoid, Cullen and lower abdominal tenderness light, I no obvious abnormalities

入院时查体：精神软，神志清，营养发育差，消瘦明显，体重23kg，中度贫血貌，两肺未闻及明显的干湿罗音，腹软，上腹部剑突下压痛，脐周及下腹部轻压痛，余未见明显异常。

The straight portion of the meridian from the heart system goes upward to the lung, then it runs out from the axilla, it goes along the posterior border of the medial aspect of the upper arm behind the Lung Meridian and Pericardium Meridian, it runs downward the medial aspect ot the elblow and descends along the posterior border of the medial aspect of the forearm to the pisiform region proximal to the palm and enters the palm, it follows the medial aspect of the little finger to its tip.

它的直行脉：从心系（即心与它脏相联系的系带）上行至肺，向下出于腑下，沿上臂内侧后缘，走手太阴，手厥阴经之后，下向肘内，沿前臂内侧后缘（灵道、通里、阴郄、神门），到掌后豌豆骨部进入掌内后边，沿小指的桡侧出于末端，接手太阳小肠经。《灵枢·经脉》：是动则病：嗌（1）干，心痛，渴而欲饮，是为臂厥（2）。是主心所生病者：目黄、胁痛，臑臂内后廉痛、厥，掌中热。

We consider that it is better to choose abdominal median incision plus left ribs resection in patients with upper gastric cancer in which subphrenic esophageal invasion is under 2cm of length and the function of heart or lung is severely damaged.

作者认为，该入路暴露良好，创伤小，痛苦少，适宜于胃癌膈下食管下端受侵2cm以下以及心肺功能严重受损不宜开胸的患者。

The chest cavity is opened at autopsy to reveal numerous large bullae apparent on the surface of the lungs in a patient dying with emphysema.Bullae are large dilated airspaces that bulge out from beneath the pleura.

肺气肿病人死后尸检胸腔被剖开，见肺表面数目众多的明显的肺大疱，是极度扩张的含气区，它从胸膜下膨胀起来。

HRCT scan showed peripheral area of ground-glass attenuation adjacent to subpleural honeycombing in one patient,and diffusely distributed ground-glass opacity in another patient.Two patients had received cortieosteroid treatment.For one patient, the symptoms improved, and ground-glass attenuation adjacent to subpleural honeycombing had almostly resolved.The other patient died of respiratory failure.

其中1例患者的双肺新出现的磨玻璃影，沿胸膜下蜂窝肺外周分布；另1例患者HRCT表现为新出现的磨玻璃影呈弥漫性分布。2例患者均接受激素治疗。1例患者气紧、咳嗽症状明显缓解，胸部HRCT的磨玻璃样影基本吸收；另1例患者死于呼吸衰竭。

The split between the two groups can hardly be papered over.

这两个团体间的分歧难以掩饰。

This approach not only encourages a greater number of responses, but minimizes the likelihood of stale groupthink.

这种做法不仅鼓励了更多的反应，而且减少跟风的可能性。