不同头颈位对LMA-Supreme^(TM)间歇正压通气时口咽漏气压的影响

目的评价不同头颈位对LMA-SupremeTM(SLMA)间歇正压通气时口咽漏气压(OLP)的影响。方法妇科全麻手术患者60例,麻醉诱导后插入SLMA行间歇正压通气,设定喉罩气囊压(ICP)为60 cm H2O。喉罩插入即刻,机械通气后60 min分别测量正中位、前屈位、旋转位、后仰位四个头颈位时的OLP和ICP。统计各头颈位正压通气时漏气率。分别在四个头颈位通过引流管插入润滑后的胃管,记录胃管插入成功率并经通气导管插入纤维支气管镜(FOB),采用FOB分级法评价喉罩解剖位置。结果喉罩置入即刻和机械通气后60 min的OLP,前屈位>正中位>后仰位,旋转位与正中位比较无明显差异(P<0.05)。ICP在前屈位大于正中位,后仰位小于正中位,旋转位与正中位比较无明显差异。各种头颈位下患者喉罩解剖位置FOB分级无差异;前屈位时胃管插入成功率低于其他头颈位。结论头前屈位可改善SLMA气道密闭性,适度前屈患者头部是改善SLMA正压通气效果的有效方法。相对于正中位,旋转位不影响SLMA通气效果,而后仰位降低SLMA气道密闭性。

不同头颈位对气管插管患者呼吸道各段长度的影响

气管插管广泛用于临床麻醉和重症加强治疗病房，对保护呼吸道通畅起着至关重要的作用。在麻醉过程和急危重症抢救过程中，气管插管患者存在气管内导管位置变化的问题，如果发生在头部位置变动的患者，头颈部屈曲和后仰可以引起气管导管位置改变，可能出现气管导管插入支气管或损伤、甚至退出声带；

头颈姿势位与颞下颌关节紊乱病的相关性

头颈姿势位受关注多年,其与颞下颌关节紊乱病的相关性是近年来研究与争论的热点。本文就影响头颈姿势位的因素、颞下颌关节紊乱病患者头颈姿势位的改变、异常头颈姿势位引起颞下颌关节紊乱病的可能机制等作一综述。

锥体束CT三维测量下颌前徙对颅面型及自然头颈姿势位的作用

目的通过锥体束CT（cone-beam computed tomography,CBCT）数据的三维测量,研究下颌前徙后颅面型、自然头颈姿势位的变化。方法收集2008年3月-2015年3月在伊利诺伊大学颅颌面外科中心接受下颌双侧矢状劈开术（bilateral sagittal split osteotomy,BSSO）前徙的病例25例,男4例,女21例,平均年龄（17.95±1.43）岁。均为安氏二类牙颌面发育性骨性错颌畸形患者。分为A组（单颌BSSO前徙）8例、B组（双颌前徙）12例、C组（双颌前徙＋颏成型）5例。将入选病例术前（T1）、术后1.5～3个月（T2）、术后1～2年（T3）的CBCT数据导入第三方软件进行三维测量并记录T1、T2、T3的颅面型和自然头颈姿势位（natural head posture,NHP）。主要测量指标：1）上颌颅面型测量指标：NSPNS（后鼻棘点PNS与颅底成角）、PNS-S_CP（PNS到三维坐标系冠状面距离）、PNS-S_FH（PNS到坐标系横断面距离）、GPF R_L（双侧腭大孔的空间距离在坐标系横断面上的投影,其变化值代表上颌水平宽度的变化）;2）下颌颅面型测量指标：NSL（下颌正中联合舌侧最凸点L与蝶鞍中心点S连线与颅底所成角度）、L-S_CP（L到坐标系冠状面距离）、L-S_FH（L到坐标系横断面距离）;3）NHP测量指标：NSC2（颅颈角,颅底与第二颈椎轴线所成空间角度在坐标系矢状面上的投影角度）、CIP-S_CP（第二颈椎椎体最后下点CIP与坐标系冠状面的距离）和CSP-S_CP（第二颈椎椎体最后上点CSP与坐标系冠状面的距离）;4）颅面型与NHP关系测量指标：NSC2-NSL（NSC2与NSL两个角度差值）、L-CIP（L与CIP距离在坐标系矢状面的投影）、PNS-CSP（PNS与CSP距离在坐标系矢状面的投影）。分析颅面型和NHP的测量值及两者变化值的相关性。结果颅面型测量指标在T1、T2、T3的测量值差异有统计学意义（P〈0.05）：其中NSPNS（P〈0.001）、NSL（P=0.015）、L-S_CP（P〈0.001）,且L-S_CP在分组间有交互作用（P=0.018）。NHP测量指标CSP-S_CP（P=0.03）在分组间有交互作用。颅面型与NHP关系测量指标在T1、T2、T3的测量值差异有统计学意义（P〈0.05）：其中L-CIP（P=0.005）、PNS-CSP（P〈0.001）。颅下颌角NSL与颅颈角NSC2在T1（r=0.487,P=0.014）、T2（r=0.576,P=0.003）、T3（r=0.675,P〈0.001）时相线性相关。结论下颌前徙可使颅颌面形态和NHP产生变化,在三维坐标系中重叠颅底可以一定程度减少由于NHP变化而导致的颅面型误判,从而获得立体、全面的正颌正畸疗效评估。

牛头颈侧弯位难产前肢截除方法的改进

牛头颈侧弯位难产前肢截除方法的改进张新华（黑龙江省北安市畜牧局，１６４０００）翟仁德（北安市建华兽医院）李志民（北安农校兽医院）张天龙（北安市海兴镇兽医院）在兽医临床中，常遇到胎儿过大、骨盆狭小、胎位不正引起的头颈侧弯难产，特别是实施品种改良后本地品...

张口仰头含牙颈部侧位片在预测困难支撑喉镜中的应用

目的评价张口仰头含牙颈部侧位片用于术前预测支撑喉镜手术声门暴露困难程度的应用价值。方法2010年10月至2012年2月纳入77例支撑喉镜下喉显微手术的患者,术前拍摄张口仰头含牙颈部侧位片,通过测量甲颏间距(mm)、舌颏间距(mm)、舌骨颏间距(mm)、舌甲颏距离(mm)、颏-舌-甲夹角()、上切牙长度(mm)、张口度(mm)、舌体厚度(mm)8个预测参数,与术中声门暴露困难度程度的视觉模拟评分法(visual analogue scale,VAS)作相关性分析,并选择有相关性的参数制定量表来评价张口仰头含牙颈部侧位片预测支撑喉镜声门暴露困难程度的可行性。结果多因素分析显示舌-甲颏距离(B=0.109,P=0.014)和上切牙长度(B=0.179,P=0.023)与喉镜手术声门暴露困难度程度的VAS主观评分之间存在正相关性;舌颏间距(B=-0.090,P=0.011)和张口度(B=-0.098,P=0.000)与喉镜手术声门暴露困难度程度的VAS主观评分之间存在负相关性。结论推荐患者在接受支撑喉镜手术前拍摄张口仰头含牙颈部侧位片以客观评估预测支撑喉镜声门暴露的困难程度。

头位改变对Supreme和Ⅰ-gel喉罩正压通气的影响

目的观察头位改变对Supreme与Ⅰ-gel喉罩正压通气时通气参数和喉罩对位的影响。方法选择择期喉罩全身麻醉患者60例,随机分为Ⅰ-gel喉罩组(Ⅰ组)和Supreme喉罩组(S组)。喉罩置入成功并通气5 min后,分别于头部正中位、俯屈位(头前屈45°)、仰伸位(头后仰45°)及侧旋位(头部右旋45°)记录口咽漏气压(OLP),喉部解剖结构暴露评分和气道峰压。结果两组俯屈位OLP、气道峰压均高于正中位(均P<0.05);两组仰伸位OLP均低于正中位(均P<0.05),侧旋位对OLP、气道峰压均无显著影响(均P>0.05)。4个头位下,喉部解剖结构暴露评分差异均无统计学意义(均P>0.05);两组4个头位下OLP、漏气压-气道压的差值差异均有统计学意义(均P<0.05),喉部解剖结构暴露评分差异均无统计学意义(均P>0.05)。结论Supreme喉罩密封性高于Ⅰ-gel喉罩。俯屈位增加两种喉罩的密封性同时增加气道峰压,仰伸位与之相反,侧旋位对密封性和气道峰压均无影响。

成人颞下颌关节紊乱病与颈椎姿势的相关性研究

目的:探讨颞下颌关节紊乱病成人患者颈椎姿势与健康者的差异,研究颞下颌关节紊乱病与颈椎姿势的相关性。方法:对20例成人颞下颌关节紊乱病患者及20例成人健康者拍摄自然头位时的头颅定位侧位片,进行投影测量及统计学分析。结果:成人颞下颌关节紊乱病组的颈椎弯曲度大于健康对照组而颈椎倾斜度小于健康对照组,颈椎齿突切线、颈椎切线分别与前颅底平面及水平线交角减小,表明成人颞下颌关节紊乱病患者头呈前倾、前伸位。结论:头颈姿势位与颞下颌关节紊乱病存在明显相关性,颞下颌关节紊乱病患者头呈前倾、前伸位。

Prophylactic PEG placement in head and neck cancer:How many feeding tubes are unused (and unnecessary)?

AIM:To determine the rate of use and non-use of prophylactic percutaneous endoscopic gastrostomy(PEG) tubes among patients with head and neck cancer(HNC) patients.METHODS:All patients with HNC undergoing PEG between January 01,2004 and June 30,2006 were identified.Patients(or their next-of-kin) were surveyed by phone and all available medical records and cancer registry data were reviewed.Prophylactic PEG was def ined as placement in the absence of dysphagia and prior to radiation or chemoradiation.Each patient with a prophylactic PEG was assessed for cancer diagnosis,type of therapy,PEG use,and complications related to PEG.RESULTS:One hundred and three patients had PEG tubes placed for HNC.Thirty four patients(33%) could not be contacted for follow-up.Of the 23(22.3%) patients with prophylactic PEG tubes,11/23(47.8%) either never used the PEG or used it for less than 2 wk.No association with PEG use vs non-use was observed for cancer diagnosis,stage,or specific cancer treatment.Non-use or limited use was observed in 3/6(50%) treated with radiation alone vs 8/17(47.1%) treated with chemoradiation(P = 1.0),and 3 of 10(30%) treated with surgery vs 8 of 13(62%) not treated with surgery(P = 0.21).Minor complications were reported in 5/23(21.7%).One(4.3%) major complication was reported.CONCLUSION:There is a high rate of unnecessary PEG placement when done prophylactically in patients with head and neck cancer.

Clinical observation on Governor Vessel-unblocking and brain-refreshing scalp acupuncture for cerebral palsy complicated with intellectual disabilities

Objective：To observe the clinical efficacy of Governor Vessel-unblocking and brain-refreshing scalp acupuncture for cerebral palsy （CP） complicated with intellectual disabilities. Methods：A total of 300 CP cases aged between 1 and 5 years were randomly allocated into a treatment group （n=150） and a control group （n=150）. Patients in the treatment group were treated with Governor Vessel-unblocking and brain- refreshing scalp acupuncture combined with rehabilitation training, whereas patients in the control group received rehabilitation training alone. The Beijing Gesell developmental （Gesell） scale and gross motor function measure （GMFM） scale were used to assess the motor and intellectual development before and 3 months after the treatment. In addition, the head CT/MRI examination was applied to assess the brain nerve repair before and after the treatment. Results：After the treatment, the total effective rate in the treatment group was 78.0%, versus 42.7% in the control group, showing a statistical significance （P〈0.05）. As for scores of five subscales in the Gesell scale, there were significant intra-group differences in the treatment group （allP〈0.05）; and the scores in the treatment group were significantly better than those in the control group （allP〈0.05）. As for scores of five dimensions in GMFM scale, there were significant intra-group differences in the treatment group （allP〈0.05）; and the scores in the treatment group were significantly better than those in the control group （allP〈0.05）. According to the head CT/MRI findings, the total effective rate was 73.3% in the treatment group, versus 62.0% in the control group, showing a statistical significance （P〈0.05）. Conclusion：When used in combination with rehabilitative training, Governor Vessel-unblocking and brain-refreshing scalp acupuncture can significantly improve the clinical efficacy for cerebral palsy complicated with intellectual disabilities. It can also improve the patients＆#39; motor function, intelligence and language ability.

Therapeutic observation of cranial suture acupuncture in treating depression

Objective： To observe the clinical efficacy and safety of cranial suture acupuncture plus paroxetine in treating depression, and to discuss the action mechanism of this acupuncture method. Methods： One hundred depression patients were allocated to an observation group and a control group according to the random number table, with 50 cases in each group. The control group was intervened by oral administration of paroxetine tablets, 20 mg each time, once a day for successive 6 weeks; the observation group was additionally given cranial suture acupuncture, once a day for 6 weeks. They were scored by Hamilton depression scale-17 （HAMD-27） before the treatment and respectively after 1-week, 2-week, 4-week and 6-week treatment. The clinical efficacy and safety were also observed. Results： After 6-week treatment, the total effective rate was 94.0% in the observation group versus 78.0% in the control group, and the between-group difference was statistically significant （P〈0.01）. The HAMD-17 scores respectively after 1-week, 2-week, 4-week and 6-week treatment were significantly lower than the score before the treatment in the observation group （all P〈0.05）; the HAMD-17 scores respectively after 2-week, 4-week and 6-week treatment were significantly different from the score before the treatment in the control group （all P〈0.05）. There were significant differences in the HAMD-17 score between the two groups respectively after 4-week and 6-week treatment （both P〈0.05）. Conclusion： Cranial suture acupuncture plus paroxetine can ease the symptoms of depression, with faster onset and more significant therapeutic efficacy compared with paroxetine alone.

Clinical study on acupuncture for primary insomnia

Objective： To observe the clinical effect of Acupuncture at Baihui（GV 20）, Sishencong（EX-HN 1） and Anmian [Extra, locates at the midpoint between Yiming（EX-HN 14） and Fengchi（GB 20）] for primary insomnia. Methods： A total of 112 patients with primary insomnia were randomized into an acupuncture group and a medication group according to the visiting sequence, 56 cases in each group. The acupuncture group was intervened by acupuncture at Baihui（GV 20）, Sishencong（EX-HN 1） and Anmian [Extra, locates at the midpoint between Yiming（EX-HN 14） and Fengchi（GB 20）], and points selected based on syndrome differentiation, while the medication group was by oral intake of zopiclone tablet. The Pittsburgh sleep quality index（PSQI） was measured before and after treatment, and the clinical efficacy was compared after 1 month of treatment. Results： After treatment, subscales of PSQI and global score in the acupuncture group were improved, and intra-group comparisons showed statistical differences（all P〈0.05）; subscales of sleep quality, sleep latency, sleep duration and global score of PSQI in the medication group were improved, showing statistical differences（all P〈0.05）. Inter-group comparison of global and subscales scores of PSQI showed statistical differences（all P〈0.05）. The total effective rate in the acupuncture group was 92.9%, higher than 67.9% in the medication group, and between-group comparison showed a statistical difference（P〈0.05）. Conclusion： Acupuncture at Baihui（GV 20）, Sishencong（EX-HN 1） and Anmian [Extra, locates at the midpoint between Yiming（EX-HN 14） and Fengchi（GB 20）] as the main treatment method can produce a better effect than oral intake of zopiclone tablet.

Therapeutic efficacy observation on combining interaction and routine acupuncture for intractable facial palsy

Objective： To observe the clinical efficacy of interaction acupuncture combining with routine acupuncture for intractable facial palsy.Methods： A total of 60 eligible cases were randomly allocated into a treatment group（n=30） and a control group（n=30）. Cases in the treatment group received interaction and routine acupuncture, whereas cases in the control group received routine acupuncture alone. The treatment was done once a day and 10 times made up a course of treatment. The patients were treated for a total of 3 courses and there were no intervals between two courses. Results： The total effective rate was 93.3% in the treatment group（including 17 recovery cases, 11 improvement cases and 2 failure cases）, versus 76.7% in the control group（including 8 recovery cases, 15 improvement cases and 7 failure cases）, showing a statistical difference（P〈0.05）. Conclusion： Combining interaction and routine acupuncture can obtain better effect than routine acupuncture alone for intractable facial palsy.

Observation on clinical effects of acupuncture plus external medicine application for cervical radiculopathy

Objective： To observe the clinical effects of acupuncture plus external medicine application for cervical radiculopathy. Methods： A total of 98 patients with cervical radiculopathy were randomly divided into an observation group and a control group based on the random digital table. The observation group （50 cases） was treated by acupuncture plus external medicine application and the control group （48 cases） was treated by acupuncture alone. The patients received the treatment every day. Ten sessions made a course. Cervical spondylosis symptom scale was used to assess the cases before and after the treatment. The clinical efficacy was compared between the two groups after the treatment. Results： The total effective rate was 98.1% in the observation group versus 87.6% in the control group with a statistically significant difference between the two groups （P〈0.05）. The cure rate was 52.0% in the observation group versus 18.8% in the control group with a significant difference between the two groups （P〈0.05）. There was no significant difference in the score of cervical spondylosis symptom scale between the two groups before the treatment （P〉0.05）. It increased with a significant difference in both groups after the treatment （both P〈0.05）, while a significant difference was found in the results between the two groups after the treatment （P〈0.05）. Conclusion： Acupuncture plus external medicine application is more effective than acupuncture alone for treating cervical radiculopathy. The method also effectively improves the clinical symptoms.

Therapeutic effect observation on acupuncture plus medication for post-stroke depression

Objective: To observe the clinical efficacy of acupuncture with medication for post-stroke depression. Methods: A total of 96 patients with post-stroke depression were randomized into an observation group and a control group, with 48 cases in each group. The control group was treated with oral fluoxetine hydrochloride capsules, and the observati on group was treated with acup un cture on the basis of the treatme nt of the con trol group. After 6 mon ths of treatment, the traditional Chinese medicine (TCM) symptom scores, and Hamilton depression scale (HAMD) component scores and total scores of the two groups before and after treatment were observed, and the clinical efficacy and adverse reaction rate were compared between the two groups. Results: The total effective rate was 95.8% in the observation group and 83.3% in the control group, and the differenee between the two groups was statistically significant (Pv0.05). After treatment, the intra-group differences in TCM symptom scores and HAMD score of both groups were statistically significant (all P<0.01). In the observation group, the scores of in differe nt expressi on, emoti onal restlessness, and sen time ntality in the TCM symptoms were statistically differe nt from those in the control group (all P<0.01). The scores of desperate factor and sleep disorder factor and total score in HAMD in the observation group were significantly different from those in the control group (all P<0.01). The incidenee of adverse reactions was 6.3% in the observation group and 4.2% in the control group, and the differenee was not significant between the two groups (P>0.05). Conclusion: Acupuncture plus medication is an effective method for post-stroke depression, and it can further improve the patient's bad mood.

Analysis of points selection pattern in acupuncture treatment of sleep apnea syndrome based on data mining

To explore the points selection pattern of acupuncture for sleep apnea syndromes by data mining technique. Methods： Clinical literature about acupuncture therapy for sleep apnea syndromes was derived from China National Knowledge Infrastructure （CNKI）, Wanfang Academic Journal Full-text Database （Wanfang）, Chongqing VIP Database （CQVIP）, PubMed and Science Direct between the time that databases were created and March 25th,2017. Relevant excel database was established and descriptive studies and association rules were analyzed. Results： The most frequently used point was Lianquan （CV 23） and the most frequently used meridian was the Stomach Meridian. The analysis of association rules showed that the clinical choice of acupuncture points was highly correlated, among which the combination of the highest degree of confidence and the highest degree of support was Shenmen （HT 7） and Sishencong （EX-HN 1）; Lieque （LU 7）, lianquan （CV 23） and Zhaohai （KI 6）. Conclusion： Acupuncture treatment of sleep apnea syndromes has specific selection rules of points, providing certain references for clinical and scientific research.

Therapeutic observation on tuina at head and abdomen for headache due to phlegm turbidity

Objective:To observe the clinical efficacy of tuina at head and abdomen for headache due to phlegm turbidity.Methods:A total of 56 patients with headache due to phlegm turbidity were randomized into a tuina group and a Chinese medicine group by the random number table,with 28 cases in each group.The tuina group was treated mainly with tuina at the head and abdomen,while the Chinese medicine group was treated with oral administration of Ban Xia Bai Zhu Tian Ma Tang(Pinellio,Atractylodes Mocrocepholo and Gastrodio Decoction).The course of treatment was 30 d.The scores of headache index,traditional Chinese medicine syndrome scale,and the therapeutic efficacy were observed.Results:There were 2 dropouts in each group during treatment.The total effective rate was 92.3%in the tuina group,significantly higher than 76.9%in the Chinese medicine group(P<0.05).The scores of headache index and traditional Chinese medicine syndrome scale in both groups decreased after treatment(both P<0.05),and scores in the tuina group were lower than those in the Chinese medicine group(both P<0.05).Conclusion:Tuina mainly at head and abdomen is effective in treating headache due to phlegm turbidity,and has a better effect than Ban Xia Bai Zhu Tian Ma Tang(Pinellia,Atractylodes Macrocephalo and Gastrodio Decoction).

Clinical study on nape cluster acupuncture for 50 cases of migraine

To observe the clinical efficacy of nape cluster acupuncture in treating migraine. Methods： Fifty patients with confirmed diagnosis of migraine were intervened by using nape cluster acupuncture, and were evaluated at the outset and after 2-month treatment by the short-form of McGill pain questionnaire （SP-MPQ） and self-rating depression scale （SDS）. Results： After treatment, the number of positive words, sensory pain rating index （S-PRI）, affective pain rating index （A-PRI）, total pain rating index （T-PRI）, visual analogue scale （VAS）, and present pain intensity （PPI） were significantly changed （P〈0.01）; the SDS score was （56.42＋8.12） points before treatment versus （41.08＋5.73） points after treatment, and the difference was statistically significant （P〈0.01）. The total effective rate was 86.0%; the therapeutic efficacy of the patients with a shorter disease duration was superior to that of the patients with a longer one （P〈0.05）; the efficacy of mild-moderate migraine was superior to that of severe one （P〈0.01）; the total effective rate of patients without depression was higher than that with depression, but without a significant difference in comparing the therapeutic efficacy （P〈0.05）. Conclusion： Nape cluster acupuncture is effective in treating migraine, significantly improving headache and depression.