全身麻醉经口气管插管下颈椎后路手术患者发生Tapia综合征风险及相关因素分析

目的:分析全身麻醉经口气管插管下颈椎后路手术患者发生Tapia综合征风险及相关危险因素。方法:对2019年1月—2021年12月收治的行全身麻醉经口气管插管下颈椎后路手术治疗后发生Tapia综合征的7例患者临床资料进行回顾性分析,以年龄、性别、主刀医生及相同手术类型作为匹配条件,按1∶4原则,随机数字表法选择28例术后未发生Tapia综合征的患者作为对照组,对比两组麻醉时间、中立位下颌骨—椎体距离、中立位舌骨—椎体距离、中立位甲状软骨—椎体距离、过屈位舌骨—椎体距离、过曲位Cobb角、中立位Cobb角、住院时间等相关资料,分析Tapia综合征风险及相关危险因素。结果:术后Tapia综合征发生率为0.28%,症状出现在术后1~2d,平均症状出现时间(0.62±0.12)d。临床表现以伸舌偏移者6例(85.71%),构音障碍5例(71.43%),吞咽困难3例(42.86%),舌头表现不灵活者4例(57.14%),声音嘶哑者2例(28.57%)为主,经糖皮质激素、营养神经、康复锻炼等综合治疗,术后3个月复查患者症状改善。Tapia综合征患者中立位下颌骨—椎体距离明显低于对照组(P<0.05);且下颌骨—椎体距离由中立位至过屈位时,Tapia综合征组由3.96mm降至1.97mm,降幅为50.25%,而对照组由7.21mm降至4.92mm,降幅为31.76%。Tapia综合征患者术后住院时间、总住院时间均高于对照组(P<0.05)。结论:全身麻醉经口气管插管下颈椎后路手术患者发生Tapia综合征风险相对较低,但发生后可对患者术后康复及日常生活情况造成影响;术前中立位颈椎X片下颌骨角—椎体前缘距离较小可能是术后发生Tapia综合征的危险因素。

气管插管并发单侧Tapia综合征1例

Tapia综合征首先于1904年被西班牙耳鼻喉专家Tapia AG提出,是迷走-舌下神经综合征,主要见于创伤时,尤其是下颌角后部创伤导致Ⅹ、Ⅺ、Ⅻ颅神经受累（周围性损害）,表现为吞咽困难、构音障碍、同侧舌肌萎缩和伸舌偏向患侧等,此外咽喉部长时间被肿物压迫也可引起Tapia综合征,同时,其还是气管插管中罕见的并发症。

Tapia 半内积与 Banach 空间的几何性质

利用Ｔａｐｉａ半内积（ｘ，ｙ）Ｔ＝ｌｉｍｔ→０＋［（ｘ＋ｔｙ２－ｘ２）／（２ｔ）］，ｘ，ｙ∈Ｘ，研究了Ｂａｎａｃｈ空间Ｘ的自反和逼近性质，并在光滑的Ｂａｎａｃｈ空间Ｘ上利用由Ｔａｐｉａ半内积定义的一类连续线性泛函Ｔ（Ｘ）＝｛ｆｘ∈Ｘ＊｜〈ｆｘ，ｙ〉＝（ｘ，ｙ）Ｔ；ｘ，ｙ∈Ｘ｝研究了Ｂａｎａｃｈ空间的严格凸、一致凸以及具有性质（Ｈ）的特征．

Isolated bilateral Tapia's syndrome after liver transplantation: A case report and review of the literature

AIM To describe one case of bilateral Tapia's syndrome in a liver transplanted patient and to review the literature.METHODS We report a case of bilateral Tapia's syndrome in a 50-year-old man with a history of human immunodeficiency virus and hepatitis C virus child. A liver cirrhosis and a bi-nodular hepatocellular carcinoma, who underwent liver transplantation after general anesthesia under orotracheal intubation. Uneventful extubation was performed in the intensive care unit during the following hours. On postoperative day(POD) 3, he required urgent re-laparotomy due to perihepatic hematoma complicated with respiratory gram negative bacilli infection. On POD 13, patient was extubated, but required immediate re-intubation due to severe respiratory failure. At the following day a third weaning failure occurred, requiring the performance of a percutaneous tracheostomy. Five days later, the patient was taken off mechanical ventilation and severe dysphagia, sialorrea and aphonia revealed. A computerized tomography and a magnetic resonance imaging of the head and neck excluded central nervous injury. A stroboscopy showed bilateral paralysis of vocal cords and tongue and a diagnosis of bilateral Tapia's syndrome was performed. With conservative management, including a prompt establishment of a speech and swallowing rehabilitation program, the patient achieved full recovery within four months after liver transplantation. We carried out MEDLINE search for the term Tapia's syndrome. The inclusion criteria had no restriction by language or year but must provide sufficientavailable data to exclude duplicity. We described the clinical evolution of the patients, focusing on author, year of publication, age, sex, preceding problem, history of endotracheal intubation, unilateral or bilateral presentation, diagnostic procedures, type of treatment, follow-up, and outcome.RESULTS Several authors mentioned the existence of around 70 cases, however only 54 fulfilled our inclusion criteria. We found only five published studies of bilateral Tapia's syndrome. However this is the first case reported in the literature in a liver transplanted patient. Most patients were male and young and the majority of cases appeared as a complication of airway manipulation after any type of surgery, closely related to the positioning of the head during the procedure. The diagnosis was founded on a rapid suspicion, a complete head and neck neurological examination and a computed tomography and or a magnetic resonance imaging of the brain and neck to establish the origin of central or peripheral type of Tapia's syndrome and also the nature of the lesion, ischemia, abscess formation, tumor or hemorrhage. Apart from corticosteroids and anti- inflammatory therapy, the key of the treatment was an intensive and multidisciplinary speech and swallowing rehabilitation. Most studies have emphasized that the recovery is usually completed within four to six months. CONCLUSION Tapia's syndrome is almost always a transient complication after airway manipulation. Although bilateral Tapia's syndrome after general anesthesia is exceptionally rare, this complication should be recognized in patients reporting respiratory obstruction with complete dysphagia and dysarthria after prolonged intubation. Both anesthesiologists and surgeons should be aware of the importance of its preventing measurements, prompt diagnosis and intensive speech and swallowing rehabilitation program.

Lectin from Crataeva tapia bark exerts antitumor,anti-inflammtory and analgesic activities

Crataeva tapia bark lectin was evaluated for its antitumor activity against sarcoma 180 in Swiss albino mice.The anti-inflammatory and analgesic properties were investigated in models of inflammation and nociception.The anti-inflammatory assay was induced by carrageenan induced peritonitis and the analgesic activity was induced by acetic acid-induced writhing response.The lectin presents low toxicity with a LD50 of 2,500 mg/kg body weight and significant antitumor activity causing inhibition of tumor growth.The lectin also promoted significant reduction(35.4%)in the number of neutrophil migration induced by carrageenan.Concerning its analgesic property,the lectin inhibits abdominal contractions induced by acetic acid.The current results revealed a lectin with significant antitumoral,anti-inflammatory and antinociceptive activities.Further investigations to unveil the exact mechanisms are needed.

Rare complication:Tapia's syndrome following shoulder surgery under endotracheal general anesthesia

Tapia's syndrome is a rare disorder, characterized with paralysis of extracranial part of Nervus Vagus and Nervus Hypoglossus, effecting the ipsilateral vocal cord and the tongue. This complication is usually related to intubation and head positioning during surgery. In this study, we report a case with Tapia's syndrome under general anesthesia, following arthroscopic shoulder instability surgery. Patient recovered as short as 3 mo, following complication.

全身麻醉经口气管插管下颈椎后路手术后Tapia综合征的发生及其相关因素

目的分析全身麻醉经口气管插管下行颈椎后路手术后出现Tapia综合征的发生率及相关的危险因素。方法回顾性分析2018年6月至2021年5月北京大学第三医院骨科在全身麻醉经口气管插管下行颈椎后路手术后出现Tapia综合征的脊髓型颈椎病和颈椎后纵韧带骨化症患者的临床资料。选取相同手术类型、主刀医生、年龄及性别作为匹配因素,每个病例选择4例未发生Tapia综合征的患者作为对照组。在颈椎侧位X线片上测量下颌骨‑椎体距离、舌骨‑椎体距离、甲状软骨‑椎体距离、C_(2)‑C_(7)前凸Cobb角。分别在中立位、过屈位和过伸位X线片上测量上述参数。分析发病组及对照组在上述参数的差异。结果在2431例全身麻醉经口气管插管下行颈椎后路手术患者中,9(0.37%)例出现Tapia综合征,其中男3例,女6例,年龄(61±5)岁,症状平均发生在术后0.67 d(0~2 d)。临床表现为:伸舌偏移8例(8/9,88.9%),构音障碍6例(6/9,66.7%),吞咽困难3例(3/9,33.3%),舌头不灵活3例(3/9,33.3%),声音嘶哑及咽部不适各1例(1/9,11.1%)。所有患者在术后3个月复查时,上述所有症状均缓解。颈椎中立位时,下颌骨‑椎体前缘的距离对照组为(7.19±3.96)mm,Tapia组为(3.98±3.01)mm,差异有统计学意义(P<0.05)。下颌骨‑椎体距离由中立位至过屈位时:Tapia组由3.98 mm降至1.95 mm,降幅为51.0%,而对照组由7.19 mm降至4.90 mm,降幅为31.8%。结论经口气管插管全身麻醉下颈后路术后Tapia综合征发生率低。术前中立位颈椎X线片下颌骨‑椎体前缘距离较小可能是经口气管插管全身麻醉下颈后路术后发生Tapia综合征的危险因素。