颈部内镜手术充二氧化碳和氦气对颅内压的影响

目的 通过兔颈部灌注二氧化碳（CO2）和氦气（He）,检测不同压力和灌注持续时间对于颅内压的影响。方法将15只新西兰兔随机分成5组。分别为5mmHg CO2组、10mmHg CO2组、15mmHg CO2组、15mmHg He组及颈部不充气对照组。分别在充气前,充气后45分钟、90分钟和放气后30分钟记录动脉血PaCO2、pH值及颅内压（intracranial pressure,ICP）。结果5mmHg CO2组对各项检测指标均没有显著影响。颈部灌注CO2压力为10mmHg组在45分钟和90分钟时PaCO2有显著性升高（P＜0.05）。颈部灌注CO2压力为15mmHg组在45分钟和90分钟时PaCO2、pH及ICP有显著性变化（P＜0．05）,放气后30分钟未回落到基线水平。颈部灌注He压力为15mmHg在45分钟和90分钟时ICP显著升高（P＜0．05）,放气后30分钟均回落到基线水平。He不引起高碳酸血症。结论在颈部内镜手术中将CO2和He充气压力控制在10mmHg对颅内压无明显影响。     

兔颈部CO2和生理盐水灌注内镜甲状腺手术

目的:在兔颈部皮下灌注CO2和生理盐水以营造手术空间完成甲状腺切除术。检测不同压力和持续灌注时间对代谢、血流动力学参数、Na+以及红细胞压积(HCT)的影响。方法:将21只新西兰兔随机分成7组,分别为颈部不充递质对照组、0.67kPaCO2组、1.33kPaCO2组、2.00kPaCO2组、0.67kPa生理盐水组、1.33kPa生理盐水组和2.00kPa生理盐水组。CO2和生理盐水灌注各组动物接受内镜甲状腺手术,分别在术前(T0),充气(充水)后45min(T1)、90min(T2)和放气(放水)后30min(T3)记录PaCO2、pH、心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、Na+和HCT。结果:0.67kPaCO2组各项检测指标均无明显变化;1.33kPaCO2组在T1和T2时,PaCO2显著升高(P<0.01);2.00kPaCO2组在T1和T2时,PaCO2、pH和CVP显著变化(P<0.01),T3时上述参数仍高于基线水平(P<0.05)。生理盐水灌注各组在各时间点PaCO2、pH和Na+无明显变化,HCT有下降趋势,但差异无统计学意义(P>0.05)。1.33kPa生理盐水组在...     

两种麻醉方法用于气管切开及插管的效果比较

目的 观察瑞芬太尼复合咪达唑仑能否减轻喉肿瘤患者气管切开及插管时的心血管反应并同时降低知晓发生率。方法 择期喉肿瘤手术患者30例,年龄35～55岁,ASA为Ⅰ～Ⅱ级,喉阻塞为Ⅰ～Ⅱ度,随机分为氟芬合剂组（I组）、瑞芬太尼+咪达唑仑组（R组）,每组15例。所有患者在1%利多卡因局部浸润麻醉下行气管切开,气管切开之前,I组患者静脉注射氟芬合剂2mL,R组患者缓慢静脉注射咪达唑仑50μg·kg－1,继之瑞芬太尼0.05μg·kg－1·min－1持续输注。气管切开完成即将插管时,I组患者静脉注射氟芬合剂2mL,R组患者缓慢静脉注射瑞芬太尼1μg·kg－1（大于1min）,记录局部浸润麻醉前(T0)、插管前即刻(T1)、插管成功即刻(T2)、麻醉诱导后2min(T3)的HR、MAP、SpO2;记录麻醉诱导时得普利麻的用量;记录气管切开过程中患者有无躁动、呛咳等反应。术后随访患者对气管切开及插管过程的知晓情况。患者SpO2＜90％定义为呼吸抑制。结果 与T0比较,I组T1时的MAP及HR无明显变化,T2时MAP及HR明显升高（P＜0.05）,T3时MAP及HR明显降低（P＜0.05）;R组T1及T2时MAP及HR无明显变化,T3时MAP与T0比较有所下降,但无统计学意义,而HR明显降低（P＜0.05）。与I组比较,T2时R组MAP及HR明显降低（P＜0.05）,而T3时MAP明显升高（P＜0.05）。所有患者均无明显呼吸抑制。两组患者气管插管完成后麻醉诱导所需得普利麻量有显著差异（P＜0.01）;与I组比较,R组呛咳、躁动等插管反应及插管知晓发生率明显降低（P＜0.01）。结论 在局部麻醉的基础上,瑞芬太尼复合咪达唑仑能明显减轻气管切开及插管引起的心血管反应及知晓发生率。     

无肌 松药全麻下实施鼻内镜手术的临床观察

目的探讨无肌松药（muscle loose medicine，NMB）全麻下鼻内镜手术的安全性和有效性。方法根据美国麻醉师协会（ASA）分级标准选择ASAⅠ～Ⅱ级择期行鼻内镜手术患者160例随机分为A、B两组，每组80例，均以瑞芬太尼、丙泊酚及氯化琥珀胆碱静脉快诱导，气管插管后A组以瑞芬太尼和丙泊酚维持麻醉，B组以瑞芬太尼、丙？白酚和维库溴铵维持麻醉。记录两组患者T1～T6各观察时点心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）、呼末二氧化碳分压（EtCO2）、术中体动次数、麻醉苏醒时间、拔管时间、有无不良反应及并发症。结果两组患者T1～T4各观察时点HR、MAP、SpO2变化无明显差别（P〉0．05），术中无体动反应；T5、T6时点A组麻醉苏醒时间和拔管时间明显短于B组（P〈0．01），B组麻醉苏醒后，低氧血症、分泌物增多、心动过缓发生率明显高于A组（P〈0．01）。结论瑞芬太尼一丙泊酚无肌松药全麻下实施鼻内镜手术效果肯定，麻醉苏醒和呼吸功能以及保护性反射恢复早，避免了肌松药及其拈抗药的不良反应。     

丙泊酚联合七氟烷对扁桃体切除术患儿苏醒期躁动及血流动力学的影响

目的 探究丙泊酚联合七氟烷对扁桃体切除术患儿苏醒期躁动及血流动力学的影响。方法 将择期行扁桃体切除术的88例患儿随机分为2组，每组44例。对照组患儿采用七氟烷麻醉，实验组患儿采用七氟烷复合丙泊酚麻醉。观察两组患儿不同时间点的血流动力学指标变化，使用Ramsay镇静评分、PAED躁动评分量表评估患儿镇静、躁动情况，记录两组患儿拔管时间、苏醒时间及PACU停留时间，并统计苏醒期躁动持续时间>15min的患儿人数。结果 两组在T0时的MAP、HR比较差异无统计学意义（P>0.05），在T1时的MAP、HR均明显升高，而在T2～T4时的MAP、HR逐渐下降，且实验组在T1～T4时的MAP、HR均低于对照组（P<0.05）。实验组在T2～T4时的Ramsay镇静评分均高于对照组（P<0.05）,PAED躁动评分均低于对照组（P<0.05）。两组拔管时间、苏醒时间及PACU停留时间比较差异均无统计学意义（P>0.05），实验组苏醒期躁动持续时间>15min的发生率低于对照组（P<0.05）。结论 丙泊酚联合七氟烷对扁桃体切除术患儿血流动力学影响较小，...     

低氧对人喉癌Hep-2细胞乙酰肝素酶蛋白表达及其侵袭力的影响

目的 探讨低氧对喉癌细胞表达乙酰肝素酶（heparanase，HPSE）蛋白及其侵袭力的影响。方法 将Hep-2细胞分为常氧组和低氧组，分别置于常氧（37℃，5％CO2，20％O2）和低氧（37℃，5％CO2，2％O2）条件下培养6、12、24、36h，采用流式细胞学方法对HPSE蛋白表达进行检测，以荧光指数表示HPSE蛋白表达的相对含量，采用基质凝胶侵袭实验检测各组细胞侵袭力。结果 常氧及低氧6、12、24、36h状态下Hep-2细胞HPSE蛋白的相对表达量依次升高，常氧组与低氧6h组HPSE蛋白的相对表达量比较差异有统计学意义（P〈0．05），常氧组与低氧12、24、36h组HPSE蛋白的相对表达量比较差异有统计学意义（P值均〈0．01），而低氧6、12及24h组间荧光指数比较，HPSE蛋白表达量差异有统计学意义（P〈0．05）；常氧组侵袭细胞数与低氧6h组比较差异无统计学意义（P〉0．05），常氧组侵袭细胞数与低氧12h组比较差异有统计学意义（P〈0．05），常氧组侵袭细胞数与低氧24、36h组比较差异有统计学意义（P〈0．01），而且随着低氧时间延长，侵袭细胞数逐渐增多，组间比较差异有统计学意义（F=20．01，P〈0．01），在低氧6～36h期间，低氧引起的细胞侵袭力的提高呈时间依赖性；低氧时HPSE蛋白表达的变化与细胞侵袭力的变化呈正相关（r=0．8092，P〈0．01）。结论 低氧可显著提高Hep-2细胞HPSE蛋白的表达及其细胞的侵袭力，其侵袭力的增加可能与HPSE表达水平增高有密切关系。     

Eotaxin基因和趋化因子受体3在变应性鼻炎大鼠模型鼻腔黏膜和骨髓中的表达及意义

目的：探讨Eotaxin（嗜酸粒细胞趋化因子）基因和趋化因子受体3（CCR3）在变应性鼻炎（AR）大鼠模型鼻腔黏膜和骨髓中的表达及其意义。方法：采用6～8周龄雄性SD大鼠20只,随机分成实验组（AR组）和对照组,每组10只,以卵清蛋白致敏激发制成AR模型,瑞特染色计数骨髓涂片和外周血涂片中白细胞比例,免疫组织化学技术检测骨髓中CCR3的表达;制备大鼠鼻腔黏膜组织病理标本,苏木精-伊红染色,原位分子杂交方法检测鼻腔黏膜中Eotaxin mRNA的表达,免疫组织化学技术检测Eotaxin在鼻腔黏膜中的表达。结果：AR组骨髓涂片中嗜酸粒细胞比例显著高于对照组（P〈0．01）,AR组外周血涂片中嗜酸粒细胞比例显著高于对照组（P〈0．01）;与对照组比较,AR组大鼠鼻腔黏膜中Eotaxin阳性细胞数与EotaxinmRNA表达明显增强（P〈0．01）,且二者呈正相关性（r=0．804,P〈0．01）。AR组Eotaxin的表达与鼻腔黏膜嗜酸粒细胞的数量呈显著正相关（r=0．795,P〈0．01）。AR组骨髓涂片中CCR3阳性细胞比例显著高于对照组（P〈0．01）,AR组骨髓涂片中CCR3阳性细胞比例和外周血嗜酸粒细胞比例呈显著正相关（r=0．736,P〈0．05）。结论：AR组中Eotaxin和CCR3表达增强,为嗜酸粒细胞从骨髓快速募集到鼻腔黏膜提供了可能。     

蛋白激酶C和激活蛋白-1信号级联在变应性鼻炎患者T淋巴细胞IL-5表达中的调控作用

目的：探讨蛋白激酶C（PKC）和激活蛋白-1（AP-1）信号转导级联在变应性鼻炎（AR）患者外周血T淋巴细胞IL-5表达中的作用。方法：25例AR患者和23例鼻中隔偏曲（DNS）患者为研究对象，分别从每位受试者外周血中分离T淋巴细胞，并随机分为空白组、PKC激动剂12-肉豆蔻酰-13-乙酸佛波酯（PMA）组、PMA和AP-1抑制剂姜黄素组进行培养。将培养的T淋巴细胞涂片，用免疫细胞化学染色方法检测AP-1的表达，用酶联免疫吸附（ELISA）法检测上清液中的IL-5含量。结果：①加PMAAR组T淋巴细胞的AP-1活化细胞百分比和培养上清液中的IL-5与DNS空白组与AR空白组比较，均差异有统计学意义（均P〈0．01）；与加PMADNS组及加PMA和姜黄素DNS组T淋巴细胞比较，均差异有统计学意义（均P〈0．01）；与加PMA和姜黄素AR组T淋巴细胞比较，差异亦有统计学意义（P〈0．01）；②加PMA和姜黄素AR组T淋巴细胞AP-1活化细胞百分比、培养上清液中的IL-5含量与AR空白组、加PMAAR组、DNs空白组、加PMADNS组、加PMA和姜黄素DNS组比较，均差异有统计学意义（均P〈0．01）；③T淋巴细胞的AP-1活化与IL-5表达呈显著正相关（r=0．92，P〈0．01）。结论：AR患者T淋巴细胞PKC活化后促进IL-5表达增加的生物信号可能是通过AP-1进行转导，提示T淋巴细胞PKC—AP-1信号转导级联的激活可能是AR发病机制之一。     

喉鳞状细胞癌患者预后的多因素分析

目的：探讨影响喉鳞状细胞癌患者预后的主要因素。方法：采用免疫组织化学SP法检测79例喉鳞状细胞癌患者肿瘤组织和10例癌旁正常组织中细胞s期激酶相关蛋白（Skp2）、p27、上皮细胞钙黏素（E-cad）、r连环素（α-cat）的表达,并对可能影响喉鳞状细胞癌患者预后的12项临床病理因素进行单因素和多因素分析。结果：①Skp2在喉鳞状细胞癌和癌旁正常组织中的表达率分别为53,16％和0,p27分别为30．38％和90．00％,E-cad分别为34．18％和100,00％,α-cat分别为40．51％和100,00％,其差异均有统计学意义（P〈0．05或P〈0．01）。②本组患者总的5年生存率为58．75％,Skp2蛋白低表达组的5年生存率（72．18％）显著高于高表达组（44．17％）（P〈0.01）;p27蛋白高表达组的5年生存率（72．98％）显著高于低表达组（51．13％）（P〈O．01）;E-cad及α-cat阳性表达组的5年生存率（分别为63．80％和81．74％）显著高于阴性表达组（分别为50.68％和41．09％）（P〈0．05和P〈0．01）。③单因素分析显示：病理分级,颈淋巴结转移,临床分期,T分期,复发,Skp2、p27、E-cad及α-cat表达对患者预后的影响均有统计学意义（P〈0．05或P〈0．01）;多因素分析显示：复发、Skp2及α-cat表达为影响患者预后的独立因素（P〈0．05或P〈O．01）。④Skp2和p27蛋白表达之间存在着负相关关系（P〈0.01）;p27和α-cat蛋白表达之间、E-cad和α-cat蛋白表达之间存在正相关关系（均P〈0．01）。结论：复发、Skp2及α-cat表达为影响喉鳞状细胞癌患者预后的重要因素。     

初诊鼻咽癌患者血清TGF-β1、PDGF-β水平及其与肿瘤分期的相关性

目的研究初诊鼻咽癌患者血清TGF-p1及PDGF-D水平变化及其与肿瘤分期的关系。方法分别采用放射免疫分析法及酶联免疫吸附试验法（ELISA）法检~f]30例健康对照者（正常对照组）及61例初诊鼻咽癌患者（患者组,临床TNM分期I期7例、Ⅱ期16例、Ⅲ期21例、Ⅳ期17例）血清TGF-D1及PDGF-p水平,分析其与肿瘤分期的相关性。结果与正常对照组比,患者组血清TGF-plzk平明显升高,其值为（46．66±4-14．10）ug／L,正常组为（8．61±2．55）ug／L,鼻咽癌患者血清PDGFp水平亦显著升高,其值为（376．72±16．47）ug／L,正常组为（25．33土7．18）ug／L,（P〈0．01）;血清TGF-D1（I期-Ⅳ期分别为：27．91±8．21、34．26±5．56、40．34±7．88、47．57±12．03）及PDGF-p水平（I期-Ⅳ期分别为：277．30±31．97、312．68±22．03、360．25±18．89、401．36±14．72）均随TNM分期的递增而逐步升高,其中Ⅳ期较其他各期显著升高（P〈0．01,P〈0．05）;1I期与Ⅲ期患者血清TGF-D1及PDGF-p水平较I期明显升高,差异有统计学意义（P〈0．01,P〈0．05）;11I期患者血清TGFp1较Ⅱ期明显升高,差异有统计学意义（P〈0．05）,但血清PDGF-p水平较Ⅱ期无统计学意义（P〉0．05）;相关性分析表明,血清TGF-D1与PDGFp水平呈明显正相关（r=0．763,P〈0．01）;血清TGF-p1、PDGF-p水平与TNM分期呈明显正相关（盼别为O．667、0．816,P〈0．01）。结论初诊鼻咽癌患者血清TGF-p1与PDGF-p明显升高,其升高的程度与临床分期显著相关。     

Cuff pressure and microvascular occlusion in the tracheal mucosa. An intravital microscopic study in the rabbit

A method is described for the intravital microscopic observations of rabbit tracheal mucosa microcirculation during compression with a thin, transparent high volume cuff. The cuff pressure (CP) required to cause complete ischemia in the mucosa over the cartilages was measured and a correlation was found to the mean arterial blood pressure (MAP). Ischemia was not observed below CP-MAP ratios of 0.40 for untreated animals or below 0.44 for animals where the MAP had been elevated by adrenalin. However, marked reduction of the microvascular blood flow was present at lower CP-MAP ratios, 0.2-0.3, which at a MAP of 75 mmHg corresponds to cuff pressures of 15-20 mmHg. It is therefore advocated that endotracheal cuff pressures are kept below these values to avoid ischemic tissue injury.     

Endoscopic resection of the submandibular gland in a porcine model

OBJECTIVE: To examine the feasibility of endoscopic resection of the submandibular gland in a porcine model. STUDY DESIGN: Experimental, nonrandomized prospective study. METHODS: Twelve endoscopic submandibular gland resections were performed on seven Yorkshire adult pigs using a combination of balloon dissection and low-pressure CO2 insufflation. The operative time, blood loss, blood pressure, oxygen saturation, temperature, arterial blood gas values, and weight of the glands were measured. RESULTS: All 12 submandibular gland resections were successfully performed endoscopically, and no conversions to open resection were necessary. The procedures lasted 42 to 140 minutes (median duration, 59 min). The median estimated blood loss was 15 mL. The submandibular glands weighed 13.3 +/- 1.5 g. The arterial blood pH varied from a decrease of 0.08 to an increase of 0.09 units from the beginning to the end of the operation. Similarly, the arterial CO2 pressure at the end of the case varied from a decrease of 15.8 to an increase of 16.2 mm Hg from the starting value. The presence of normal glandular architecture and lack of trauma or thermal injury were confirmed histologically. There were no cases of pneumothorax or air embolism, and no animals had to be killed. In one animal, a modest amount of subcutaneous emphysema could be appreciated, which was confined to the area over the operative pocket. CONCLUSION: Endoscopic resection of the submandibular gland is possible by combining balloon dissection with low-pressure CO2 insufflation, thereby avoiding complications of high-pressure insufflation such as pneumothorax and air embolism.     

Relief of posttonsillectomy pain with low-dose tramadol given at induction of anesthesia in children

OBJECTIVE: Pain is major problem regarding quality of life in children undergoing tonsillectomy. Preemptive analgesia by medicine given before commencement of surgery is a new way recommended for relief of pain during and after operation. The purpose in this study to evaluate preemptive efficacy and safety of lower dose of tramadol, which was recently introduced in children undergoing tonsillectomy. METHODS: This study was performed on 45 children undergoing tonsillectomy with or without adenoidectomy as a double-blinded trial, by using tramadol in two dosages (1 and 0.5 mg kg(-1)) and placebo. Pain assessment was done by facial pain score (FPS), visual analog scale (VAS) and postoperative analgesic requirement; further, duration of anesthesia and duration of awakening time, heart rate (HR) and mean arterial pressure (MAP) during and after anesthesia, postoperative nausea and vomiting (PONV) and recall of intraoperative events were recorded. RESULTS: It was found that 73% children in placebo group needed analgesic medicine at the end of the first hour after operation, although no analgesic medicine was needed in tramadol groups (chi(2) test, P<0.001). However, statistically significant decrease in FPS and VAS in tramadol groups were only found up to 15th and 30th min after operation, respectively (Kruskall-Wallis test, P<0.05). On the other hand, intraoperative HR (10th, 20th and 30th min) and MAP (10th and 20th min) were found to be higher in placebo groups (ANOVA variance analysis, Tukey-Kramer test adjusted paired t-test, P<0.001 and <0. 01, respectively). No significant difference was found in the other parameters, and no surgical complication and adverse side effect were occurred in this number of study sample. CONCLUSION: Tramadol in lower doses (0.5-1 mg kg(-1)) was an efficient preemptive analgesic that could be used at induction of anesthesia in adenotonsillectomies of children for providing both good analgesia during operation as supplementation to propofol anesthesia and postoperative analgesia in only early period.     

Daily noise duration influences cardiovascular responses

In this study, third in a series on non-auditory health effects of noise, we provide data on the previously developed proposition that exposure to intense noise is linked with altered blood pressure regulation through the establishment of a long-term dose----response relationship between the two variables. We also sought to determine the effect of interposed rest sessions on the course of heart rate (HR) and blood pressure (BP) during 97 days of exposure to tape-recorded industrial noise. The stimulus, delivered to 2 female adult macaque monkeys (M. fascicularis) fitted with indwelling cannulas, consisted of pile-driver impacts and other construction noises presented either in 4-hr (Leq24 = 86.6 db) or 8-hr (Leq24 = 89.6 db) daily sessions. When compared to their pre-exposure responses, mean arterial pressure (MAP) for the Ss rose 8.2% during 4-hr and 16.5% during 8-hr exposure sessions, i.e., close to a doubling effect for a doubling of total energy. When compared with control monkeys (N:10) used in earlier studies, however, MAP rose in the present Ss only 44% for the same doubling of energy. In general, HR and BP displayed quite different tendencies during the per-exposure rest sessions and the post-exposure period: HR tended to return to baseline levels upon noise termination whereas MAP, once elevated, tended to remain significantly elevated. Applicability of the "law" of Initial Values was demonstrated for noise-induced BP increases, in the sense that the percentage of change in BP produced by 8-hr exposure sessions in the 2 present Ss was 16.5%, or somewhat less than that previously observed in exposed monkeys with lower baseline levels (i.e., 30.5%), even though absolute levels of per-exposure MAP were similar (i.e., 99 vs 100 mmHg) for the two sets of exposed monkeys.     

食管音气流注入位置筛选与新发声方式的研究

目的：探讨全喉切除后寻找最佳发声位置与可行的措施。方法：全喉切除安装发音管健在的33例患者,有12例不能发声,选择10例作为失声组;在发声病例中选择10例性别、年龄、病理类型、手术方式较接近者为发声组。分别进行食管上端测压、充气发声试验、吞钡检查及纤维喉镜检查。结果：前鼻孔至食管入口、最佳发声位置、发音管水平距离两组均无差异。发声充气试验显示,发音管水平失声组无一例发声阳性;发声组7例阳性,3例阴性。最佳发声位置,失声组在发音管水平上方3．6cm,发声组在2．0cm处。食管上端测压显示,食管入口下1．0cm与发音管水平下2．0cm压力较低,2组差异无统计学意义（P〉0．05）。发音管水平压力较高,2组差异有统计学意义（P〈0．01）。失声组4例简易型食管音发声器试用均可发声,发声组中1例应用亦能发声。结论：发音管平面、失声组压力明显高于发声组,是不能发声的主要因素。2组在食管入口下方可找到最佳发声位置,该位置下方是压力最高的发音管平面,可有效阻止气流向下进入胃内,从而解决了失声组不能发声的问题,提高了发声成功率。若使发声气流到达该处,可通过手术;发音管改革;食管音发声器均可将气流引入该处。     

Effects of intramuscular and peritonsillar injection of tramadol before tonsillectomy: a double blind, randomized, placebo-controlled clinical trial

BACKGROUND/AIMS: Our objective was to investigate the efficacy of intramuscular injection and peritonsillar infiltration of tramadol to prevent pain in children undergoing tonsillectomy. METHODS: In a double-blinded trial, 45 children were randomized into three groups: infiltration anesthesia with tramadol (2 mgkg(-1)) to the peritonsillar area (INF group, n=15), intramuscular analgesia with tramadol (2 mgkg(-1)) (IM group, n=15), and the placebo controls (PL group, n=15). Visual analog scale (VAS) scores for pain assessment, heart rate (HR) and mean arterial pressure (MAP) during and after anesthesia were recorded. RESULTS: Mean HR values were higher in INF than PL group at 10th, 20th, and 30th minutes of operation (P<0.05). Nine children required analgesics within the first hour after surgery in PL compared to 1 child in INF group (P=0.036). VAS scores on awakening were significantly better in INF than PL group (P=0.015). The difference between IM and PL groups was not significant for any of the parameters. CONCLUSION: Peritonsillar infiltration with tramadol provided good intraoperative analgesia, less postoperative pain on awakening and lower analgesic requirement within the first hour after surgery.     

Marked hypotension induced by adrenaline contained in local anesthetic

OBJECTIVES: Local anesthetics containing adrenaline, which often cause cardiovascular side effects, are routinely used in functional endoscopic sinus surgery (FESS) for the main purpose of hemostasis. The controversies concerning hemodynamic effects of adrenaline in local infiltration are widely discussed, but there is no definite conclusion. A prospective, randomized, double-blinded study was carried out to discover the hemodynamic effects after local infiltration of 1:200,000 adrenaline contained in 2% lidocaine under general anesthesia. STUDY DESIGN: Seventy-six adult patients undergoing FESS during general anesthesia were allocated randomly into three groups. Group I patients (n = 26) received 2% lidocaine 2 mL with adrenaline (1:200,000), group II patients (n = 25) received saline 2 mL with adrenaline (1:200,000), and group III patients (control group, n = 25) received saline 2 mL without adrenaline for local infiltration. Electrocardiogram (ECG) and heart rate (HR) were monitored simultaneously; systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP) were directly measured in radial artery continuously after local infiltration. METHODS: SBP, DBP, MAP, and HR were recorded at 10 time points: before infiltration (baseline), 0.5 minutes, 1 minute, 1.5 minutes, 2 minutes, 2.5 minutes, 3 minutes, 3.5 minutes, 4 minute, and 5 minutes after infiltration. RESULTS: Significant hemodynamic changes, particularly hypotension (P < .01), after local infiltration were observed in group I and group II compared with the baseline, but not in group III. However, there were no significant hemodynamic changes between group I and group II at the same time points (P > .05). The significant hemodynamic changes lasted no longer than 4 minutes. CONCLUSIONS: Lidocaine (2%) or saline with adrenaline (1:200,000) does cause temporary hypotension and other hemodynamic changes during general anesthesia, which last no longer than 4 minutes. The causative mechanism is caused by the effect of adrenaline. This is a preliminary study.     

玻璃体腔注射雷珠单抗联合小梁切除术及全视网膜光凝治疗新生血管性青光眼的效果评价

目的 评价玻璃体腔注射雷珠单抗联合小梁切除术及全视网膜光凝治疗新生血管性青光眼的疗效及安全性。方法 2013年12月至2014年5月山东省立医院眼科收治新生血管性青光眼24例(24眼), 行玻璃体腔注射雷珠单抗联合小梁切除术及全视网膜光凝治疗, 比较手术前后患者视力、眼压, 观察术后并发症及手术成功率。结果 随访8.6±1.7个月, 患者术后1周、1个月、3个月、6个月时的眼压分别为10.9±2.7 mmHg、13.3±3.2 mmHg、14.0±3.4 mmHg、15.4±5.1 mmHg, 与术前相比, 眼压均明显下降(P<0.01);患者应用抗青光眼药物数量分别为(0.2±0.5)种、(0.4±0.7)种、(0.4±0.8)种、(0.5±1.0)种, 与术前相比, 用药数量明显下降(P<0.01)。随访结束时, 14例患者视力稳定, 8例患者视力提高, 2例患者视力下降。术后6个月时的手术成功率为91.7%。 结论 玻璃体腔注射雷珠单抗联合小梁切除术及全视网膜光凝治疗新生血管性青光眼安全、有效。     

食管充气试验在二期发音重建中的作用

目的 尽快恢复无喉者语言功能，减少手术创伤，提高预测二期发音重建手术成功的准确性，客观评价食管充气试验的实际临床意义。方法 对全喉切除术后无喉者行食管充气试验及二期发音重建，特别就食管充气试验阴性患者进行研究分析。结果 ４５例食管充气试验阴性患者行二期发音重建，而不行咽缩肌切断术的发音成功率９４％（３６／３８），阳性患者成功率１００％（７／７）；无论充气试验阴性或阳性患者术后发音效果均好于预测试验