不同麻醉方式在腮腺肿瘤切除术时面神经监测中的应用比较

目的 比较静吸复合麻醉与全凭静脉麻醉用于腮腺肿瘤切除术时面神经监测的临床效果及安全性。方法 70例接受腮腺肿瘤切除手术的患者,随机分为静吸复合组（S组）和全凭静脉组（V组）（n=35）。麻醉诱导时静脉给予顺式阿曲库铵0.15 mg/kg,气管插管后S组吸入七氟醚复合泵注丙泊酚+瑞芬太尼维持,V组则仅泵注丙泊酚+瑞芬太尼维持。使用肌松监测仪测定拇指内收肌的4个成串刺激（TOF）反应,记录阻滞起效时间、深度阻滞恢复时间（T₁的出现时间）、T₁ 50%及TOF 90%恢复时间。术中采用面神经电生理监测,记录2组患者在T₁ 50%时监测的成功率,比较2组患者术中发生体动与心血管药物使用情况及术后拔管时间。采用SPSS 20.0软件包对数据进行统计学分析。结果 2组患者肌松起效时间无显著差异(P>0.05),S组T1的出现时间晚于V组,但组间差异无统计学意义(P>0.05),S组的T₁ 50%及TOF 90%恢复时间显著延长（P<0.05）。2组患者在T₁ 50%时均能成功获得面神经监测信号。2组均无使用血管活性药物的患者;V组有2例患者术中发生轻微体动。2组患者拔管时间无显著差异（P>0.05）。结论 静吸复合麻醉和全凭静脉麻醉均能满足术中面神经监测的手术要求,全凭静脉麻醉有利于更早地获得面神经电生理信号,而静吸复合麻醉有利于预防术中体动发生。     

罗库溴铵用于小儿唇腭裂修复术的量效关系及肌松残余的观察

目的:观察全凭静脉麻醉下不同剂量的罗库溴铵应用于小儿唇腭裂修复术时的起效时间和肌松效应以及拔管时肌松残余发生率.方法:择期全麻小儿唇腭裂修复术96例,年龄1～6岁,按随机数字表分为3组(n=32).麻醉入睡后,采用TOF-Watch(@) SX肌松监测仪进行肌松监测,定标成功后,静注罗库溴铵,A、B、C组应用剂量分别为0.6、0.9、1.2 mg/kg,观察记录麻醉效果.结果:3组患儿气管插管条件优良率为100％.起效时间随剂量增加而缩短(P＜0.05).肌松维持时间随剂量增加而延长(P＜0.05).恢复指数Ⅲ组与Ⅱ组、Ⅰ组相比明显延长(P＜0.05),Ⅱ组与Ⅰ组相比无统计学差异(P＞0.05).肌松残余发生率Ⅲ组高于Ⅱ组和Ⅰ组(P＜0.05),Ⅱ组与Ⅰ组间差异无统计学意义.结论:罗库溴铵0.6、0.9 mg/kg在小儿唇腭裂修复术中获得满意的插管条件,起效和恢复迅速,术后肌松残余发生率低.     

面神经损伤182例临床资料回顾性分析

目的 分析颌面部外周性面神经损伤后功能恢复的规律和相关影响因素.方法 回顾分析182例面神经损伤患者的病历资料,分析损伤部位、损伤方式、损伤后治疗时间及治疗方式对于面神经功能恢复结果的影响.结果 口腔颌面部面神经损伤以分支损伤为主.神经损伤方式、部位、患者年龄、修复时间等因素均对面神经功能恢复结果有影响.随访至最终有完整记录的解剖性损伤49例中,45例(92%)在6个月内完全恢复;断裂损伤59例中,53例(90%)于6个月内开始恢复;12个月内,神经吻合35例中33例(94%)面神经功能开始恢复;8例神经移植病例中5例(62%)完全恢复.结论 口腔颌面部手术中应尽量降低对神经的损伤,尽早修复受损神经,这样能够更好地保存面神经功能.     

外源性BMP—2对家兔面神经创伤愈合过程中神经干传导速度作用的实验观察

目的 为研究面神经损伤后再生过程BMP－2对神经功能恢复的影响。方法 采用家兔的面神经压榨伤模型,以自身左右侧为对照,实验侧给予BMP－2,对照侧给予生理盐水,对两组面神经进行了神经传导速度的测定和组织形态学观察,结果 实验侧面神经组织学形态更接近正常,平均传导速度也略快于对照侧,而统计学检验无显著性差异,提示BMP－2可能对面神经的再生过程有一定的作用,但还不能确定这种作用是否能影响面神经功能的恢复。     

Optimal duration of ultra low frequency-transcutaneous electrical nerve stimulation (ULF-TENS) therapy for muscular relaxation in neuromuscular occlusion: A preliminary clinical study

Objectives: The primary aim of this work was to determine the duration of ultra-low-frequency transcutaneous electrical nerve stimulation (ULF-TENS) application necessary to achieve sufficient relaxation of the masticatory muscles. A secondary aim was to analyze the influence of stimulation on muscle relaxation in pathological subjects and determine whether ULF-TENS has a noteworthy impact on muscle relaxation.

Methods: Sixteen adult subjects with temporomandibular disorders (TMD) and muscle pain and a group of four control subjects were included in this study. ULF-TENS was applied, and muscular activities of the masseter, temporal, and sternocleidomastoid muscles (SCM) were recorded for 60 min.

Results: Significant relaxation was achieved in the TMD group from 20, 40, and 60 min for the temporal, masseter, and SCM muscles (p < 0.05), respectively. Maximum relaxation was achieved in 12.5% of the subjects after 20 min, in a further 12.5% after 40 min, and in the remaining 75% after 60 min. Significant relaxation was achieved in the control group from 20 to 40 min for the masseter and temporal muscles, respectively (p < 0.05).

Discussion: Taken together, the results suggest that an ideal ULF-TENS application would last 40 min to obtain sufficient muscle relaxation both in patients with masticatory system disorders and healthy subjects, a time constraint that is consistent with everyday clinical practice.     

Extracapsular dissection with a transparotid facial nerve dissection approach versus partial superficial parotidectomy for benign tumours in the tail of the parotid gland: a single-centre retrospective study of 89 patients

The aims of this study were (1) to evaluate the transparotid facial nerve dissection approach (TFND), in which the intraparotid cervicofacial or temporofacial division is identified first through a superficial lobe incision; and (2) to compare extracapsular dissection with a TFND (ECD-TFND) with partial superficial parotidectomy with a retrograde approach (PSP) for benign tumours in the tail of the parotid gland with respect to surgical outcomes. Eighty-nine patients underwent PSP or ECD-TFND for benign tumours in the tail of the parotid gland: 49 were treated surgically with PSP and 40 with ECD-TFND. The mean ( ± standard deviation) surgical time did not differ significantly between the groups: 64 ± 22.4 min for PSP and 59 ± 19.8 min for ECD-TFND (P = 0.302). There was a significant difference in sialocele: 18 (36.7%) patients in the PSP group and four (10%) in the ECD-TFND group (P = 0.002). There was also a significant difference in facial nerve injuries: temporary paralysis was observed in 13 (26.5%) patients in the PSP group and two (5%) in the ECD-TFND group (P = 0.007). It appears that TFND is a viable and safe approach when performing ECD for benign tumours in the tail of the parotid gland. ECD-TFND should be preferred over PSP for benign tumours in the tail of the parotid gland.     

Quantitative analysis of the impact of radiotherapy on facial nerve repair with sural nerve grafting after parotid gland surgery

In this study, we aimed to reveal the long-term impact of radiotherapy on recovery of facial animation function after facial nerve repair using sural nerve grafting in patients undergoing parotid gland surgery.We reviewed the medical records of patients who did or did not undergo radiotherapy following sural nerve graft repair after parotid gland surgery. Facial function metrics, such as House–Brackmann (HB) scale scores and FACEgram measurements, were used to compare facial muscle function between groups.Postoperative radiotherapy was performed in 14 of 21 patients. There was no significant difference regarding successful repair (HB I–III), which was achieved in three of 14 irradiated patients and two of seven non-irradiated patients (p = 0.181). On FACEgram analysis, there was no significant difference in mean smile excursion length between the radiotherapy group (9.16 ± 8.48 mm) and the control group (6.15 ± 4.24 mm) (p = 0.392). There was no significant difference in the mean angle of excursion between the irradiated group (3.59 ± 3.73°) and the non-irradiated group (1.06 ± 5.24°) (p = 0.216).In this study, postoperative radiotherapy did not appear to prevent successful recovery of facial function after sural nerve grafting in parotid gland surgery.     

大鼠面神经再生过程中BMP-2、-6在面神经核内的定位表达及其作用

目的：探讨BMP－2，－6在面神经损伤后再生过程中可能的作用。方法：建立大鼠面神经切断吻合伤模型，利用免疫组化方法及图象分析系统，检测BMP－2、－6在面神经核团内的定位及表达变化。结果：大鼠面神经运动神经元正常状态下可见BMP－2、－6表达。损伤发生后：①BMP－2阳性表达呈下调型改变，6h时最低，与正常对照组相比有显著性差异（P＜0．05）；4周时恢复到接近正常表达水平（P＞0．05）；②BMP－6阳性表达呈现上调型改变，2周时达到最高值，4周时仍处于高表达状态，与正常对照组相比差异显著（P＜0．05）。结论：BMP－2可能主要参与面神经损伤后早期应激及修复再生活动，BMP－6则可能参与晚期面神经再生。     

bFGF复合降解膜对面神经离断3周后神经再生的作用

目的：探讨碱性成纤维细胞生长因子（bFGF）复合降解膜对面神经离断伤延期修复神经再生的作用。方法：选取SD大鼠60只,随机分为复合降解膜组（吻合处包绕复合降解膜）、降解膜组（吻合处包绕不含试剂的降解膜）和对照组（不放置任何膜）,每组20只。制备大鼠面神经离断伤模型。3周后,再次解剖出面神经断端．修剪后进行吻合,、术后12周取材,进行形态学观察,测定各组大鼠有髓神经纤维数量、直径,并测定动作电位传导速度。应用SPSS11．5软件包对数据进行统计学分析。结果：复合降解膜组再生神经纤维的数量、卣径以及动作电位传导速度均明显较降解膜组多、粗、快,2组问存在显著差异（P〈0．05）。降解膜组与对照组间无显著差异眇0．05）。结论：bFGF复合降解膜具有提高面神经离断伤延期修复神经再生的作用。     

胶质细胞源性的神经营养因子促进面神经损伤后再生的实验研究

目的：研究胶质细胞源性的神经营养因子（ＧＤＮＦ）对面神经损伤后的促再生作用。方法：家兔面神经双侧造成５ｍｍ神经缺损,以硅胶管套接后将硅胶管与神经外膜缝合固定。一侧硅胶管内淳入纯化ＧＤＮＦ,另一侧注入等量生理盐水对照。于不同时间段取材,切片行甲苯胺兰、ＨＥ、Ｂｉｅｌｓｃｈｏｗｓｋｙ银染改良法染色观察面神经元细胞体及再生神经结构。图像分析测量再生神经轴突直径及单位面积轴突数量、再生轴突恢复率。６０ｄ及     

自体神经组织匀浆修复面神经缺损的实验研究

目的：观察聚四氟乙烯膜管内植入自体神经组织匀浆桥接兔面神经缺损的修复效果，寻找修复面神经的新方法。方法：36只成年新西兰大白兔，均制成双侧面神经颊支8mm缺损的模型，用聚四氟乙烯膜管内植入自体神经组织匀浆桥接每只动物右侧面神经缺损作为实验组，单纯膜管桥接左侧为对照组。分别于术后4、8、12周行神经电生理测试后，处死动物，切取再生的神经组织标本进行大体观察、HE染色，普通光镜观察。结果：电生理测试显示，匀浆组术后4周，电刺激通过神经缺损区可引起肌收缩，空管组未引出肌动作电位。术后8、12周两侧均有动作电位引出，但匀浆组的神经传导速度明显大于空管组。光镜观察，匀浆组在术后各个时期神经再生情况均优于对照组，术后8周匀浆组管内充满再生神经纤维和髓鞘，排列较规则、整齐，呈束状分布，束间新生血管丰富；空管组有极少量再生神经纤维通过缺损区，纤维排列较紊乱。结论：自体神经组织匀浆进行神经再生室内移植．可获得比空膜管桥接面神经缺损更好的修复效果。