几种不同降压药物用于内镜鼻窦手术的临床分析

目的观察硝普钠、硝酸甘油、硝酸甘油 盐酸艾司洛尔及尼卡地平用于内镜鼻窦手术中控制性降压的有效性和安全性及其对血液动力学的影响.方法 80例Ⅱ型3期慢性鼻窦炎鼻息肉患者随机分成四组,即组Ⅰ(硝普钠)、组Ⅱ(硝酸甘油)、组Ⅲ(硝酸甘油 盐酸艾司洛尔)和组Ⅳ(尼卡地平).用美国cardiodyn无创血液动力学监测系统阻抗法连续观察用药期间的血液动力学的变化.结果血压的变化:注药后5分钟平均动脉压(MAP)均较基础值下降(P＜0.05).组Ⅰ舒张压(DBP)的下降幅度明显大于其它三组(P＜0.01);组Ⅲ和组ⅣDBP的影响较小.心率(HR)的影响:组Ⅱ心率(HR)增快较其它三组更明显,而组Ⅲ对HR的影响明显小于其它三组(P＜0.01),其次组ⅣHR增快的幅度略低于组Ⅰ和组Ⅱ.心输出量(CO)的影响:组Ⅰ和组Ⅳ5～10分钟心输出量(CO)较基础值均有不同程度的增加(P＜0.05),而组Ⅱ和组ⅢCO较基础值有所下降(P＜0.05),5分钟分别下降33.3%和27.1%.结论硝酸甘油 盐酸艾司洛尔或尼卡地平用于内镜鼻窦手术中控制性降压对血液动力学影响较小,降压过程平稳,易于调控.     

鼻内镜手术中瑞芬太尼和硝普钠控制性降压效果比较

目的比较鼻内镜手术中瑞芬太尼和硝普钠控制性降压的效果。方法72例择期鼻内镜手术患者随机分成3组，每组24例。N组硝普钠控制性降压：C组硝普钠控制性降压并用爱络控制心率（heart rate，HR）：R组瑞芬太尼控制性降压。前两组术中平均动脉压（mean arterial blood pressure，MAP）维持在60-65mmHg，C组将HR控制在80～90次／分，R组MAP控制在66-75mmHg。根据Fromme术野质量评分（scores of surgical field quality，SSFQ）由同一术者在手术开始后5，15，30，45分钟进行评定。结果R组MAP明显高于前两组，SSFQ和HR明显低于C组，更明显低于N组。结论鼻内镜手术中瑞芬太尼控制的靶血压明显高于硝普钠，术野质量亦明显优于硝普钠。     

The effect of functional endoscopic sinus surgery on nasal resonance

Background and objectiveFunctional endoscopic sinus surgery (FESS) increases the nasal volume, and thereby it can alter the nasal resonance. The objectives were to measure the percentage of nasal resonance following FESS and compare it with healthy individuals with normal nasal findings.MethodsThe nasometric analysis of voice was done using n/p/m consonant sounds in 72 individuals with healthy post FESS cavities (group 1) and 72 healthy individuals with normal nasal findings without any nasal pathology (group 2). The scores of nasal resonances were expressed in percentages and were compared between the two groups. Both in group 1 and group 2, 32 (44.4%) were females, and 40(55.6%) were males. In group 1, 51 participants had bilateral FESS cavities, and 21 had unilateral FESS cavities. Kannada was the mother tongue in 30 (41.7%) participants in group 1 and 36 (50.0%) in group 2. Malayalam was the mother tongue in 42(58.3%) participants in group 1 and 36 (50.0%) in group 2.ResultsIn both cases and control groups, more than 80% of the participants were showing less than 20% of nasal resonance. In group 1, the mean values of/n/p/m sounds were 11.23%, 10.23% and 11.42% respectively, and in group 2 the mean values were 8.27%, 8.58% and 8.58% respectively. But the P value was not statistically significant. Individuals with unilateral FESS cavities had more nasal resonance values compared to bilateral FESS cavities. Similarly, Kannada speaking people had more values compared to Malayam speaking individua.ConclusionChanges in nasal resonance after FESS is minimal, and it is unnoticed. But it may affect the speech quality in professional voice users, depending on their language. Though the nasometer is considered as the most validated instrument to record nasal resonance, we feel that further standardization is needed to evaluate the nasalance.     

Informed consent in functional endoscopic sinus surgery

OBJECTIVES: Functional endoscopic sinus surgery (FESS) is one of the more common procedures performed by otolaryngologists. Before performing FESS, surgeons are obligated to discuss the procedure and its risks through the process of informed patient consent. The study identifies current practices in informed consent for FESS and formulates guidelines for informed consent for FESS. STUDY DESIGN: Survey. METHODS: Surveys were sent to 1000 American Academy of Otolaryngology-Head and Neck Surgery members in the United States. Surveys inquired about current informed consent practices related to FESS. RESULTS: Three hundred forty-six surveys were returned. Nearly 60% of respondents thought that 1% incidence of a complication warrants a discussion with patients. The percentage of respondents who discuss specific risks were as follows: bleeding, 96.7%; infection, 84.8%; cerebrospinal fluid leak, 99.1%; orbital injury, 96.7%; smell changes, 40.2%; cerebrovascular accident, 17.9%; myocardial infarction, 81%; and death, 28.0%. CONCLUSIONS: The study suggests that there is variability in specific informed consent practices for FESS among otolaryngologists. It also suggests that the incidence or severity of a complication does not necessarily correlate with whether or not it is mentioned during the informed consent process. The authors think that practicing otolaryngologists may be able to use this information to improve their consent practices.     

Sorbalgon藻酸钙敷料在功能性鼻内镜手术中的应用

目的：选择有效的鼻腔堵塞止血材料。方法：比较功能性鼻内镜手术凡士林纱条和Sorbalgon藻酸钙敷料鼻腔堵塞止血效果及堵塞后鼻腔反应情况。结果：应用Sorbalgon藻酸钙敷料止血效果好，头痛及鼻腔疼痛较轻，抽除堵塞物时鼻腔很少出血，术后鼻粘膜反应轻。结论：Sorbalgon藻酸钙敷料是一种良好的鼻腔，鼻窦手术后堵塞止血材料。     

功能性鼻内镜鼻窦手术后换药应用布地奈德混悬液的效果分析

目的 探讨在慢性鼻-鼻窦炎患者术后应用布地奈德混悬液（普米克令舒）的效果。方法 分析280例慢性鼻-鼻窦炎行鼻内镜手术的患者,随机分为2组,A组常规换药,术后常规使用布地奈德鼻喷剂喷鼻;B组对有囊泡及水肿明显者在术后换药过程中清理后予以明胶海绵浸润布地奈德混悬液置于囊泡及水肿部位,每周1~2次,观察术后1个月、3个月及6个月的疗效,包括VAS视觉量表主观评估及鼻内镜Lund-Kennedy客观评估。结果 A、B组术后1、3、6个月VAS评分分别为4.48±1.33,2.16±0.81,2.04±0.96;3.85±1.09,1.90±0.88,1.93±0.74。A、B组术后1、3、6个月Lund-Kennedy评分分别为11.44±1.73,4.51±1.05,3.94±0.86;6.82±2.08,4.26±1.17,2.17±0.79。两组患者的VAS评分在术后三个时间点差异均有统计学意义（P<0.05）;术后3个月、6个月与术后1个月比较,差异有统计学意义（P<0.05）;而术后3个月与术后6个月相比,差异无统计学意义。两组间Lund-Kennedy 客观评估比较,在术后1个月和6个月两个时间点差异有统计学意义（P<0.05）,而在术后3个月,两组比较差异无统计学意义;术后3个月、6个月与术后1个月比较,差异有统计学意义（P<0.05）;而术后3个月与术后6个月相比,A组在两个时间点差异有统计学意义,B组在两个时间点差异无统计学意义。结论 慢性鼻-鼻窦炎鼻内镜术后应用布地奈德混悬液能更好地减少术后囊泡形成、减轻水肿,促进黏膜上皮化。     

The role of functional endoscopic sinus surgery (FESS) in patients with asthma with chronic sinusitis

25 patients of bronchial asthma with chronic sinusitis were operated with the aim to evaluate the efficacy of functional endoscopic sinus surgery (FESS) on asthma symptoms. The mean postoperative daytime asthma symptom scores, nocturnal asthma symptom scores, mean postoperative nocturnal awakening scores and number of asthma attacks reduced significantly (p<0.001). The mean FEV₁ observed postoperatively showed significant increase (p<0.001). 21 patients reported overall significant improvement in the asthma. 6 patients were completely taken off from all sort of anti-asthmatic drugs [inhalational corticosteroids (ICS) + long acting β₂ agonist (LABA) ]. In 3 patients there was significant / substantial decrease in the dosage of anti-asthma drugs. It is concluded that FESS is a viable option for improving the control of asthma.     

Plasma catecholamine levels during functional endoscopic sinus surgery

Plasma adrenaline and noradrenaline concentrations were measured in 10 consecutive patients during functional endoscopic sinus surgery (FESS). Surgery was preceeded by nasal packing with 5 ml 2% cocaine solution, followed by infiltration with 1:80 000 adrenaline and 2% lignocaine. All patients showed a marked rise in plasma adrenaline concentration within 4 min of commencing infiltration, which was not related to the patient's sex, age, weight, the total amount injected, nor the amount injected into the nose. Surgeons should be aware of this marked, but unpredictable, systemic absorption of locally infiltrated vasoconstrictors. Pulse and ECG monitoring should be considered mandatory for such procedures, even when surgery is performed under local anaesthesia.     

老年慢性鼻-鼻窦炎鼻息肉患者功能性鼻内镜围手术期治疗

目的:探讨老年慢性鼻-鼻窦炎鼻息肉患者在鼻内镜术围手术期的治疗特点。方法:回顾分析187例老年慢性鼻-鼻窦炎鼻息肉患者(年龄≥60岁)的临床资料。结果:经系统有针对性围手术期治疗后,治愈132例(72.5%),好转43例(23.6%),无效7例,总有效率96%,无一例发生手术并发症。结论:老年患者经系统有针对性的围手术期治疗后行鼻内镜手术是安全有效的。     

The contemporary practice of functional endoscopic sinus surgery: a nationwide survey

Recent years have seen a rapid growth in the practice of functional endoscopic sinus surgery (FESS). Its introduction into clinical practice has, however, been conspicuous by an absence of good scientific evidence that it is superior to previous techniques. This postal questionnaire survey aimed to identify the diversity in the practice of FESS at a national level and, as a result, highlights areas of patient management requiring standardization. All full members of the British Association of Otolaryngologists—Head and Neck Surgeons (BAO-HNS) were contacted, 64% responded: 14% of surgeons do not always perform preoperative computerized tomography (CT) scanning; only 25% use grading systems for symptoms and/or CT assessment; a wide variety of topical agents are used both before and after operation; nearly half (47%) no longer operate principally under endoscopic vision but via TV monitors; and the majority of surgeons review patients more than 1 week after surgery with a minority advocating earlier postoperative assessment.     

Functional endoscopic sinus surgery

Summary The Messerklinger technique is a primarily diagnostic endoscopic concept demonstrating that the frontal and the maxillary sinuses are subordinate cavities. Disease usually starts in the nose and spreads through the ethmoidal prechambers to the frontal and maxillary sinuses, with infections of these latter sinuses thus usually being of secondary nature. Standard rhinoscopy and sinus X-rays are frequently not sufficient to demonstrate the underlying causes for chronic or recurring acute sinusitis in the clefts of the anterior ethmoidal sinuses. The combination of diagnostic endoscopy of the lateral nasal wall with conventional or computed tomography in the coronal plane has proven to be the ideal method for the examination of inflammatory diseases of the paranasal sinuses. In so doing, diseases and lesions that other-wise might have gone undiagnosed can be identified and consequently treated. Based on this diagnostic approach, an endoscopic surgical concept was developed, aiming for the underlying causes of sinus diseases instead of the secondarily involved larger sinuses. With usually very limited surgical procedures, diseased ethmoid compartments are operated on, stenotic clefts widened and prechambers to the frontal and maxillary sinuses freed from disease. In our experience, there is rarely a need for major manipulations inside the larger sinuses per se. Based on exact diagnosis, the surgical technique used allows a very individualized staging according to the prevailing pathology. In the extreme, a total sphenoethmoidectomy can be performed with this technique, although the true advantage of the technique is that even in cases of massive disease such radical procedures can be avoided. By reestablishing sinus ventilation and drainage via the natural ostia, there is also no need for fenestration of the inferior meatus. The Messerklinger technique can be applied to a wide spectrum of indications, apart from nasal polyposis. The technique has its clear limits as well as its specific problems. Adequate training and experience are required for the surgical approach, as the technique bears all the risks and hazards of all kinds of endonasal ethmoid surgery but has a minimal complication rate in the hands of an experienced surgeon. Results and complications of a series of more than 4500 patients over a period of over 10 years are presented and discussed in detail.Dedicated to Professor W. Messerklinger on the occasion of his 70th birthdayoffprint requests to: H. Stammberger     

Major complications of functional endoscopic sinus surgery

The results of a postal questionnaire indicate an exponential rise in the practice of functional endoscopic sinus surgery (FESS) in the UK and a major complication rate of 0.23%. Cerebrospinal fluid leak was the most common serious complication accounting for 24 of the 36 reports.     

加速康复外科理念在功能性内镜鼻窦手术围手术期护理的初步应用

目的 初步探讨加速康复外科理念(ERAS)在功能性内镜鼻窦手术(FESS)围手术期护理中的作用。 方法 将在2017年10月1日~2017年12月31日行全麻功能性鼻内镜鼻窦手术的48例患者按入院日期的单、双分配到ERAS组(n=17)及常规手术组(n=31)。将住院费用、术后疼痛程度、术后睡眠情况、术后活动意愿及术后进食质量进行组间对比。 结果 两组的住院费用差异无统计学意义(P=0.16)。ERAS组在术后当天即摆脱了疼痛的困扰,活动意愿及进食质量也显著高于常规手术组(P<0.001)。常规手术组的疼痛程度需在术后第2天方能达到ERAS组相似的水平(P=0.14),活动意愿及进食质量也需在术后第1天才能达到ERAS组相似的水平(P=0.23,P=0.15)。睡眠质量在术后当天虽然未见显著的组间差异(P=0.25),但ERAS组的睡眠时间显著长于常规手术组(P=0.002)。 结论 在住院费用无显著增加的前提下,ERAS有望帮助FESS患者获得更大的术后舒适度。     

Effect of functional endoscopic sinus surgery in patients of chronic sinusitis with bronchial asthma

Rhinosinusitis and bronchial asthma have been found to be coexistent in different studies. A prospective study of 23 patients with bronchial asthma who underwent Functional endoscopic sinus surgery (F.E.S.S) for coexistent chronic sinusitis was undertaken and the effect of endoscopic sinus surgery on bronchial asthma was analyzed in these patients using both subjective and objective criteria. It is concluded in this study that Functional endoscopic sinus surgery for chronic sinusitis in cases of bronchial asthma helps in reduction of their asthma symptoms, requirement of medication and helps in improving their peak expiratory flow.     

鼻腔,鼻窦冠状位CT扫描解剖学观测及其指导意义

对１００例无明显鼻部疾病的成人行鼻腔，鼻窦冠状位ＣＴ扫描，从不同层面观测鼻腔，鼻窦重要解剖结构的值限范围和形态。结果昌：高台型筛板与筛顶间的平均高度差为５．１７ｍｍ，筛泡宽度为１１．１５ｍｍ，中鼻甲的宽度为５．４０ｍｍ；Ｈａｌｌｅｒ气房的出现率为１４．０％，中鼻甲气化为１４．０％，Ｏｎｏｄｉ气房的出现率为８．５％。     

鼻窦内窥镜手术处理病变中鼻甲的意义

目的：探讨功能性鼻窦内窥镜于术（ＦＥＳＳ）中处理病变中鼻甲的临床意义。方法：按照成人中鼻甲解剖学标准,在３２例鼻窦炎、鼻息肉患者ＦＥＳＳ中,对病变中鼻甲进行适当处理,并于术后对中鼻甲形态恢复、筛窦术腔及上凳窦窦中开放率进行随访观察。结果：术后６个月中鼻甲形态恢复正常２４例（７５％）,发生粘连８例（２５％）,其中术腔闭塞２例（６．３５％）;上颌窦窦口开放良好２５例（７８．１％）,狭窄６例（１８．８％     

Important clinical symptoms in patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis

OBJECTIVE: To evaluate the prevalence and severity of individual Rhinosinusitis Task Force (RSTF) symptoms in patients with chronic rhinosinusitis (CRS) undergoing functional endoscopic sinus surgery (FESS). METHODS: Retrospective analysis of prospectively collected data in 201 patients treated with FESS. The prevalence and severity of individual RSTF major and minor symptom scores graded on a visual analogue scale (VAS) were compared. Correlation between absolute improvement in individual symptom scores at 1-year postoperative was performed. RESULTS: One-hundred fifty-eight of 201 patients met inclusion criteria giving a response rate of 78%. The average age was 49.4 (range 18-80) with a male-to-female ratio of 1.1:1. The preoperative leading mean symptom scores were postnasal drip (5.8 +/- 0.3), nasal obstruction (5.7 +/- 0.3), and facial congestion (5.1 +/- 0.3). These symptoms were also the most prevalent with 82%, 84%, and 79% of patients reporting these symptoms, respectively. Postoperative symptom improvements were significant (P < .0001) across all RSTF domains except fever. The highest percentage improvement was seen with facial congestion (93%), nasal obstruction (92%), and postnasal drip (85%). Multivariate analysis revealed significant (P < .0001) high correlation between improvements of facial pain/pressure with facial congestion (R = 0.72), facial congestion with nasal obstruction (R = 0.65), and facial pain/pressure with headache (R = 0.72). CONCLUSION: The top three RSTF symptoms were postnasal drip, nasal obstruction, and facial congestion in terms of prevalence and severity. Symptom scores improved after FESS. Of these symptoms, the degree of improvement of facial pain/pressure, facial congestion, nasal obstruction, and headache are highly correlated.     

Outcome of spray cryotherapy plus functional endoscopic sinus surgery on management of healing in nasal polyposis

Background

Nasal Polyposis is a benign tumor in nasal or paranasal mucosa, which confronts difficulties in management of healing after treatments with surgery. The aim of this study was to evaluate the effects of Spray Cryotherapy (SCT) on management of healing in patients with nasal polyposis who undergone functional endoscopic sinus surgery.

适宜剂量芬太尼用于鼻内镜手术非控制性 降压麻醉中的临床观察

目的探讨适宜剂量芬太尼在鼻内镜手术非控制性降压麻醉中应用的有效性、可行性及安全性。方法选取择期行鼻内镜手术的患者45例,ASA分级I～Ⅱ级, 年龄18～45岁,均经过规范化治疗控制炎症,采用随机数字表法分为3组,即Ι组、Ⅱ组和Ⅲ组。麻醉诱导时给予芬太尼3 μg/kg,手术开始前Ι组追加芬太尼1.5 μg/kg,Ⅱ组追加芬太尼2.5 μg/kg,Ⅲ组追加芬太尼3.5 μg/kg,连续监测血流动力学。观察并记录麻醉诱导前（T1）、手术开始时（T2）、手术开始15 min（T3）、手术开始30 min（T4）、鼻腔填塞医用PVA棉时（T5）患者的收缩压（SP）、舒张压（DP）、平均动脉压（MAP）、心率（HR）、心输出量（CO）、每搏量（SV）以及拔管时间和术后并发症,同一术者采用Fromme术野质量评分法(scores of surgical field quality, SSFQ)评定术野质量。结果与Ι组比较,Ⅱ组和Ⅲ组在T3、T4时点的MAP、HR、CO均低于Ι组,差异具有统计学意义（P<0.05）;而Ⅱ组和Ⅲ组相比T3、T4时点的MAP、HR、CO无明显差异（P>0.05）; 术野质量SSFQ评分与Ι组比较,Ⅱ组和Ⅲ组的术野质量高于Ι组（P<0.05）, Ⅱ组与Ⅲ组无明显差异; 拔管时间比较Ι组与Ⅱ组无明显差异（P>0.05）, Ⅲ组较Ⅱ组拔管时间延长有统计学意义（P<0.05）; Ⅱ组未见明显不良反应。结论麻醉诱导时给予芬太尼3 μg/kg,手术开始前追加芬太尼2.5 μg/kg用于鼻内镜手术非控制性降压麻醉可使手术顺利完成,该方法有效且安全可行。     

Microdebriders used in functional endoscopic sinus surgery: secondary analysis and validation of a new tissue model

OBJECTIVES/HYPOTHESIS: To validate a previously reported in vitro tissue model for microdebrider comparison and determine which microdebrider, tissue type, blade type, and suction strength is most efficient. Specifically, the goal of the secondary analysis is to expand on the results of the preliminary analysis by increasing the sample size, and introduce an aspiration efficiency score (AES) to facilitate microdebrider comparison. STUDY DESIGN: Prospective randomized comparison. METHODS: A prospective randomized comparison of the Diego Powered Dissector and XPS 3000 Powered ENT System was conducted using a soft tissue and a firm tissue model. In addition to evaluating tissue aspiration with straight and angled blades, clogging rates and clearance times were measured. Both standard wall suction and liposuction were used. Basic statistical analysis, a one-way analysis of variance, and a post hoc Student's t test were performed to compare outcomes. RESULTS: With standard wall suction, the microdebriders were equivalent for the overall microdebrider comparison. For the 'head to head' comparison with standard wall suction, the devices were also equivalent when using the straight blades, but the XPS 3000 aspirated more tissue when using the angled blades. With liposuction, the XPS 3000 and liposuction independently aspirated more tissue but clogged more often compared with the Diego PD and regular suction. The aspiration efficiency of soft tissue (oysters) and straight blades was superior compared with firm tissue (scallops) and angled blades. For the 'head to head' comparison with liposuction, the XPS 3000 aspirated more tissue regardless of tissue type, but the Diego PD clogged less with firm tissue (scallops). Overall, the AES favored the XPS 3000, soft tissue (oysters), straight blades, and liposuction. CONCLUSION: Our tissue model represents a reliable and reproducible means of microdebrider comparison. Statistically significant differences between the Diego PD and XPS 3000, as well as between tissue types, blade types, and suction strengths, are reported. Using these results, microdebrider manufacturers can adopt similar tissue models, expand on the current AES, and include other commercially available microdebrider devices to test and report product performance to the consumer. Perhaps an optimal open to closed ratio or liposuction pressure can be determined that yields the greatest tissue aspiration with the fewest number of clogs.