托烷司琼对口腔颌面外科术后带管患者恶心、呕吐的预防作用

目的:探讨盐酸托烷司琼用于预防口腔颌面外科手术后带气管导管(以下简称为带管)患者恶心、呕吐的效果.方法:120例全麻下择期行口腔颌面外科手术患者,ASA评分Ⅰ或Ⅱ级,术前无恶心、呕吐,无胃肠疾病,术前24h未用任何抗呕吐药物,术毕苏醒后均带管人SICU.所有患者均无手术及麻醉史.对药物过敏,有精神性恶心、呕吐者除外.以随机双盲法将患者分为A、B、C、D、E、F 6组,每组20例.A为对照组,不使用盐酸托烷司琼;B组在手术结束即刻静脉推注盐酸托烷司琼2.5mg;C组在手术结束即刻静脉推注盐酸托烷司琼5mg;D组只在自控静脉镇痛泵(PCIA)中加盐酸托烷司琼2.5mg;E组只在PCIA泵中加盐酸托烷司琼5mg;F组在手术结束即刻静脉推注盐酸托烷司琼2.5mg,同时在PCIA泵中加盐酸托烷司琼2.5mg.采用视觉模拟评分法(VAS).对术后12、24、48h镇痛评分;采用4级评分法对恶心、呕吐评分.采用SPSS11.0软件包对数据进行统计学分析.结果:各组均有恶心、呕吐患者,但其发生率及程度不同,A组恶心、呕吐发生例数显著高于其余5组(P<0.05).F组恶心、呕吐发生率以及程度显著低于A、B、C、D组(P<0.05).各组患者术后镇痛评分(VAS)无显著性差异(P>0.05).结论:静脉注射盐酸托烷司琼能有效降低口腔颌面外科手术后带管患者恶心、呕吐的发生率,而且持续泵入给药较单次静脉给药效果更确切.     

雷莫司琼和托烷司琼预防口腔颌面外科术后恶心、呕吐的疗效观察

目的:比较雷莫司琼和托烷司琼预防口腔颌面外科术后恶心、呕吐的效果。方法:选择120例ASAⅠ～Ⅱ级择期行口腔颌面外科手术的患者,随机分为3组,在麻醉诱导前静脉注射雷莫司琼(R组,n=40)0.3mg、托烷司琼(T组,n=40)5mg、生理盐水(对照组,C组,n=40)5mL。观察术后24h内恶心、呕吐的发生情况,采用SPSS 11.0软件包对数据进行χ2检验。结果:术后24h内,恶心、呕吐的发生率R组和T组显著低于C组,差异有统计学意义(P<0.05),R组和T组比较差异无统计学意义(P>0.05)。结论:雷莫司琼和托烷司琼均可显著减少术后恶心、呕吐的发生率,两者疗效相当。     

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目的比较盐酸戊乙奎醚和阿托品用作口腔手术患者术前用药的临床效果。方法选择河南大学淮河医院2004年8月至2007年10月收治的100例美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级择期全麻下行口腔颌面外科手术患者,随机分为两组,Ⅰ组(盐酸戊乙奎醚组)和Ⅱ组(阿托品组),每组50例。两组患者分别于三角肌注射盐酸戊乙奎醚0.01mg/kg和阿托品0.01mg/kg,观察注药后10min、20min和30min的血压、心率,用视觉模拟评分(VAS)测定口干程度,手术结束后评估恢复期口干和腺体分泌情况。结果两组患者肌注盐酸戊乙奎醚或阿托品后30min内收缩压、舒张压与注药前比较差异均无统计学意义;阿托品组对心率的影响明显,以肌注后20min至30min最为明显,与注药前及盐酸戊乙奎醚组比较差异有统计学意义;两组注药后均有口干,但两组间差异无统计学意义。结论盐酸戊乙奎醚不影响血压和心率,是口腔颌面手术麻醉前用药的更佳选择。     

口腔颌面外科术后延迟拔管患者应用盐酸戊乙奎醚的疗效观察

目的:比较观察口腔颌面外科术后肌注盐酸戊乙奎醚和硫酸阿托品对患者口腔、气道腺体分泌的影响,探讨术后肌注盐酸戊乙奎醚的临床疗效。方法:45例美国麻醉医师学会分级Ⅰ～Ⅱ级、术后需要保留气管导管2d的口腔颌面外科手术患者随机分为3组,每组15例,A组为对照组,B组为硫酸阿托品组,C组为盐酸戊乙奎醚组。于术毕以及术后24h分别肌注生理盐水、硫酸阿托品0.5mg和盐酸戊乙奎醚0.01mg/kg。观察术后0～12h、12～24h、24～36h和36～48h各时间段内患者平均每小时口腔、气道分泌物量和不良反应,采用SAS6.12统计软件包进行分析。结果:从平均每小时口腔分泌物量看,给药后前12h内(0～12h和24～36h),B组和C组显著少于A组(P<0.05和P<0.01),C组也显著少于B组(P<0.05);后12h(12～24h和36～48h)内,C组显著少于A组(P<0.05)而B组与A组差异不大(P>0.05)。从平均每小时气道分泌物量看,各时间段C组均显著少于A组和B组(P<0.05);各组均未发生严重不良反应。结论:术后肌注盐酸戊乙奎醚能明显抑制保留气管插管的口腔颌面外科患者口腔、气道腺体分泌,安全有效。     

盐酸戊乙奎醚对接受口腔颌面部手术的老年患者认知功能的影响

目的: 探讨麻醉前应用阿托品以及不同剂量盐酸戊乙奎醚对接受口腔颌面部手术的老年患者术后认知功能的影响。方法: 选择2017年12月—2018年7月于上海交通大学医学院附属第九人民医院择期行口腔颌面部手术的老年患者134例,麻醉诱导前随机接受阿托品0.5 mg（A组,n=32）、盐酸戊乙奎醚0.01 mg/kg（C1组,n=34）、盐酸戊乙奎醚0.015 mg/kg（C2组,n=33）、生理盐水（NS组,n=35）作为术前用药。比较4组患者术前焦虑评分、术前认知功能评分、用药后生命体征变化、口腔腺体分泌程度、手术时间、失血量、苏醒时间、术后疼痛评估、术后认知功能评分。采用SPSS 18.0软件包对数据进行统计分析。结果: A组患者用药后心率变化较其余3组显著升高（P<0.05）,A组、C1组、C2组患者用药后在准备室需要吸引口腔内分泌物次数较对照组显著减少（P<0.05）,C2组苏醒时间较其余3组显著延长（P<0.05）,MMSE评分显著下降（P<0.05）。结论: 麻醉诱导前应用小剂量（0.01 mg/kg）盐酸戊乙奎醚,不延长苏醒时间、不增加术后认知功能下降风险,同时其抑制口腔腺体分泌效果好,对老年患者心肺系统影响较小,是老年口腔颌面部手术患者理想的术前用药。     

小剂量舒芬太尼复合丙帕他莫对口腔颌面外科手术术后苏醒期应激反应的影响

目的:观察小剂量舒芬太尼复合丙帕他莫对口腔颌面外科手术患者术后苏醒期拔管时应激反应的效果。方法:选取60例ASAⅠ～Ⅱ级择期在全身麻醉下行口腔颌面外科手术的患者,随机分为舒芬太尼组(S组)、舒芬太尼复合丙帕他莫组(S+P组)和生理盐水对照组(C组),每组各20例。S组于手术结束时静脉推注舒芬太尼0.2μg/kg,S+P组于手术结束时静脉推注舒芬太尼0.1μg/kg+静脉输注20g/L丙帕他莫50mL,C组于手术结束时静脉输注生理盐水50mL。分别记录患者手术结束时(T0)、拔管后1min(T1)、3min(T2)、5min(T3)时的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR),并于以上各时点抽取动脉血测定血糖,记录清醒和拔管时间以及其他不良反应。采用SPSS12.0软件包进行统计学处理。结果:T1-T3时,S组及S+P组的MAP、HR均低于C组;T1-T3时,C组血糖高于T0时,同时也高于S组及S+P组。拔管时,C组躁动发生率显著高于S组及S+P组,S组的清醒时间较S+P组及C组显著延长。结论:口腔颌面外科手术患者拔管前给予小剂量舒芬太尼复合丙帕他莫,可以减轻苏醒期拔管时的应激反应。     

瑞芬太尼复合七氟醚在口腔颌面外科手术中的应用

［摘要］ 目的 观察瑞芬太尼-七氟醚静吸复合麻醉与瑞芬太尼-丙泊酚全凭静脉麻醉在口腔颌面外科手术中的应用。方法 40例ASAⅠ~Ⅱ级患者,择期行口腔颌面外科手术,随机分为瑞芬太尼-七氟醚组(S组)和瑞芬太尼-丙泊酚组(P组),每组20例。记录围麻醉期各时点的血流动力学变化,及唤醒时间、拔管时间和苏醒期的不良反应,比较两组瑞芬太尼使用总量。结果 2组病例术中麻醉效果满意,诱导前、诱导后、手术开始后30 min和术毕的平均压、心率组间比较差异无显著性(P>0.05)。S组瑞芬太尼使用总量较P组低,差异有显著性(P<0.05)。两组患者在手术结束后均能快速苏醒,S组与P组的停药到唤醒时间和拔管时间比较差异无显著性(P>0.05)。但S组患者在苏醒期躁动反应发生率高于P组(P<0.05)。结论 瑞芬太尼复合七氟醚可以安全、有效的运用于口腔颌面外科手术中。     

盐酸戊乙奎醚用于小儿口腔全麻前给药的研究

目的:观察比较盐酸戊乙奎醚(penehyclidine hydrochloride)和阿托品、东莨菪碱用作小儿口腔全麻前用药的临床效果。方法:45例小儿唇裂或腭裂修补手术患儿根据术前用药情况随机双盲分为盐酸戊乙奎醚组(PHE)、阿托品组(ART)和东莨菪碱组(SCO),每组15例,分别在麻醉开始前30min肌注盐酸戊乙奎醚或阿托品、东莨菪碱0.01mg/kg,记录给药前(T0)及给药后10min(T1)、30min(T2)患儿的血压(BP)、心率、脉搏血氧饱和度(SpO2)及T0、T1、T2和气管导管拔除时(T3)患儿面红、腺体分泌情况。结果:3组患儿年龄、性别、体质量均无显著性差异(P>0.05);PHE组术前注药后心率、血压无明显改变(P>0.05),ART组、SCO组注药后心率均明显增快(P<0.01或P<0.05),与PHE组比较有显著性差异(P<0.05);PHE组口干持续时间较ART、SCO2组明显延长,与后2组比较,气管拔管时分泌物量明显减少,且面红发生率较低(P<0.05)。结论:盐酸戊乙奎醚具有显著的心率稳定作用及强大持久的腺体分泌抑制作用,作为术前用药效果满意,优于阿托品和东莨菪碱,可安全用于小儿颌外口内手术麻醉前给药。     

口腔颌面外科学：麻醉与手术

咪哒唑仑用于颌面外科手术后留置气管导管患者的临床研究；下颌升枝矢状劈开截骨术对骨性下颌前突舌骨位置和气道宽度的影响；口腔颌面外科术后延迟拔管患者应用盐酸戊乙奎醚的疗效观察；静脉泵入眯达唑仑清醒镇静技术控制牙科恐惧症的临床效果评价；保留自主呼吸全身麻醉用于小儿唇裂手术的安全性探讨     

牙颌面畸形患者手术前后生活质量变化研究

目的    评估牙颌面畸形患者正颌手术前后口腔健康相关生活质量的变化，为临床方案制定和医患沟通提供参考。方法    选择2019年6—12月于中国医科大学附属口腔医院口腔颌面外科接受正颌手术的牙颌面畸形患者35例作为研究组，100名健康正常人作为对照组，以正颌手术生活质量问卷（OQLQ）对患者手术前后口腔健康相关生活质量进行评估。结果    牙颌面畸形患者的口腔功能、面部美学、牙颌面美学感知以及社会因素的术后评分均低于术前（P < 0.001），术前评分均高于对照组（P < 0.001）；术后牙颌面美学感知和社会功能的评分高于对照组（P < 0.05）。结论    牙颌面畸形患者正颌手术术前的口腔健康相关生活质量低于正常群体，术后各维度比术前均明显改善，但术后牙颌面美学感知和社会功能方面的生活质量仍低于正常人群。     

Postoperative nausea and vomiting after oral and maxillofacial surgery: a prospective study

Postoperative nausea and vomiting (PONV) is one of the most unpleasant experiences after surgery. It reduces patient satisfaction and also increases hospital costs due to longer hospitalizations. The aim of this prospective study was to determine whether orthognathic surgery is associated with more PONV than less invasive maxillofacial surgery. Three hundred and eight patients aged 8–87 years who underwent maxillofacial surgery were included. The PONV score, based on the Apfel score, was calculated preoperatively. PONV occurred in 142 (46.1%) patients during the first three postoperative days; these patients were further categorized as having postoperative nausea (PON) and/or postoperative vomiting (POV). PON was most frequent after orthognathic surgery to the mandible (75%), and POV was most frequent after maxillary surgery, including bimaxillary surgery, Le Fort I osteotomy, and surgically assisted rapid palatal expansion (SARPE) (43.1%). There was a small significant relationship between the preoperative PONV score and the incidence of PONV: patients experienced more PONV when the PONV score calculated preoperatively was higher. The incidence of PONV after orthognathic surgery was very high compared with the incidence after dental extractions and other minor surgeries. Further investigation is required to establish a strategy to reduce PONV after orthognathic surgery.     

动态营养支持对口腔颌面肿瘤术后能量代谢、免疫功能及应激反应的影响

目的：观察动态营养支持对口腔颌面部肿瘤患者术后能量代谢、免疫功能及应激反应的影响。方法：选取口腔颌面部肿瘤手术患者56例,随机分为实验组（28例）和对照组（28例）。实验组术后根据应激期给予动态肠内、肠外营养支持,并添加ω-3鱼油脂肪乳注射液及谷氨酰胺;对照组常规术后肠内、肠外营养支持。分别于术前1 d、术后2 d及7 d检测能量代谢、免疫功能及应激指标。采用SPSS 19.0软件包对数据进行统计学分析。结果：实验组前白蛋白术后第2天及血清白蛋白、前白蛋白术后第7天能量代谢指标高于对照组,实验组空腹血糖、甘油三酯术后第2天及第7天均显著低于对照组（P<0.05）。实验组术后第7天IgA、IgG、IgM、CD3⁺、CD4⁺、CD4⁺/CD8⁺水平显著高于对照组（P<0.05）。实验组术后第2天IL-6以及术后第7天CRP、TNF-α、IL-6水平显著低于对照组（P<0.05）,2组术后并发症无显著差异。结论：动态营养支持可以改善口腔颌面肿瘤术后能量代谢,提高机体免疫功能,缓解应激反应。     

Predicting postoperative nausea and vomiting in patients undergoing oral and maxillofacial surgery

A common predictive measure of postoperative nausea and vomiting (PONV) is the Apfel score. Although tested in many different operations, it has not been tested extensively in oral and maxillofacial surgery (OMFS). This study was designed to determine whether it applied to OMFS and whether there were other factors in this population that would improve its accuracy. A retrospective chart review was carried out on a randomly selected group of patients who had OMFS during a 10-month period. In addition to the Apfel score risk factors, PONV data were collected in relation to type of anesthetic induction and maintenance, type of surgery, use of maxillomandibular fixation (MMF), use of opioids, and anesthesia and surgery times. One-hundred and sixty-seven patients were included in the analysis; 24% had nausea and 11% had nausea and vomiting. Patients who had orthognathic or temporomandibular joint surgery had the highest rate of PONV. Young age, anesthesia and operation time, and use of MMF were also associated with increased PONV. Adding age, MMF or limited postoperative mouth opening, and surgery type to the Apfel score should make it more predictive in OMFS.     

Do oropharyngeal throat packs prevent fluid ingestion during orthognathic surgery?

The oropharyngeal throat pack is commonly used in oral and maxillofacial surgery despite debated evidence regarding its barrier function. The study objectives were to investigate whether the oropharyngeal pack reduces blood ingestion and to evaluate its relationship with postoperative nausea and vomiting (PONV) and throat pain. This was a single-center, parallel group, single-blind randomized controlled trial. Participants undergoing orthognathic surgery, age ≥16 years, were included in the study. After intubation and prior to surgery start, the treatment group received oropharyngeal packing; the control group received no packing. Outcome variables were the quality of gastric contents aspirated by nasogastric tube (bloody or not bloody), PONV, and throat pain (visual analog scale). Thirty patients (treatment n = 15; control n = 15) were randomized and analyzed. There was no difference between the groups in quality of gastric contents (P = 1.00) or incidence of PONV at 2 hours and 24 hours (P = 1.00). Throat pain incidence and severity at 2 hours were both higher in the treatment group, but this was not statistically significant (P = 0.128, P = 0.223). The results indicate that the oropharyngeal pack is not an effective barrier against blood ingestion. Oropharyngeal packs do not improve or worsen PONV, but may increase throat pain.     

口腔颌面外科患者手术前后甲状腺激素水平的变化

目的:观察口腔颌面外科不同程度手术创伤患者手术前、后甲状腺激素水平的改变,为术后康复治疗提供参考依据。方法:利用放射免疫方法检测60例口腔颌面手术患者(局麻小手术患者30例,全麻手术患者30例)术前及术后第1、4、7天血清中促甲状腺激素(TSH)、甲状腺素(T4)、三碘甲状腺原氨酸(T3)、反-三碘甲状腺原氨酸(rT3)等激素水平的改变。采用SPSS10.0软件包对数据进行单因素方差分析。结果:与术前相比,口腔颌面外科全麻手术患者术后第1、4、7天的T3、T4、rT3水平下降有显著差异(Ρ<0.01),TSH亦显著下降(Ρ<0.05);而局麻小手术患者,术前与术后第1、4、7天的T3、T4、rT3、TSH水平下降均无显著差异(Ρ>0.05)。结论:手术创伤和麻醉种类与患者甲状腺激素水平高低有一定关系。     

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目的观察和比较两种不同全身麻醉方法对青年患者颌面部手术后早期认知功能的影响。方法选取2009年2—5月中国医科大学口腔医学院择期行口腔颌面部手术青年(18～39岁)患者80例,随机分为两组,Ⅰ组为丙泊酚复合瑞芬太尼全凭静脉麻醉,Ⅱ组为七氟烷复合瑞芬太尼静吸复合麻醉,每组各40例。记录两组患者术后苏醒情况(包括睁眼时间、拔管时间、听从指令时间、定向力恢复时间)。采用简易精神状态量表(MMSE)对术前1天以及术后第1、3、7天的认知功能进行测试评估。结果Ⅰ组患者听从指令时间与定向力恢复时间均早于Ⅱ组患者,差异均有统计学意义(P<0.05),术后第1天Ⅰ组和Ⅱ组患者MMSE评分均较术前基础值略有降低,术后第3天恢复至术前,两组术后第7天MMSE评分略有升高,两组间术后各时段比较差异均无统计学意义(P>0.05)。Ⅰ、Ⅱ组患者术后第1天发生术后认知功能障碍(POCD)分别为1例和2例。结论全凭静脉麻醉和静吸复合麻醉对青年患者颌面部手术后早期认知功能均有不同程度的影响,可引起一过性POCD。     

Effect of chlorhexidine/benzydamine soaked pharyngeal packing on throat pain and postoperative nausea & vomiting in orthognathic surgery

Pharyngeal packing is believed to reduce postoperative nausea and vomiting (PONV) frequency, but has the disadvantage of causing throat pain. The present study aimed to investigate whether applying pharyngeal packs soaked with a combination of chlorhexidine gluconate 0.2% and benzydamine hydrochloride 0.15% (CGBH) were effective in preventing postoperative throat pain and PONV in patients undergoing orthognathic surgery. A total of 101 patients scheduled for orthognathic surgery were enrolled in this prospective, double-blind, randomized study. Patients were randomly allocated into two groups: those with CGBH-soaked packing, and those with saline-soaked pharyngeal packing. PONV was recorded using a 5-point Likert scale (0: no PONV to 4: severe PONV) immediately after the surgery at 5, 10, and 30 min, and at 2, 4, 6, 12, and 24 h postoperatively. The severity of throat pain was assessed via two methods: visual analogue scale (VAS, 0: no pain, 10: severe pain) and 6-point Likert scale (0: no pain, 5: strongly severe pain) score at 2, 4, 6, 12, and 24 h postoperatively. Mean VAS scores of throat pain were significantly lower in patients receiving CGBH-soaked pharyngeal packs compared to patients receiving saline-soaked pharyngeal packs, at all measured time points. There was a tendency towards less PONV in patients receiving a CGBH-soaked pharyngeal pack compared to those receiving a saline-soaked pharyngeal pack; however, this difference did not reach statistical significance. The results of this study suggest that the usage of CGBH-soaked pharyngeal packs reduce postoperative throat pain in patients undergoing orthognathic surgery. Our results support the implementation of CGBH-soaked pharyngeal packing in orthognathic surgery practice, as a measure to improve patient comfort.     

The effect of preoperative ondansetron on the incidence of postoperative nausea and vomiting in patients undergoing outpatient dentoalveolar surgery and general anesthesia.

PURPOSE: The purpose of this investigation was to evaluate the efficacy of ondansetron in controlling postoperative nausea and vomiting (PONV) when used prophylactically in patients undergoing routine dentoalveolar surgery performed under general anesthesia. PATIENT AND METHODS: This was a prospective, double-blind, randomized, placebo-controlled evaluation. Fifty adult ASA I or II patients, requiring routine dentoalveolar surgery performed under general anesthesia, without a prior history of PONV, were randomly assigned to the experimental or control groups. Ondansetron (2.0 mL = 4.0 mg) or normal saline (2.0 mL) were administered intravenously before surgery. Age, gender, type of surgery, duration of surgery, anesthetic dosages, and PONV were evaluated. PONV was evaluated at time 0 (end of anesthesia) and at 30 and 60 minutes postoperatively. Nausea was evaluated using a visual analog scale (1, not nauseous; 5, about to vomit). Vomiting was assessed as a yes or no response. At 20 to 28 hours postoperatively, PONV was evaluated via a telephone call as a yes or no response, along with the number of episodes of nausea, vomiting, or both. Means and standard deviations were calculated for age, surgery, and anesthetics, and differences were assessed using an independent samples t-test. Differences for gender between the control and experimental groups were tested by a nonparametric chi-squared test. Differences between groups for nausea and vomiting were tested with a continuity correction chi-squared test. Differences were considered significant for a P < .05. RESULTS: No significant differences (P < .05) were found between the PONV groups for gender, duration of procedure, or anesthetic dosages. Statistically significant differences were noted in age and the type of surgical procedures performed. No statistically significant differences (P < .05) were noted between groups for nausea or vomiting. CONCLUSION: Based on the results of this study, PONV occurred in approximately 20% of patients (20% for nausea, 8% for vomiting). With the types of anesthetic agents and techniques used in this investigation, there were no significant differences between ondansetron and placebo for prophylaxis against PONV.