环甲膜穿刺置管术及在临床中的效果

目的观察环甲膜穿刺-穿孔置管术的临床应用效果。方法对1998年6月～2006年1月期间,在39例常规气管插管困难患者及286例急性喉梗阻患者施行环甲膜穿刺穿孔置管术的情况进行回顾性总结分析,探讨其临床应用效果。结果所有病例均1次操作成功,穿刺和穿孔时间不超过1分钟,术中出血量不超过3ml,无1例出现皮下或纵隔气肿、食道损伤和气胸及其它严重并发症。拔管后,环甲膜穿刺穿孔置管处仅见小条索状瘢痕。结论环甲膜穿刺-穿孔置管术安全、快速、简便易行、微创而有效,可供临床选择使用。     

环甲膜穿刺置管术临床应用

目的探讨环甲膜穿刺置管术在临床中的效果。方法1998年7月～2006年1月对39例常规气管插管困难、喉显微外科手术需开阔内镜视野者以及286例急性喉梗阻患者进行了环甲膜穿刺置管术建立人工气道,并对其病例资料进行回顾性分析。结果所有病例均一次操作成功,穿刺时间不超过1分钟,出血量不超过3ml,无1例出现皮下或纵隔积气、食管损伤和气胸,无1例死亡。所有病例拔管后环甲膜伤口均愈合良好,仅见小条索状瘢痕,无严重并发症。结论环甲膜穿刺置管术是一安全、有效、快速且简便易行的微创操作方法,必要时可选择性使用。     

环甲膜穿刺置管术在麻醉气管插管中的应用

目的探讨环甲膜穿刺穿孔置管在麻醉气管插管中的应用。方法1999年5月-2006年1月,我院对39例常规气管插管困难及喉显微手术需开阔内镜视野的患者进行环甲膜穿刺穿孔置管术,并对其病例资料进行回顾性分析。结果所有病例均1次操作成功,穿刺时间不超过1 min,经环甲膜穿刺穿孔置管出血量不超过3 ml,无1例出现皮下或纵隔积气、食道损伤和气胸,无1例死亡病例。所有病例拔管后环甲膜伤口均愈合良好,环甲膜穿刺穿孔置管愈合处仅见小条索状瘢痕,无严重并发症。结论环甲膜穿刺穿孔置管在气管插管麻醉中是一种安全、有效、快速、简便易行和微创的操作方法,必要时可选择性使用。     

环甲膜穿刺通气法在急救中的价值

急性喉梗阻可严重威胁患者生命，如何用最简便的操作，在最短的时间内解除梗阻，是救治的关键所在，我院采用环甲膜穿刺通气法治疗急性喉梗阻52例，用于院前现场急救，取得良好效果，现报道如下。     

紧急环甲膜切开术救治急性喉梗阻临床分析

急性喉梗阻病情凶险,必须迅速紧急开放气道改善呼吸才能缓解病情及挽救生命,如处理不及时或方法不当,患者可因缺氧窒息死亡。我院自1995年以来,因急性喉梗阻导致的窒息昏迷患者做紧急环甲膜切开术4例,效果显著,现报道如下。     

急性会厌炎致呼吸骤停抢救成功1例

患者，女，40岁。咽喉部疼痛13h，呼吸困难3h，于1996年5月21日上午8点15分急诊入院。体检：体温37．8℃，急性痛苦面容，轻度烦躁，Ⅲ度吸气性呼吸困难；心、肺、腹检查无异常。口咽部急性充血，间接喉镜下见会厌高度红肿，呈球形，被裂及声门均看不见，左颈侧胸锁乳突肌上1／3处轻度肿胀压痛。诊断为急性会厌炎致急性喉梗阻。立即给予10％葡萄糖500ml＋地塞米松10mg静滴。8点50分呼吸困难无缓解，加快输液速度并给氧，9点10分患者诉胸闷，呼吸困难加重，烦躁不安，挣扎乱动，随即呼吸骤停，故行紧急坏甲膜穿刺。以16号针头刺入环甲膜后，…     

环甲膜切开术的临床观察

为了探讨环甲膜切开术置管时间超过４８小时的喉部变化情况,我们选择１２例置管时间为７～１５天的患者,于拔除套管后１、３、６、１２个月采用纤维喉镜和电子动态喉镜对喉部进行观察。一、对象与方法本组男１１例,女１例,年龄６～７０岁。紧急环甲膜切开术２例,预防性环甲膜切开术１０例。气管套管留置时间：７天３例,８天３例,１０天３例,１１天２例,１５天１例。紧急环甲膜切开术：用尖刀沿环状软骨上缘横形切开皮肤、皮下组织及环甲膜,立即用刀柄伸入并撑开切口,随即插入气管套管。预防性环甲膜切开术：平卧、垫肩,局部麻醉…     

环甲膜切开术165例报告

目的 探讨环甲膜切开术能否广泛应用于临床。方法 选择性环甲膜切开术165例，其中有颈椎骨折、颈外伤、胸外伤、颅脑外伤、烧伤、脑血管病、喉阻塞以及手术前预防性甲膜切开术。结果 带管最短4d，最长21d，平均带管6d。165例中，发生并发症9例，包括出血、阵发性咳嗽、喉部不适，无1例发生喉、气管狭窄。结论 环甲膜切开术是一种安全、简便、有效的手术方法，尤其在紧急抢救时更有突出的优点。     

喉科学

选用甲醛固定的成人死体50具。用游标卡尺测量喉高、喉宽、环甲膜纵径、环甲膜横径计算出环甲膜面积。并对环甲膜的横径和纵径分别与喉宽、喉高作相关回归分析及自身比例分析。结果:1.男性环甲膜横径平均为2.18±     

环甲膜穿刺术与环甲膜切开术的临床应用

目的 探讨环甲膜穿刺术与环甲膜切开术在临床中的应用。方法 对Ⅳ度呼吸困难患者根据具体情况进行抢救,采用环甲膜穿刺19例（气管切开术前进行环甲膜穿刺15例,气管切开术中进行环甲膜穿刺4例）,环甲膜切开6例。结果 行环甲膜穿刺19例患者全部抢救成功。环甲膜切开患者均已成功插入气管套管,但仍有3例即时（1h内）死亡; 1例24h后多器官功能衰竭而死亡; 2例抢救成功,并于病情平稳后行常规气管切开。结论 对大部分Ⅳ度呼吸困难的患者采用环甲膜穿刺结合气管切开可以解决气道通气问题。环甲膜切开术可适用于：血氧饱和度90％以下,呈快速进行性下降;上气道大出血随时有阻塞气道导致窒息危险;呼吸突然停止等病例。     

新生儿重度上呼吸道梗阻的病因分析

目的了解新生儿重度上呼吸道梗阻的原因。方法回顾性分析47例发生重度吸气性呼吸困难的新生儿的临床表现、直接喉镜、CT、上消化道造影等检查结果及治疗经过。结果47例中先天性疾病占87．2％（41／47）：先天性喉喘鸣15例，占31．9％，其中6例伴有胃食管反流；上呼吸道先天性囊肿14例（舌根囊肿10例，会厌囊肿3例，喉囊肿1例），占29．8％，其中有13例曾被误诊为先天性喉喘鸣；先天性总气管狭窄3例；先天性喉蹼2例；声带麻痹2例；皮耶-罗宾综合征3例；猫叫综合征2例。急性膜性喉气管支气管炎6例。47例中3例放弃治疗，44例经吸氧、药物治疗后呼吸困难缓解，其中曾行气管插管、吸痰37例次，行直接喉镜、支撑喉镜手术19例次。结论新生儿重度上呼吸道梗阻病因以先天性疾病为主，对这类患儿应及时进行相关检查，尽早明确病因，迅速解除梗阻，以降低新生儿死亡率和预防不良后遗症的发生。     

Congenital laryngeal saccular cyst of the newborn

Congenital laryngeal saccular cysts of the newborn frequently cause severe dyspnea and upper respiratory tract obstruction. When confronted with this emergency situation necessary therapeutic action may consist of intubation, puncture or incision to reduce the volume of the cyst or tracheotomy. The CO₂ laser was effectively used not only to incise the supraglottic saccular cyst but also to vaporize the lining.     

琥珀酰胆碱与罗库溴铵用于麻醉诱导对甲状腺手术患者术中喉返神经监测的影响[论著]

目的　比较常规剂量琥珀酰胆碱与小剂量罗库溴铵用于麻醉诱导对甲状腺手术患者术中喉返神经监测的影响。方法　选取2019年4月至2019年7月本院120例同一外科医师团队甲状腺手术喉返神经监测患者，随机分为A组：麻醉诱导肌松药物为琥珀胆碱1.5 mg/kg；B组：麻醉诱导肌松药物为罗库溴铵0.3 mg/kg。麻醉医师待肌松监测显示到最大抑制后，通过气管插管条件评分评估两组患者气管插管条件。记录各组插管时间、等待时间；迷走神经和喉返神经电信号基础值；以及术中血压波动、术后咽痛、声音嘶哑、低氧血症、苏醒延迟等并发症。外科医师通过神经肌电监测仪进行喉返神经刺激评估两组患者喉返神经监测情况。结果　A组患者气管插管条件优于B组，A组插管时间、肌松监测时间小于B组，两组手术监测时间差异无统计学意义。A组首次神经监测信号值大于B组，A组首次监测例数多于B组，两组患者术中无体动，血压下降差异无统计学意义。麻醉术后并发症，A组咽痛少于B组，A组有少量患者发生肌痛，差异无统计学意义。结论　1.5 mg/kg琥珀酰胆碱用于甲状腺手术患者的麻醉诱导，可以提供较好的插管条件，不影响外科医师术中行喉返神经监测，同时减少患者术后咽痛的发生。     

Experience with the treatment of cicatrical laryngotracheal obstruction in children

A total of 152 children presenting with various forms of laryngotracheal obstruction were admitted to the Russian Children's Clinical Hospital during the period between 1995 and 2009. Cicatrical stenosis predominated in the structure of chronic laryngeal obstruction accounting for 33% of the cases. In the overwhelming majority of these patients, the main cause underlying the process of formation of rough cicatrical tissue in the larynx was a long-standing intubation injury (3-4 days during the inflammatory reaction and 7-8-day laryngeal intubation period). The patients with pronounced cicatrical obliteration of the larynx underwent laryngotracheal reconstruction of the laryngeal lumen with the formation of an external passage, removal the cicatrical conglomerate with the obligatory enlargement of the laryngeal cross section area in the stenosed region, and subsequent long-term prosthetic treatment with plastic closure of tracheostoma. Endoscopic microsurgery in the cicatrical stenosis region during direct laringoscopy under video control was used to treat the patients with superficial forms of cicatrical stenosis, such as membrane stenosis, synechiae, and circular stenosis, characterized by moderate narrowing of the laryngeal lumen.     

Clinical features and influencing factors of curative effect in children with acute laryngitis and laryngeal obstruction

ObjectiveWe aim to explore the clinical features and influencing factors of curative effect in children harboring acute laryngitis with laryngeal obstruction.MethodsThere involved 237 children with acute laryngitis and 80 healthy children who required physical examination in our hospital between January and September in 2021. The healthy children who required physical examination were allocated into the healthy/control group. The clinical data and laboratory indexes of each group were compared. We also analyzed the risk factors for curative effect of acute laryngitis with laryngeal obstruction among children using univariate/multivariate logistic regression.ResultsThe incidence of barking cough, sore throat, dryness, pruritus, dyspnea, diffuse congestion and swelling of laryngeal mucosa and vocal cord congestion or covered with vascular striation in degree III laryngeal obstruction group were significantly higher than other study groups, with degree II laryngeal obstruction group higher than degree I group, and degree I group higher than no laryngeal obstruction group (P<0.05). Moreover, the levels of CRP, TNF-α, IL-6, IL-8 and WBC in degree III laryngeal obstruction group were higher than other three study groups, with degree II higher than degree I laryngeal obstruction group and no obstruction group, and degree I higher than no laryngeal obstruction group (P<0.05). Multivariate logistic regression analysis showed that CRP, TNF-α, IL-6 and IL-8 were the risk factors affecting the curative effect of acute laryngitis with laryngeal obstruction in children, and the differences were statistically significant (P<0.05).ConclusionThe study revealed the incidence of barking cough, sore throat, dryness, pruritus, dyspnea, diffuse congestion and swelling of laryngeal mucosa vocal cord congestion or covered with vascular striation is highly associated with the severity of acute laryngitis with laryngeal obstruction in children. Additionally, higher levels of CRP, TNF-α, IL-6, IL-8 and WBC indicated serious condition of the disease among children. Hence the risk factors responsible for the efficacy of acute laryngitis in children are CRP, TNF-α, IL-6 and IL-8.     

小儿喉乳头状瘤切除术不同全麻诱导方式的对照研究

目的探讨儿童喉乳头状瘤伴呼吸困难病例更加安全可行的全麻诱导方式。方法选择喉阻塞Ⅱ度的喉乳头状瘤患儿50例,随机分为七氟烷吸入诱导组（吸入组）与氯胺酮．眯唑安定静脉诱导组（静脉组）,每组25例。分别记录诱导前、插管后1分钟血压、心率及脉搏血氧饱和度（saturated pulse oxygen,SpO2）变化并进行气管插管条件评分。结果①吸入组气管插管条件满意者16例,一般者7例,差者2例;静脉组气管插管条件满意者6例,一般者13例,差者6例,插管满意率吸人组明显高于静脉组,P〈0．05。②两组气管插管前血压、心率及SpO2无明显差异,P〉0．05。③插管完成后即刻静脉组血压和心率明显高于吸入组[（68．7±6．4）mmHgvs．（64．0±8．0）mmHg;（142．6±13．8）bpmvs．（124．6±12．5）bpm;P〈0．05];插管完成后即刻静脉组血压和心率明显高于插管前[（68．7±6．4）mmHg vs．（63．6±5．8）mmHg;（142．6±13．8）mmHg vs．（121．2±11．7）bpm;P〈0．05];吸入组血压和心率与插管前对比无显著差异[（64．0±8．0）mmHg vs．（61．8±7．7）mmHg：（124．6±12．5）bpm vs．（118．2±11．3）bpm;P〉0．05]。④静脉组3例插管后呛咳剧烈,SpO2低于93％：吸入组插管后未出现剧烈呛咳及SpO2下降。两组SpO2下降率存在明显差异,P〈0．05。结论七氟烷吸入诱导法,无需肌肉松弛剂即可提供良好的气管插管条件,用于存在呼吸困难的喉乳头状瘤患儿安全可行。与氯胺酮、咪唑安定静脉诱导相比,更利于保持循环稳定,减少插管后低氧血症发生。     

Surgery of adult bilateral vocal fold paralysis in adduction: history and trends

Bilateral vocal fold paralysis (BVFP) in adduction is characterised by inspiratory dyspnea, due to the paramedian position of the vocal folds with narrowing of the airway at the glottic level. The condition is often life threatening and therefore requires surgical intervention to prevent acute asphyxiation or pulmonary consequences of chronic airway obstruction. Aside from corticosteroid administration and intubation, which are only temporary measures, the standard approach for improving respiration is to perform a tracheotomy. Over the past century, a vast majority of surgical interventions have been developed and applied to restore the patency of the airway and achieve decannulation. Surgeons can generally choose for every individual patient from various well-established treatment options, which have a predictable outcome. An overview of the surgical techniques for laryngeal airway enlargement in BVFP is presented. Included are operative techniques, which have found application in clinical practice, and only to a small extent in purely anatomic or animal studies. The focus is on two major groups of interventions—for temporary and for definitive glottic enlargement. The major types of interventions include the following: (1) resection of anatomical structures; (2) retailoring and displacing the existing structures, with minimal tissue removal; (3) displacing existing structures, without tissue resection; (4) restoration or substitution of the missing innervation of the laryngeal musculature. The single interventions of these four major types have always followed the development of the medical equipment and anaesthesia. At the beginning of the twentieth century, when medicine was unable to counteract surgical infection, endoscopic or extramucosal surgical techniques were dominant. In the 1950s, the microscopic endoscopic laryngeal surgery boomed. At the end of the twentieth century many of the classical endoscopic operations were performed either with the help of surgical lasers alone, or in combination with other interventions.