文章

目前顯示的是 五月, 2019的文章

氣胸患者的可以搭飛機嗎?(air travel after pneumothorax)

若是創傷性氣胸(例如車禍)或高瘦的年輕人的自發性氣胸,在胸部X 光確認氣胸完全痊癒(或胸管引流後復原)後,可以搭航空機。
若因為肺氣腫等導致的複雜性氣胸,情況比較複雜,視情況而定。

反覆的自發性氣胸患者,建議做完手術(胸腔內視鏡氣泡切除術和肋膜沾黏術)後會更安全。為什麼?因為有可能有未破的肺部氣泡因為搭航空機高度的變化而體積增加更易破掉。

參考資料 https://doi.org/10.1136/bmj.g2928 https://www.uptodate.com/contents/pneumothorax-and-air-travel




小腸阻塞的X光(X ray film in small bowel obstruction)

X 光片能出現大約在小腸阻塞3到5小時後出現,12小時候開始明顯。

有主要兩點要看:
其一,脹小腸 X光片呈現 dilated small-bowel loops measuring>3cm in diameter 伴隨 air/fluid levels.(站立的X片)
但是Air/fluid levels 可能出現在機械性小腸阻塞和無動性腸阻塞( adynamic ileus.),此外有另外兩項X光特徵:
Progression of dilation results in a “stepladder” pattern of air/fluid levels“string of beads” or “string of pearls” sign: the bowel is predominantly fluid-distended with minimal amounts of air trapped in the valvulae這個在機械性腸阻塞有診斷價值,可用來區別adynamic ileusClosed-loop obstruction refers to segmental dilation of bowel due to obstruction at two points. Occasionally a dilated loop is seen to acquire a “coffee bean” shape. Persistence of this dilated loop on serial x-rays should raise suspicion for a closed-loop obstruction. 其二,有無大腸氣
dilated small-bowel loops with air/fluid levels with minimal to moderate colonic gas,這代表可能是腸阻塞(尚未完全塞住)也有可能只是non-obstructive ileus。
但dilated small-bowel loops with 沒有大腸氣,這就真的腸阻塞了,也是阻塞近端有氣,但遠端都沒有氣。