Peripheral Neuropathy after Open Abdominal Surgery with Self-Retaining Retractors. A Systematic Review of Randomised and Non-Randomised Clinical Trials

Objectives : A systematic review was undertaken to evaluate the effectiveness of incision retention available to surgeons conducting open abdominal or pelvic surgeries. Both the ability of the retractor to retain the wound and harm to the patient due to the retractor were reviewed. Methods : A search was conducted using the following databases: EMBASE, PubMed, BIOSIS, Engineering Village, Web of Science, Best practice, Science Direct, CRCnet BASE, Proquest, Wiley Online Library, and Comprehensive Biomaterial. Results : What the articles found were then narrowed down to those which matched the objective of the review. This resulted in ten articles to review. Two reviewers reviewed and summarized the articles. Femoral neuropathy was found to be a common complication due to Retractors. Other outcomes analysed or studied were found to be infected, postoperative pain and exposure provided. Femoral neuropathy can be estimated to occur at a rate between 2.6% and 7.5% in open pelvic and abdominal surgeries. The Alexis O-ring retractor was found to lower the required morphine intake following surgery when compared to the Belfour retractor. Conclusions : There is a lack of high quality/high levels of evidence studies that have been conducted on Retractors. Femoral neuropathy is the outcome most commonly documented in relation to Retractors. Surgeons need to be aware about the use and implementations of the retractors. Care should be taken in protecting the blades and during long surgery relocating retractors should be considered.

Curative effect of surgical treatment of vocal cord polyp under self-retaining fibrolaryngoscope and fibrolaryngoscope

Objective:To evaluate the curative effect of surgical treatment of vocal cord polyp under self-retaining fibrolaryngoscope and fibrolaryngoscope.Methods: A total of 118 patients with vocal cord polyp who received surgical treatment in our hospital between August 2013 and August 2015 were included in the study, the treatment process was retrospectively analyzed, and according to different operation methods, patients were divided into observation group (n=61) who received surgical treatment under self-retaining fibrolaryngoscope and control group (n=57) who received surgical treatment under fibrolaryngoscope. Differences in voice electroglottography parameters, oxidative stress system indexes, trauma-related indexes and so on were compared between two groups of patients 2 weeks after operation.Results:Jitter, Shimmer and NNE levels of observation group were significantly lower than those of control group while HNR and SNR levels were significantly higher than those of control group;SOD T, SOD Cu-Zn and T-AOC content in serum of observation group were significantly higher than those of control group while H2O2 and AOPP content were significantly lower than those of control group;NPY,β-EP, PGI2, HMGB-1 and HSP72 content in serum of observation group were significantly lower than those of control group.Conclusions:Surgery under self-retaining fibrolaryngoscope can better realize the accurate resection of vocal cord polyp, protect the normal vocal cord function and also reduce the body trauma, and it is a more ideal way of surgery.

Neonatal Direct Rigid Laryngoscopy and Bronchoscopy: A Near Miss

Airway management is a skill necessary for healthcare providers who manage patients. Intubation is a skill that both anesthesiologists and intensivists use daily. We present a case of a neonate that developed significant worsening stridor after a successful intubation for a hernia repair. After 4 intubation attempts, with easy visualization of the vocal cords and unsuccessful placement of the endotracheal tube, the patient was emergently brought to the operating room for evaluation.

Comparison of Cardiac Output and Hemodynamic Responses of Intubation among Different Videolaryngoscopies in Normotensive and Hypertensive Patients

Tracheal intubation with Macintosh laryngoscope（MAC） might result in severe cardiovascular complications. The results of conducted studies investigating the effects of videolaryngoscopies on hemodynamic response of tracheal intubation are conflicting. We know little about the effects of videolaryngoscopies on cardiac output changes during tracheal intubation. We compared cardiac output（COP） and hemodynamic responses in normal blood pressure（n=60） and hypertensive patients（n=60） among 3 intubation devices： the MAC, the UE videolaryngoscopy ？（UE）, and the UE video intubation stylet ？（VS）. Cardiac index（CI）, stroke volume index（SVI）, heart rate（HR）, systolic blood pressure（SBP） and diastolic blood pressure（DBP） were recorded using Lidco Rapid V2？ preinduction, preintubation, and every minute for the first 5 min after intubation. We assessed oropharyngeal and laryngeal structures injury as well. Intubation time was significantly shorter than MAC groups（P〈0.001） only in UE group of normotensive and hypertensive patients. In normotensive patients, there were no significant differences in any of COP variables or hemodynamic variables among the three devices. In hypertensive patients, SBP and DBP in the MAC group were significantly higher（P〈0.05 or 〈0.01） than the UE and VS groups at 1, 2 and 3 min after intubation, but there were no significant differences in CI, SVI and HR among the three devices. There was no significant difference in oropharyngeal and laryngeal structures injury among all groups. It was concluded that both the UE and VS attenuate only the hemodynamic response to intubation as compared with the MAC in hypertensive patients, but not in normotensive patients.

Video versus direct laryngoscopy on successful firstpass endotracheal intubation in ICU patients

BACKGROUND: Airway management in intensive care unit(ICU) patients is challenging. The aim of this study was to compare the rate of successful first-pass intubation in the ICU by using the direct laryngoscopy(DL) and that by using the video laryngoscopy(VL).METHODS: A randomized, non-blinded trial comparing first-pass success rate of intubation between VL and DL was performed. Patients were recruited in the period from August 2014 to August 2016. All physicians working at ICU received hands-on training in the use of the video and direct laryngoscope. The primary outcome measure was the first-pass intubation success. RESULTS: A total of 163 ICU patients underwent intubation during the study period(81 patients in VL group and 82 in DL group). The rate of successful first-pass intubation was not significantly different between the VL and the DL group(67.9% vs. 69.5%, P=0.824). Moreover, the overall intubation success and total number of attempts to achieve intubation success did not differ between the two groups. In patients with successful first-pass intubation, the median duration of the intubation procedure did not differ between the two groups. The Cormack-Lehane grades and the percentage of glottic opening score were similar, and no significant differences were found between the two groups. There were no statistical differences between the VL and the DL group in intubation complications(all P>0.05). CONCLUSION: Among ICU patients requiring intubation, there was no significant difference in the rate of successful first-pass intubation between VL and DL.

A comparison of lightwand and laryngoscopic intubation techniques in patients undergoing laparoscopic cholecystectomy

Objective：To assess the effects of lightwand and laryngoscopic intubation techniques in patients undergoing laparoscopic cholecystectomy （LC）. Methods： 300 ASA physical status Ⅰ and Ⅱ patients, undergoing LC, were randomly assigned to two groups, with 150 cases in each group. Patients in the LS group underwent endotracheal intubation using a standard direct-suspension laryngoscopic technique. Patients in the LW group were intubated by using transilhimination with a lightwand. Mean arterial pressure and heart rate were recorded before induction, and at 1, 3 and 5 rain after intubation. The incidence and of sore throat, hoarseness, and dysphagia was assessed twenty-four hours after surgery. Results： This study demonstrated no clinically significant difference in cardiovascular variables between the two techniques. Patients had a significantly lower incidence of sore throat, hoarseness, and dysphagia when the lightwand was used for intubation. Conclusion： This study suggests that lightwand intubation may decrease the incidence of postoperative sore throat, hoarseness, and dysphagia, thereby potentially increasing satisfaction in surgical patients. Therefore, more frequent use of the lightwand is recommended for endotracheal intubation.

Comparison of five video-assisted intubation devices by novice and expert laryngoscopists for use in the aeromedical evacuation environment

Background: The critically ill or injured patient undergoing military medical evacuation may require emergent intubation. Intubation may be life-saving, but it carries risks.The novice or infrequent laryngoscopist has a distinct disadvantage because experience is critical for the rapid and safe establishment of a secured airway. This challenge is compounded by the austere environment of the back of an aircraft under blackout conditions. This study determined which of five different video-assisted intubation devices(VAIDs) was best suited for in-flight use by U.S. Air Force Critical Care Air Transport Teams by comparing time to successful intubation between novice and expert laryngoscopists under three conditions, Normal Airway Lights on(NAL), Difficult Airway Lights on(DAL) and Difficult Airway Blackout(DAB), using manikins on a standard military transport stanchion and the floor with a minimal amount of setup time and extraneous light emission.Methods: A convenience sample size of 40 participants(24 novices and 16 experts) attempted intubation with each of the 5 different video laryngoscopic devices on high-fidelity airway manikins. Time to tracheal intubation and number of optimization maneuvers used were recorded. Kruskal-Wallis testing determined significant differences between the VAIDs in time to intubation for each particular scenario. Devices with significant differences underwent pair-wise comparison testing using rank-sum analysis to further clarify the difference. Device assembly times, startup times and the amount of light emitted were recorded. Perceived ease of use was surveyed. Results: Novices were fastest with the Pentax AWS in all difficult airway scenarios. Experts recorded the shortest median times consistently using 3 of the 5 devices. The AWS was superior overall in 4 of the 6 scenarios tested. Experts and novices subjectively judged the Glide Scope Ranger as easiest to use. The light emitted by all the devices was less than the USAF-issued headlamp.Conclusion: Novices intubated fastest with the Pentax AWS in all difficult airway scenarios. The Glide Scope required the shortest setup time, and participants judged this device as the easiest to use. The Glide Scope and AWS exhibited the two fastest total setup times. Both devices are suitable for in-flight use by infrequent and seasoned laryngoscopists. Trial registration: not applicable.

The role of direct laryngoscopy in the diagnosis of laryngeal cleft

Objective: To identify the presenting features of a laryngeal cleft in children. To compare rigid and flexible endoscopic methods available for identifying laryngeal cleft and determine their utility. Methods: The charts of all patients diagnosed with laryngeal cleft in a tertiary care institution between 2009 and 2010 were evaluated retrospectively for age, gender, comorbidity, presenting features, and results of bedside swallow evaluation. Findings on flexible and direct laryngoscopy, both performed under general anesthesia, were compared. Results: Eleven patients had a diagnosis of laryngeal cleft, confirmed by direct laryngoscopy. Nine of eleven had signs of aspiration on modified barium swallow study (MBSS). Of the eight subjects who underwent flexible laryngoscopy by a pulmonologist, a deep interarytenoid groove was only reported in four cases. In all eleven cases, the arytenoids could be physically separated during direct laryngoscopy, allowing for definitive diagnosis of the cleft and identification of its type and severity. Conclusion: Video swallow studies and flexible laryngoscopy may raise suspicion or even diagnose a laryngeal cleft, however, a laryngeal cleft must be confirmed by direct laryngscopy in which the interarytenoid space is palpated. Furthermore, a patient in whom symptoms persist but no laryngeal cleft is identified on flexible examination should have a direct laryngoscopy to rule out a cleft.

Comparison of Laryngoscopic View and Hemodynamic Changes with Flexitip McCoy and Macintosh Laryngoscope Blade in Predicted Easy and Difficult Airway

Objective: To compare the laryngoscopic view and the hemodynamic changes by using flexitip McCoy laryngoscope with Macintosh laryngoscope. Method: Study design-Prospective randomized controlled study. A total of 220 patients were included in the study. Patients were allocated on the basis of their airway anatomy in to two groups, one is predicted easy group and the other one was predicted difficult airway group. Among each group, half of the patient intubation was performed with Macintosh blade and the other half was intubated with the help of McCoy blade. The airway prediction was done on the basis of Mallampati grade, thyromental distance, inter incisor gap, jaw protrusion and weight of the patient. Larygoscopic view and hemodynamic changes were recorded. Results: The change in pulse rate was significantly (p = 0.01) higher among the patients of Group B (85.02 ± 10.13) as compared to Group A (79.20 ± 13.11) after induction in predicted easy patients. Similar observation was found for pulse rate after laryngoscopy among both predicted easy and difficult patients. The diastolic blood pressure was significantly (p = 0.0001) higher in Group B (86.34 ± 9.78) than Group A (77.12 ± 11.66) after induction among predicted easy patients. However, diastolic blood pressure was significantly (p = 0.0004) higher in Group A (82.00 ± 10.98) compared with Group B (75.00 ± 9.06) after induction among predicted difficult patients. The average time taken during laryngoscopy was in-significantly (p > 0.05) higher in Group B (13.90 ± 5.95) compared with Group A (12.42 ± 3.58) among predicted easy patients. However, the time taken was significantly (p = 0.0001) higher in Group A (20.83 ± 2.47) than Group B (12.66 ± 3.0) in predicted difficult patients. A majority of the patients of both the groups were in Grade I (Group A = 61.8%, Group B = 81.8%) followed by Grade II (Group A = 38.2%, Group B = 18.2%) among predicted easy patients. Conclusion: It was concluded that the McCoy blade may be an answer to Macintosh blade in difficult airway cases, but not the substitute of Macintosh blade in every case. The McCoy blade improved laryngeal view in patients with limited neck extension.

Pre-formed endotracheal tube and stepwise insertion for more successful intubation with video laryngoscopy

BACKGROUND In anesthesia practice,orotracheal intubation remains the primary concern of the anesthesiologist.The introduction of video laryngoscopy(VL)has increased the success rate of orotracheal intubation;however,conflicting results have been reported regarding the usefulness of the current technique with VL in clinical practice.AIM To describe a modification to improve intubation with VL,followed by evaluation of the practice in vivo.METHODS First,a mannequin trial was conducted with operators having different experience and background.Then,a retrospective analysis was performed for an>1-year period with patients who underwent general anesthesia with orotracheal intubation.The endotracheal tube used had been pre-formed with two curves.Stepwise intubation had been performed with direct eye vision,followed by screen assistance and rotation of the tube as needed to direct it toward the glottis.In the mannequin trial,the outcome measures were quantification of torque(force with angular acceleration during levering),need for external maneuvers,and time to intubate.In the clinical experience,orotracheal intubation used VL(pre-formed tube)or direct laryngoscopy(DL)at the anesthetist’s discretion and throat discomfort was reported by the patient.RESULTS In the mannequin trials using VL,there was less torque with the pre-formed tube than with a regular tube(8%and 65%,respectively).The first-pass rate was higher with the pre-formed tube(95%)than with a regular tube(81%).However,the time to intubate was longer with the pre-formed tube than with a regular tube(22 s and 12 s,respectively).In clinical practice,562 patients underwent surgery under general anesthesia with orotracheal intubation using either VL(n=244)or DL(n=318)at the discretion of the attending anesthetist.VL was specifically planned in 62 of the patients,due to anticipated difficulty.Second attempts by readjustment of the curve of the tube were significantly fewer with VL than with DL(10%vs 18%).Throat discomfort was reported by fewer patients who underwent VL than those who underwent DL(6%vs 24%).CONCLUSION Pre-formed endotracheal tube with stepwise insertion produces less torque,fewer external maneuvers and higher first-pass success rate during VL intubation.Further,prospective studies are warranted.

经颈超声检查评估咽喉部手术患者声带运动异常的价值

目的探讨经颈超声检查评估咽喉部手术患者声带运动异常的应用价值。方法选取2021年1月至2023年12月在海南省人民医院行甲状腺或咽喉部手术的49例患者纳入研究,所有患者术前及甲状腺患者术后均行喉镜及颈部超声检查声带运动情况,以喉镜评估声带运动为金标准,比较经颈超声与喉镜检查在评估声带运动方面有无差异。结果49例患者中行甲状腺肿瘤手术34例,术前超声检查显示声带区28例,超声与喉镜检查声带运动均正常。术后喉镜及超声检查均发现2例患者一侧声带固定,另喉镜提示1例患者一侧声带运动减弱,超声检查无阳性发现。喉部手术患者15例,均为喉癌;超声显示声带区结构的12例患者术前喉镜提示9例一侧声带固定,超声均正确诊断;另超声提示2例气道狭窄,声带运动减弱,因气道狭窄喉镜检查无法窥探至声带平面。将40例超声及喉镜均可显示声带区患者的声带运动情况进行比较,两者具有高度的一致性(Kappa值=0.826,P<0.001)。结论经颈超声检查作为一种非侵入式检查手段对部分患者声带运动情况的评估结果与喉镜检查结果具有高度的一致性,且简便易行,患者无需特殊准备,检查过程无痛苦,具有临床应用价值。

BURP手法在改善声门视野中的应用

直接喉镜解决困难气管插管时,BURP手法能改善声门视野,提高插管成功率,但也有研究表明BURP手法会使声门视野恶化。随着视频喉镜的广泛应用,BURP手法的临床价值再次引起争议。本文就BURP手法的定义、方法、基本原理、应用喉镜时改善声门视野的作用等方面进行综述,以期为解决困难气管插管提供参考。

支撑喉镜联合鼻内镜切除术治疗声带息肉的效果分析

目的:探讨支撑喉镜联合鼻内镜切除术治疗声带息肉的效果。方法:选取2021年8月—2022年9月北华大学附属医院耳鼻喉科收治的80例声带息肉患者作为研究对象,以随机数字表法分为试验组与对照组,各40例。对照组采用全身麻醉支撑喉镜下声带息肉切除术治疗,试验组应用支撑喉镜联合鼻内镜切除术治疗。比较两组治疗效果、嗓音功能、并发症发生情况。结果:试验组治疗总有效率高于对照组,差异有统计学意义(P=0.025)。术前,两组标准化噪声能量(NNE)、振幅微扰(Shimmer)、基频微扰(Jitter)水平比较,差异无统计学意义(P>0.05);术后14 d,两组NNE、Shimmer、Jitter水平低于术前,且试验组低于对照组,差异有统计学意义(P<0.05)。试验组并发症总发生率低于对照组,差异有统计学意义(P=0.023)。结论:支撑喉镜联合鼻内镜切除术治疗声带息肉的效果显著,能够改善患者嗓音功能,减少术后并发症。

儿童在全凭静脉麻醉下行直接喉镜和支气管镜检查中的麻醉管理

目的探讨不同年龄儿童在保留自主呼吸的全凭静脉麻醉下行直接喉镜和支气管镜检查的麻醉管理。方法选取2022年5月至2023年1月上海交通大学医学院附属上海儿童医学中心收治的气道畸形患儿71例,美国麻醉医师协会(ASA)分级Ⅱ~Ⅲ级,年龄1个月至10岁,按年龄将患儿分成<1岁组(A组)25例,≥1岁且<4岁组(B组)23例,≥4岁且≤10岁组(C组)23例。静脉注射利多卡因、舒芬太尼和右美托咪定结合滴定式静脉注射丙泊酚行麻醉诱导,并以泵注丙泊酚10~12 mg/(kg·h)维持麻醉。采用2.4%利多卡因气雾剂行声带表面麻醉。比较三组患儿麻醉后呼吸暂停、喉痉挛、呛咳和低氧血症等发生率,并记录患儿清醒状态时(T_(0))、置入硬质喉镜时(T_(1))、直接喉镜和支气管镜检查时(T_(2))的生命体征指标。结果三组患儿麻醉后呼吸暂停、喉痉挛和呛咳发生率比较差异无统计学意义(P>0.05)。A组患儿丙泊酚诱导用量较B组和C组显著减少,而低氧血症的发生率较C组显著升高(P<0.05)。A组患儿T_(1)和T_(2)时间点心率(HR)较T_(0)时间点显著降低,B组患儿T_(2)时间点HR较T_(0)时间点显著降低(P<0.05)。三组患儿T_(1)和T_(2)时间点收缩压(SBP)和舒张压(DBP)较T_(0)时间点显著降低(P<0.05)。结论保留自主呼吸的全凭静脉麻醉技术可用于儿童直接喉镜和支气管镜检查,但需注意1岁以下婴儿低氧血症的发生率较年长儿高。

纤维内镜在累及舌根的舌癌患者术后吞咽功能评估中的临床应用

目的:探讨纤维内镜评估吞咽功能(fiberoptic endoscopic evaluation of swallowing, FEES)在累及舌根的舌癌(both the oral tongue and the base of the tongue, OBOT)患者中的临床应用。方法:对2022年4月至2023年5月于我院初诊为累及OBOT病变的患者术前、术后1周、1月和1年进行吞咽功能评估。吞咽功能的评估包括MD安德森吞咽困难量表(MD Anderson Dysphagia Inventory, MDADI)、华盛顿大学生活质量问卷(University of Washington Quality-of-Life Questionnaire, UW-QOL)、头颈癌表现状态量表(Performance Status Scale for Head and Neck Cancer, PSS-HN)、洼田饮水试验(water swallow test, WST)、舌运动测量和FEES[包括渗透-吸入量表(Penetration-Aspiration Scale, PAS)和口咽吞咽效率(oropharyngeal swallowing efficiency, OPSE)]。并对FEES的评估OBOT的可靠性进行统计分析。结果:共有21例患者纳入研究。FEES具有较高的诊断价值(ROC曲线下面积=0.916)。FEES结果与WST和MDADI评分显著相关(P<0.001)。术后1年,累及OBOT病变患者的吞咽功能恢复到术前水平,但OPSE明显下降,生活质量仍受影响(P<0.001)。结论:FEES是评估累及OBOT病变患者术后吞咽功能的可靠方法,值得临床推广。在术后随访中,虽然这些患者的吞咽功能可以恢复,但应注意吞咽效率和生活质量。

超声测量应用于OSAHS病人困难喉镜暴露评估

目的:探讨通过超声测量皮肤到舌骨的距离、皮肤到会厌的距离及皮肤到声带前联合的距离来预测阻塞性睡眠呼吸暂停低通气综合征(OSAHS)病人困难喉镜暴露的可行性。方法:选取择期在气管插管全麻下行悬雍垂腭咽成形术(UPPP)的OSAHS病人150例,ASA分级Ⅰ~Ⅲ级。麻醉前进行常规气道评估(Mallampati分级)及应用超声测量皮肤到舌骨的距离、皮肤到会厌的距离及皮肤到声带前联合的距离。麻醉诱导后采用直接喉镜气管插管,记录喉镜暴露分级,将Cormack-LehaneⅢ~Ⅳ级定为喉镜暴露困难。依据喉镜暴露分级的结果将病人分为非困难喉镜暴露组和困难喉镜暴露组,比较两组间Mallampati分级及超声测量值的差异。计算各指标的受试者工作特征曲线(ROC)下面积及超声测量的最佳截点,分析各评估方法对困难喉镜暴露的预测效果。结果:困难喉镜暴露组Mallampati气道分级>Ⅱ级的病例数的比例明显多于非困难喉镜暴露组(P<0.05)。困难喉镜暴露组皮肤到舌骨的距离及皮肤到会厌的距离均明显长于非困难喉镜暴露组(P<0.05),皮肤到舌骨的距离及皮肤到会厌的距离最佳截点分别为1.12 cm及2.23 cm。皮肤到声带前联合的距离两组差异无统计学意义。结论:超声测量皮肤到舌骨,皮肤到会厌的距离对OSAHS病人困难喉镜暴露具有良好的预测作用。

探讨显微镜下支撑喉镜手术治疗声带息肉的疗效及对患者嗓音恢复情况的影响

目的:分析声带息肉治疗中采取显微镜下支撑喉镜手术方案应用效果。方法:选取2019年1月—2023年1月本院收治的66例声带息肉治疗患者为研究对象,并基于随机数字表法分为对照组与研究组。对照组接受纤维喉镜下手术,研究组开展显微镜下支撑喉镜手术治疗。对比观察两组临床疗效、嗓音功能恢复、息肉复发与并发症变化差异。结果:研究组治疗后总有效率高于对照组,且声音完全恢复时间短于对照组(P<0.05);同手术前相比,手术后研究组嗓音功能评分低于对照组、嗓音嘶哑分级低于对照组、嗓音声学参数指标优于对照组(P<0.05);两组手术后并发症发生率对比无明显统计学差异(P>0.05),随访1年发现,研究组复发率低于对照组(P<0.05)。结论:针对声带息肉疾病所采取的手术方案,显微镜下支撑喉镜手术的应用对患者嗓音恢复、嗓音声学参数与息肉复发产生的治疗效果佳,临床可进一步推广应用。

丙泊酚与依托咪酯对老年全麻可视喉镜气管插管条件及应激反应的影响

目的比较丙泊酚与依托咪酯对老年全麻可视喉镜气管插管条件及应激反应的影响。方法选取陕西中医药大学附属医院2022年6月至2023年8月收治的130例择期行骨科全麻手术老年患者进行随机对照试验,采用随机数字表法将其分为丙泊酚组(P组)与依托咪酯组(E组),各65例。P组麻醉诱导给予2.0 mg/kg丙泊酚,E组麻醉诱导给予0.3 mg/kg依托咪酯,分别联合舒芬太尼0.50μg/kg、顺阿曲库铵0.15 mg/kg。插管完毕后立即采用Viby-Mogensen插管条件量表评价插管条件;记录麻醉诱导前(T_(0))、丙泊酚/依托咪酯注射即刻(T_(1))、喉镜置入后(T_(2))、气管插管后1 min(T_(3))、气管插管成功3 min(T_(4))平均动脉压(MAP)、心率(HR)及心率压力乘积(RPP);比较T_(0)、T_(2)、T_(4)时去甲肾上腺素(NE)、皮质醇(Cor)及血糖水平;比较两组丙泊酚或依托咪酯注射30 s内注射痛发生率、严重程度;比较两组气管插管时间。采用χ^(2)检验、Mann-Whitney U检验、重复测量方差分析、t检验。结果两组患者年龄、性别、体质量指数、ASA分级等基线资料比较,差异均无统计学意义(均P>0.05)。两组患者Viby-Mogensen插管条件量表的置入喉镜、声带位置、声带运动、气道反应及肢体反应分级比较,差异均无统计学意义(均P>0.05)。T_(2)、T_(3)、T_(4)时,E组MAP均高于P组,HR均低于P组,差异均有统计学意义(均P<0.05)。E组T_(2)时NE[(135.32±30.47)μg/L比(147.54±32.16)μg/L]、Cor[(68.39±14.12)ng/L比(76.17±14.65)ng/L]及血糖[(5.46±0.64)mmol/L比(6.04±0.76)mmol/L]均低于P组,差异均有统计学意义(均P<0.05);E组T_(3)时NE[(154.69±33.42)μg/L比(170.35±36.30)μg/L]、Cor[(73.42±14.59)ng/L比(82.64±16.73)ng/L]及血糖[(6.72±0.95)mmol/L比(8.29±1.03)mmol/L]均低于P组,差异均有统计学意义(均P<0.05)。两组气管插管时间比较,差异无统计学意义(P>0.05)。E组注射痛发生率、注射痛得分均低于P组[17.46%(11/63)比56.67%(34/60)、0(0,1)分比1(0,1)分],差异均有统计学意义(均P<0.05)。结论0.3 mg/kg依托咪酯与2.0 mg/kg丙泊酚分别联合舒芬太尼0.50μg/kg、顺阿曲库铵0.15 mg/kg在老年全麻可视喉镜气管插管中应用,气管插管条件相当,但依托咪酯诱导插管血流动力学更为平稳,应激反应及注射疼痛更轻微。

声带息肉患者应用支撑喉镜等离子手术治疗后嗓音恢复、氧化应激及炎症因子水平观察

目的 观察声带息肉患者应用支撑喉镜等离子手术治疗后嗓音恢复、氧化应激及炎症因子水平。方法 回顾性选取安徽医科大学第一附属医院2021年2月至2023年4月入院治疗的60例实施声带息肉切除术患者为研究对象,按照手术方式不同将患者分为观察组(n=33)及对照组(n=27)。观察组行支撑喉镜等离子手术进行治疗,对照组行支撑喉镜显微切除术进行治疗。比较两组患者术后1 d血清氧化应激指标[超氧化物歧化酶T(SOD T)、超氧化物歧化酶Cu-Zn(SOD Cu-Zn)、过氧化氢(H2O2)、晚期蛋白氧化产物(AOPP)、总抗氧化能力(T-AOC)]水平,术前及术后1 d炎症因子[白细胞介素(IL)-6、IL-1β及肿瘤坏死因子-α(TNF-α)],术前、术后2周嗓音质量指标[嗓音基频微扰值百分数(Jitter%)、噪声能量、嗓音振幅微扰值百分数(shimme%)、谐噪比],术后1个月生活质量,并比较两组患者并发症发生情况。结果 观察组术后1 d的SOD T、SOD Cu-Zn、T-AOC水平分别为(52.74±5.84) IU/mL、(30.47±4.16) IU/mL、(13.17±1.86) U/mL,均显著高于对照组,H2O2、AOPP水平分别为(17.49±2.45) nmol/L、(41.36±4.82)μmol/L,均低于对照组,差异均有统计学意义(P<0.05)。术后1 d,两组IL-6、IL-1β、TNF-α水平较术前均降低,且观察组IL-6、IL-1β、TNF-α水平分别为(116.89±12.74)、(140.85±14.74)、(113.85±13.63) ng/L,均低于对照组,差异均有统计学意义(P<0.05)。术后2周,两组患者Jitter%、shimme%均较术前降低,噪声能量、谐噪比均较术前上升,且观察组患者的Jitter%、shimme%分别为(0.20±0.02)%、(1.58±0.34)%,均低于对照组,噪声能量、谐噪比分别为(16.54±2.51)、(26.78±2.47) dB,均高于对照组,差异均有统计学意义(P<0.05)。术后1个月,观察组患者躯体健康、心理健康、物质生活、社会功能评分分别为(21.34±3.25)、(22.47±4.38)、(15.69±3.65)、(17.60±3.75)分,均高于对照组,差异均有统计学意义(P<0.05)。观察组并发症总发生率为6.06%,低于对照组(25.93%),差异有统计学意义(P<0.05)。结论 相较于支撑喉镜显微切除术,应用支撑喉镜等离子手术治疗声带息肉,患者嗓音质量恢复更好,机体损伤更小,可更有效拮抗慢性炎症浸润,值得在临床上推广使用。

窄带成像喉镜在喉癌切除术后随访评估中的应用效果分析

目的分析窄带成像喉镜在喉癌切除术后随访评估中的应用价值。方法选取我院2019年10月~2021年10月行喉切除术治疗的84例喉癌患者进行为期1年的术后随访,定期行WLE及NBI模式电子喉镜检查,分析两种光源检查模式在术后随访中的应用价值。结果本组接受喉癌切除术治疗患者随访过程中,病理活检结果显示术后局部复发30例,WLE模式检查显示术后局部复发23例,NBI模式检查显示术后局部复发29例,NBI模式评估喉癌切除术后随访结果的敏感度、准确度分为90.00%、94.05%,显著高于WLE模式的66.67%、84.52%(P<0.05)。结论NBI模式在喉癌切除术后随访评估中有着良好的应用价值,可将NBI模式作为喉癌切除术后随访的常规检查手段。