三种药物对腭裂患儿呼吸系统顺应性的影响

4～ 7岁腭裂患儿呼吸系统顺应性 (ＣＴ)较同龄非腭裂儿童明显下降[1] ,为提高腭裂患儿ＣＴ,改善患儿呼吸功能 ,作者应用能明显提高ＣＴ 三种药于腭裂整复术中的患儿 ,观察对ＣＴ 的影响 ,现报告如下。资料与方法一般资料　 4～ 7岁腭裂患儿 4 0例 ,经体格检查和实验室检查 ,排除脊柱胸廓畸形 ,无心肺及肝肾疾患。随机分成四组 ,每组 10例。麻醉及给药方法　全组患儿麻醉均由专人测体重、身高。静脉注射氯胺酮 1 5～ 2ｍｇ/ｋｇ和维库溴铵 0 15ｍｇ/ｋｇ后 ,经口明视气管插管 ,所有气管导管均为“ＳＨＥＲＩＤＡＮ”有囊气管导管 ,接Ｄｒ¨…     

小儿麻醉与呼吸系统总顺应性

呼吸系统总须应性（Ｃｒｓ）是麻醉期间一英重要的呼吸监测指标，麻醉中的多种因素对其产生影响，从而可能干扰正常的呼吸功能，小儿麻醉较成人麻醉有自身特点，因此探讨小儿麻醉中影响Ｃｒｓ的因素和机理，对于麻醉期间呼吸监测和管理具有得要意义。     

气管内麻醉期间小儿呼吸系统总顺应性测定

５７例正常心肺功能的小儿于气管内麻醉期间采用恒定的潮气量（１０ｍｌ／ｋｇ）作机械通气时测定呼吸系统总顺应性（Ｃｒｓ）。结果显示Ｃｒｓ与身高、体重、体表面积和年龄等因素均有非常显著相关关系，尤以身高相关最显著（ｒ＝０．９１７７），各年龄组间比顺应性差别无显著意义（Ｐ〉０．０５），故比较小儿与成人的Ｃｒｓ应采用比顺应性。临床上婴幼儿可以体重进行Ｃｒｓ的预测。     

腭裂患儿中耳功能的评价

对５６例腭裂患儿和５０例正常儿的中耳功能进行对比评价。年龄５－１４岁，均进行耳科常规及声阻抗检查，发现腭裂患儿中耳静态压力与声顺值，声镫骨肌反射引起率都低于正常儿童。其咽鼓管功能不良，调节中耳压力的能力差，通过吞咽来主动开放咽鼓管的功能受限，故腭裂患儿的合理治疗需要多科医生的共同配合。     

新生儿和婴儿唇、腭裂全麻一次性修复术的呼吸道管理

唇、腭裂患儿在新生儿、要儿时期语言肌肉尚未废用性萎缩,不正确的语音习惯亦未形成,此时实施唇、腭裂一次性修复术既能早期恢复患儿的正常面貌与语言功能,又可减少其家属分次手术的经济负担与精神压力。因此,唇、腭裂修复术宜在1岁前完成为佳,以防止肺功能进一步受损,现将42例新生儿和要儿唇、腭裂全麻一次性修复术的呼吸道管理报告如下。     

小儿唇裂、腭裂修复术的麻醉处理

<正> 小儿唇裂、腭裂修复术时,在麻醉过程中较难处理的就是呼吸道管理问题。如果不进行气管插管,很难确保呼吸道通畅,如进行气管插管麻醉,患儿的风险大大降低。 1 资料与方法 1.1 一般资料:本组368例,其中唇裂170例,腭裂198例,均为5岁以下小儿,最小6个月。术前检查除2例因胸腺增大推迟手术外,全部患儿均无麻醉并发症。 1.2 麻醉装置:①“T”管;②贮气囊(根据年龄一般选择     

先天性唇腭裂小儿并气道狭小的临床观察

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5459例唇腭裂患者临床资料分析

目的：对20年来唇腭裂的治疗及唇腭裂患者的构成情况进行回顾。方法：对5459例唇腭裂患者病历资料分类整理，进行统计学分析。结果：唇腭裂各类型性别比例差异有显著性意义，唇腭裂患者的首次手术年龄差异有显著性意义，其主要修复方式随年代的变化而不同。结论：唇腭裂患者中男性明显多于女性。自1980年以来，唇腭裂患者的首次手术年龄呈逐渐下降趋势，主要手术方法也有很大的变化。     

A revised classification of the cleft lip and palate

BACKGROUND:

Submucous cleft palate is characterized by muscular diastasis of the velum in the presence of intact mucosa with variable combinations of bifid uvula and hard palatal defect. Submucous cleft palate is indicated as a separate entity in most previous classifications but it has never been properly classified on an anatomical basis.

OBJECTIVES:

To revise the Smith-modified Kernahan ‘Y’ classification of cleft lip and palate deformities, and to describe the different anatomical subtypes of submucous cleft palate.

METHODS:

The present study was conducted in Hayatabad Medical Complex, Abasin Hospital and Aman Hospital Peshawar, Pakistan, from November 2010 to December 2011. All patients who presented to the outpatient departments with cleft lip and palate, with the exception of previously operated cases, were included. All cases were described according to the Smith-modified Kernahan ‘Y’ classification and the authors’ revised Smith-modified Kernahan ‘Y’ classification. All of the data were organized and analyzed using SPSS version 17 (IBM Corporation, USA).

RESULTS:

A total of 163 cases of cleft lip and palate deformities were studied, of which 59.5% were male and 40.5% were female. Smith modification of the Kernahan ‘Y’ classification completely described the cleft deformities in 93.9% of patients. However, while the Kernahan ‘Y’ classification represented the submucous cleft palate, it did not describe its different anatomical subtypes in 6.13% of patients. The revised Smith-modified Kernahan ‘Y’ classification completely described the cleft deformities of the entire study population, including the different submucous cleft palate patients.

DISCUSSION:

The Smith alphanumeric modification of the Kernahan ‘Y’ classification of cleft lip and palate came into existence after a long search and a series of modifications over the past century. This classification system describes the cleft region, site of the cleft, degree of the cleft, rare and asymmetrical clefts, and are computer database friendly. However, this classification did not describe the different anatomical subtypes of submucous cleft palate that have variable relationships with velopharyngeal insufficiency.

CONCLUSION:

The revised Smith-modified Kernahan ‘Y’ classification described in the present study can describe all types of cleft lip and palate deformities in addition to the different types of submucous cleft palate deformities.     

双侧唇裂或唇腭裂修复后口哨畸形的分级与修复

目的 对双侧唇裂或唇腭裂修复后口哨畸形的严重程度进行分级。方法 将我院136例双侧唇裂或双侧唇腭裂术后上唇口哨畸形患者作为研究对象，观察上颌前门齿牙冠及相应牙龈暴露的程度将口哨畸形分为Ⅳ级。Ⅰ级： 牙冠显露1／2；Ⅱ级： 牙冠全显露或 牙冠全显露伴 显露近中纵行牙冠1／2—2／3；Ⅲ级： 牙冠全显露和附丽龈显露1／2或 牙冠全显露伴附丽龈显露1／2及 牙冠显露2／3以上；Ⅳ级： 牙冠及相应牙龈全显露伴 近中牙冠纵显露2／3以上。口哨畸形严重程度与双侧唇裂或唇腭裂修复术式的关系一并进行分析。结果 口哨畸形Ⅰ级者60例，占44．2％；Ⅱ级者47例，占34．5％；Ⅲ级者16例，占11．8％；Ⅳ级者13例，占9．5％。结果 显示Ⅰ级和Ⅱ级口哨畸形明显多于Ⅲ级与Ⅳ级，前者为后者的3．7倍。结论 对双侧唇裂或唇腭裂修复后口哨畸形的分级具有良好的临床参考价值，为修复上唇口哨畸形选择修复方法提供了客观依据。     

Unilateral cleft lip and palate: Simultaneous early repair of the nose, anterior palate and lip

Unilateral cleft lip and palate is a defect involving the lip, nose and maxilla. These structures are inter-related, and simultaneous early correction of all the aspects of the defect is necessary to obtain a satisfactory result that will be maintained with growth. The surgical technique combining various procedures is presented and compared with previously published reports.     

Report of a hemohiliac's cleft lip and palate repair — ten year follow-up

Summary The association of cleft lip and palate with hemophilia is rare. Recent advances in hematology have made it possible for hemophiliacs to have surgery without problems, using prior administration of anti-hemophilic globulin. The case reported was a hemophilia B patient with unilateral cleft lip and palate. When primary cheiloplasty was carried out at four months of age, there were serious bleeding problems during and after the operation. Palatoplasty was performed at age two and repair of secondary deformity of the cleft lip at age eight. On both occasions a prothrombin complex was administered, and no problem was experienced in either procedure. A ten year follow-up is presented.     

综合矫治单侧唇腭裂术后鼻畸形

目的 通过外科手术和自体骨移植综合矫治唇腭裂术后遗留的鼻畸形。方法 本手术通过自体骨移植垫高患侧鼻翼基部凹陷、凿断鼻骨使其耸立以抬高鼻背和自体鼻中隔软骨移植以增高鼻小柱和鼻尖,一次性完成鼻外形的综合矫治。结果 45例唇腭裂伴发鼻畸形综合修复,术后1～8年随访复查,效果满意。结论 综合矫治术通过一次手术能够使鼻畸形得到全面彻底的矫正。     

婴儿唇腭裂同期修复468例临床分析

目的探讨唇腭裂在婴儿期同期修复的可行性及优缺点。方法回顾性分析我科近十年来同期修复婴儿期唇腭裂468例,对术后3年以上患者进行语音评价。结果468例婴儿均完成唇腭裂同期修复,术后出现并发症173例,死亡1例。其中94例出现不同程度呼吸困难,74例出现腭部缝合口裂开(63例为悬雍垂裂开),2例唇部切口感染,1例因术中缺氧出现脑瘫,2例出现恶性高热(其中1例死亡),1例拔出碘仿纱条后大出血。术后3年以上有278例,随访168例,发音优115例,良48例,差5例。结论婴儿期同时修复唇腭裂虽具有术后语音效果好及其他优点,但呼吸困难及悬雍垂裂开发生率高,良好的麻醉对保证手术成功至关重要。     

α转化生长因子基因BamHⅠ限制酶切片段长度多态性与广东地区人群非综合征性唇腭裂的关系

目的 探讨中国广东地区人群非综合性唇腭裂与α转化生长因子(transforming growth factor α,TGF-α)基因多态性的关系.方法 应用聚合酶链式反应-限制酶切片段长度多态性(PCR-RFLP)核苷酸分型技术,以BamH Ⅰ限制性内切酶消化PCR扩增产物,对107例非综合征性唇裂或唇腭裂(nonsyndromic cleft lip with or without cleft palate,NSCL/P)患者,136例正常人为对照组的TGF-α/BamH Ⅰ等位基因多态性进行分析.结果 NSCL/P患者的A1等位基因频率比正常对照组明显增高,差异有统计学意义(P＜0.05).NSCL/P患者中,有家族史与无家族史者等位基因频数,差异无统计学意义(P＞0.05);双侧NSCL/P患者与单侧NSCL/P患者的TGF-α/BamH Ⅰ基因型频率,差异无统计学意义(P＞0.05).结论 中国广东地区人群NSCL/P患者TGF-α基因中存在BamH Ⅰ多态性位点,TGF-α基因BamH Ⅰ位点与中国广东地区人群NSCL/P的发生有关.     

唇腭裂患者手术后上颌骨发育的评价研究

目的　研究唇腭裂术后患者上颌骨发育特征及手术对发育造成的影响。方法　将 6 0例婴幼儿期手术的完全性唇腭裂患者作为研究对象 ,采用X线头影测量方法进行测量 ,拍摄标准侧位头影测量片 ,并选择 12个标志点及 12个测量项目 ,并与同年龄段正常患者的测量值进行比较分析。结果　单纯唇裂患者与正常对照组比较出现∠SNA [(76 .4± 3.0 6 )° ,P 0 .0 5 ]、N A Pg[(- 4 .8± 6 .31)mm ,P 0 .0 5 ]值变小 ;单纯腭裂及唇腭裂患者出现∠SNA[(74 .5± 4 .0 1)° ,P 0 .0 5 ;(75 .1± 1.0 7)°,P 0 .0 1]、N ANS[(47.3± 2 .4 1)mm ,P 0 .0 1;(49.8± 1.91)mm ,P 0 .0 1]等多项指标均小于正常对照 ,提示不同程度、不同表现形式的上颌骨发育受限。结论　唇腭裂患者术后上颌发育不足是先天及后天因素综合影响的结果。唇裂修复术是影响上颌前后向发育的重要因素之一 ,腭裂修复术是影响上颌骨高度及宽度发育的重要因素之一。     

Physical characteristics of young men with cleft lip,with or without cleft palate,and cleft palate only

We report the weight, stature, body mass index (BMI), and muscular strength of men about 19 years old who have cleft lip, either with or without cleft palate (CLP), or cleft palate only (CP). Data were obtained from the Swedish National Service enrolment register for the years 1991–97, and concerned 335 men with CLP and 88 with CP, who were compared with a control group of 272 879 men. The data showed that those with CLP and CP were significantly lighter than controls. Their stature in the CLP group was similar to that in controls, but those with CP significantly shorter. These findings imply that men with CLP had a significantly lower BMI whereas men with CP had a similar BMI compared with controls. Those with CLP did not differ as regards to muscular strength, but those with CP were significantly weaker than controls.