面神经监测在小儿电子耳蜗植入术中的应用

目的 评价面神经监测在小儿电子耳蜗植入术中的作用并细化其监测方法,探讨满足小儿面神经监测的麻醉方案。方法 20例行电子耳蜗植入术的婴幼儿和20例行鼓室成形术的成人患者,术中行面神经实时监测,七氟醚复合瑞芬太尼静脉滴注维持。根据直视下面神经暴露程度,分为面神经暴露组和未暴露组2个亚组,测定面神经诱发肌电位的电刺激阈值。结果 所有病例均成功诱发面神经肌电位反应,且术后面神经功能均未见异常。电子耳蜗组面神经水平段的刺激阈值:暴露组为(0.38±0.10)mA,未暴露组为(1.21±0.32)mA;垂直段的刺激阈值:暴露组为(0.40±0.14)mA,未暴露组为(0.91±0.17)mA。电子耳蜗组各亚组刺激阈值均显著高于鼓室成形术组(P值均<0.05)。结论 电子耳蜗植入术中面神经监测有助于定位与保护面神经。定位未暴露的面神经时,先用1.0 mA刺激,再用1.5 mA探寻;面神经暴露时,用0.3 mA开始刺激。七氟醚复合瑞芬太尼可以满足电子耳蜗植入术患儿面神经监测的需求。     

纤维支气管镜下声带广基息肉摘除术36例分析

声带广基息肉临床处理较为复杂.间接喉镜下手术,由于局部出血,影响手术视野,不易钳除彻底.支撑喉镜和显微镜下手术,技术要求高,部分患者由于颈短粗,后仰困难等因素,影响手术视野暴露,不易摘除近前连合处息肉.作者自1997年7月至1999年7月在纤维支气管镜电视监视下摘除声带广基息肉,取得了良好的效果,报告如下.     

眶隔-提肌腱膜增厚区法重睑术的临床疗效△

目的 评估眶隔-提肌腱膜增厚区(SAJT)法重睑术的临床疗效。方法 我科于2017年1月~2018年6月对154例单睑患者行SAJT法重睑术。切除一条眼轮匝肌暴露眶隔,于眶隔与提肌腱膜融合处上方6 mm处打开眶隔,将SAJT与切口处眼轮匝肌下唇间断缝合。结果 术后随访6个月,上睑瘢痕温哥华瘢痕量表(VSS)评分为0分,138例患者全球美学改善量表(GAIS)评分为非常满意,16例患者为满意。无伤口感染、上睑凹陷、重睑线消失、上睑下垂等并发症发生。结论 SAJT法重睑术效果确切,无瘢痕,是一种较理想的重睑术式,值得临床推广。     

鼻内镜下取自体骨个体化治疗眶内侧壁骨折疗效分析△

目的 探讨鼻内镜下经筛窦入路利用自体骨行个体化重建眶内侧壁的疗效。方法 采用鼻内镜下经鼻-鼻窦入路,根据患者眶内侧缺损大小及鼻中隔形态,行个体化重建眶内侧壁治疗16例,观察患者术后眼球运动障碍、眼球凹陷、复视症状恢复情况。结果 本组16 例患者术后随访3~13个月,眼球运动障碍、眼球凹陷、复视基本恢复,未出现鼻中隔血肿及穿孔、眶内感染、视力下降、移植骨片脱位等并发症,仅1例患者在术后第5天因不慎挖鼻后反复出现鼻出血行鼻内镜下电凝止血术。结论 经鼻内镜下鼻窦入路,利用自体鼻中隔软骨及筛骨垂直板个体化重建眼眶内侧壁,疗效较确切。     

鼻内镜联合支撑喉镜摘除声带良性病变46例

我科对支撑喉镜下声门暴露困难（difficult laryngeal exposure,DLE）声带良性病变患者,采用30°鼻内镜联合支撑喉镜进行手术治疗,现报告如下。     

自体脂肪移植在眼睑畸形矫正及功能重建中的应用及临床疗效△

目的 探讨自体脂肪移植在修复眼睑凹陷畸形伴功能障碍中的临床疗效。方法 收集2018年5月~2020年7月于我科就诊的13例眼睑凹陷畸形患者,其中伴有睁眼困难者4例,伴轻度上睑外翻者8例,伴中度眼睑闭合不全者1例。所有患者均予腹部颗粒脂肪或腹股沟区块状脂肪移植修复眼睑凹陷畸形。术后随访3~18个月,对比术前、术后眼睑凹陷畸形矫正情况,睁眼困难、眼睑外翻及眼睑闭合不全的矫正情况,眼睑美学改善情况等。结果 术后所有患者的眼窝凹陷均获得明显矫正,睁眼困难、轻度眼睑闭合不全、轻度睑外翻等也明显改善,术后眼睑形态满意率达92%。所有患者术后无脂肪栓塞、血肿、感染、脂肪结节液化等并发症。结论 自体脂肪移植治疗眼睑凹陷畸形临床效果确切,同时还可改善轻度眼睑闭合不全、轻度睑外翻等症状,恢复眼睑功能,值得临床推广应用。     

目标血压管理在全身麻醉鼻内镜下难治性鼻出血出血点定位中的应用

目的 探讨目标血压管理在全身麻醉鼻内镜下难治性鼻出血出血点定位中的应用价值。方法 选择全身麻醉中鼻内镜下未见明显出血点的难治性鼻出血患者58例,采用随机数字表法将所有患者分为对照组和观察组各29例。观察组行目标血压管理,控制性升压[目标血压不超过基础血压的120%且目标收缩压不得超过180 mmHg(1 mmHg=0.133kPa)],精确定位出血点,予电凝灼烧;对照组按常规行鼻腔选择性填塞术。记录观察组成功定位出血点例数,分别记录2组的住院时间、再出血例数、并发症例数。结果 观察组的住院时间、再出血率、并发症发生率与对照组比较差异均有统计学意义(P值均<0.05)。结论 目标血压管理在全身麻醉鼻内镜下难治性鼻出血出血点定位中的应用是行之有效的技术手段。     

二代测序技术在外源性眼内炎患者病原微生物检测中的应用

目的　探讨二代测序技术在外源性眼内炎患者病原微生物检测中的应用。方法　对2018年11月至2019年11月于武汉大学人民医院眼科中心就诊的21例（21眼）外源性眼内炎患者的临床特征和病原学结果进行分析。眼外伤史14例，内眼手术史7例。所有患者入院时均已完善相关检查并接受手术，术中尽可能清除前房及玻璃体内脓性病灶，并留存病灶样本（前房标本2份，玻璃体标本19份），通过宏基因组二代测序技术检测病原体和病原体培养两种方法对标本进行检测。对患者入院视力和末次随访视力行配对样本的非参数检验。对二代测序和病原体培养两种方法检出病原体阳性率差异行卡方检验。结果　14例外源性眼内炎患者可观察到前房积脓或玻璃体内脓性病灶；21例患者中，20例患者眼内感染均得到有效控制，眼球得以保留。与入院视力相比，患者末次随访视力提高，差异有统计学意义（P=0.006）。二代测序技术检测病原体阳性率为95.24%（20/21），病原体培养阳性率为42.86%（9/21），二者差异有统计学意义（P＜0.001）。病原体培养阳性的9例标本均检出单种病原体；利用二代测序方法检测，13例标本检出单种病原体，7例标本检出两种病原体。结论　结合使用二代测序技术与传统的培养手段，利于检出外源性眼内炎中病原微生物，指导临床诊疗。     

外耳道炎患者健康知识、态度和实践的横断面研究

目的 描述外耳道炎患者健康知识、态度和实践的横断面研究,并分析其影响因素。方法 纳入2017年门诊符合条件的526例外耳道炎患者为研究对象,采用一般资料调查表、外耳道健康知识、态度和实践调查表进行问卷调查。结果 526例外耳道炎患者中,184例首次确诊外耳道炎(34.90%),342例患者发生次数≥2次(65.10%)。不同性别、挖耳习惯、清洁外耳道方式、外耳道进水处理比较,差异均有统计学意义(P值均<0.05)。多因素分析显示,性别、清洁外耳道方式为外耳道炎复发的影响因素。结论 性别和清洁外耳道方式是外耳道炎复发的影响因素,门诊护理人员应该加强外耳道健康知识宣教。     

大腿皮肤游离中厚皮片修复重度结膜囊狭窄的临床疗效

目的 观察大腿皮肤游离中厚皮片修复重度结膜囊狭窄的临床疗效。方法 收集2018年1月~2019年3月在广西医科大学第一附属医院眼科住院行大腿皮肤游离中厚皮片移植修复结膜囊狭窄的患者资料,共6例(6眼)。观察患者术后移植组织存活情况、结膜囊深度以及是否可戴上义眼。结果 所有患者植片与残留结膜融合良好,组织全部存活。所有患者结膜囊深度恢复,均能安装义眼。2例患者出现再次狭窄,经二次手术修复后,结膜囊狭窄改善,能安装义眼。结论 大腿皮肤游离中厚皮片是修复重度结膜囊狭窄的理想组织材料。     

Effects of head elevation on intraocular pressure in healthy subjects: raising bed head vs using multiple pillows

Purpose

To evaluate the effects of different methods of head elevation on intraocular pressure (IOP) in healthy young subjects.

Methods

Twenty-four healthy young Korean subjects were included in this prospective observational study. The IOP measurements were taken with the subjects in the sitting position and in the supine positions with the head flat and 30° up using two different methods: (1) raising the bed head and (2) using multiple pillows. IOP was measured using Tonopen AVIA in both eyes 10 min after assuming each position in a randomized sequence. The Wilcoxon signed-rank test was used to compare the IOP by changing the methods of head elevation.

Results

Mean IOP of both eyes when sitting was lower than that measured in the supine position with head flat (P=0.001). Compared with that measured in the supine position with head flat, the mean IOP was lower when measured in the supine position with the head kept 30 ° up by bed head elevation (P=0.001), whereas the mean IOP was not significantly different when measured in the supine position with the head elevated using multiple pillows (right eye, P=0.061; left eye, P=0.089).

Conclusion

In normal subjects, IOP was lower when measured in the supine position with the head kept up by the bed head elevation compared with that measured when lying flat. However, such head-up position-induced IOP reduction was not found when the head was kept up using multiple pillows. These findings suggest that elevating the head using multiple pillows may not help to reduce IOP in the supine posture.     

电子喉镜在耳鼻喉科疾病诊治中的应用探讨

目的探讨电子喉镜在耳鼻喉科疾病诊断及治疗中的应用，以及手术应注意的问题。方法在表麻下采用日本FUJINONER-270T型电子喉镜，连接JVC彩色监视器，配电脑图文系统，对968例有耳鼻喉科症状的患者进行检查或治疗，并打印图文报告，其中喉部检查678例、鼻咽部检查236例、耳部检查54例。对132例声带息肉、声带小结等喉部疾病患者行电子喉镜下的手术治疗。结果968例患者均顺利通过检查，并明确诊断。91例声带息肉、41例声带小结、3例声带囊肿在电子喉镜下行摘除术，28例咽喉部异物的患者在电子喉镜下顺利取出异物，对118例鼻衄患者进行准确止血。结论电子喉镜是耳鼻喉科疾病诊治的新型有效工具，诊断率高。     

Differences in bioavailability of fornixes in different head positions.

Clinically, in infectious corneal or scleral ulcers, we have found some upper lesions to show a poorer response to eye-drops than lower lesions. This clinical observation stimulated our interest to investigate the differences of drug bioavailability in upper and lower fornixes in three different head positions. Seventeen people, 34 eyes, were enrolled in this study. There were three head positions for 0.1% fluorescein eye-drops application, including sitting, supine, and supine-with-chin-up. Schirmer's test paper was placed in the fornix to absorb the fluorescein, and the bioavailability was analyzed by fluorescence spectrophotometry. Fluorescein bioavailability of upper-and-lower fornixes were 1.30 x 10(-5)% and 7.33 x 10(-5)%, 3.93 x 10(-5)% and 9.57 x 10(-5)%, and 23.19 x 10(-5)% and 5.09 x 10(-5)% in sitting, supine, and supine-with-chin-up positions, respectively. Bioavailability of the lower fornix was significantly higher than that of the upper in the sitting position, and the bioavailability of the upper fornix was significantly higher than for the lower fornix in the supine-with-chin-up position. The bioavailability of the upper fornix in the supine-with-chin-up position was significantly higher than that in the sitting and supine positions, respectively. The total fluorescein bioavailability of both fornixes in the supine-with-chin-up position was significantly higher than that in the sitting position. We postulate that different head positions can influence drug bioavailability in the upper and lower fornixes. Ocular surface lesions in different sites may require different head positions during eye-drop application to obtain the best therapeutic results.     

导流杂交基因芯片技术在成人喉乳头瘤病毒感染分型检测中的临床应用

目的探讨核酸分子快速导流杂交基因芯片技术（HybriMax）在人乳头瘤病毒（HPV）喉部感染分型检测中的应用,并探讨HPV感染与成人喉乳头瘤发病的关系。方法选取2010年3月-2012年10月在本科住院的患者,其中喉乳头瘤36例、声带息肉30例。在支撑喉镜下手术切除喉部病变组织,留取部分组织。同时留取本院妇科门诊HC-Ⅱ检测阴/阳性各10份的宫颈细胞标本;采用HybriMax技术行HPV感染分型检测。结果 10例HC-Ⅱ法阳性宫颈细胞标本HybriMax法均检测出HPV,亚型分别为52、59、68型,其中52型50%（5/10）、58型30%（3/10）,59型20%（2/10）;1例HC-Ⅱ法阴性宫颈细胞标本HybriMax法检测出HPV。36例喉乳头瘤患者HPV阳性率50%（18/36）,分别检测出2种亚型,依次为HPV 6型（33.33%、12/36）、11型（16.67%、6/36）;声带息肉患者均未检测出HPV。结论 HybriMax检测HPV有很好的敏感性和特异性,能检测HPV亚型,是临床喉HPV感染分型检测的有效方法。HPV6、HPV11型可能在成人喉乳头瘤的发病中起作用。     

飞秒激光辅助白内障超声乳化术中患者眼球旋转的临床观察

目的　探讨飞秒激光辅助白内障超声乳化术（FLACS）中眼球旋转的规律。方法　前瞻性分析2018年1月至2021年1月行FLACS的患者679例（775眼）的临床资料。术前应用VERION数字导航系统在坐位时采集术眼眼前节图像，术中应用配有VERION数字导航系统的Alcon LenSx飞秒激光手术设备获取患者仰卧位时眼前节图像，记录术中眼球旋转的方向和角度。结果　775眼中，719眼（92.77%）发生了旋转，内旋最多见。患者逆时针旋转度数（5.08°±3.49°）大于顺时针旋转度数（4.29°±2.85°），差异有统计学意义（P=0.001）。患者内旋度数（5.12°±3.38°）大于外旋度数（3.86°±2.67°），差异有统计学意义（P<0.001）。患者右眼与左眼相比，顺时针及逆时针旋转发生率、旋转度数、顺时针旋转度数、逆时针旋转度数、内旋度数差异均有统计学意义（均为P<0.05）。男性患者外旋度数（4.58°±3.14°）大于女性患者（3.37°±2.18°），差异有统计学意义（P=0.001）。年龄＜50岁患者和年龄≥50岁患者相比，眼球旋转方向和旋转度数差异均无统计学意义（均为P>0.05）。结论　FLACS手术中，眼球普遍存在一定程度的旋转，眼球旋转的规律主要与眼别有关。VERION数字导航系统的应用可以使飞秒激光角膜切开术更加精确。     

Traumatic Superior Oblique Palsies

The differences in the clinical and diagnostic characteristics of 33 consecutive traumatic unilateral (21 patients, 62% ) and bilateral (12 patients, 38%) superior oblique palsies were studied. The unilateral palsies had a large hypertropia in primary postion, more vertical than torsional diplopia, a compensatory head tilt to obtain fusion, and a positive Bielschowsky head tilt test. In contrast, the bilateral palsies had small hypertropias in primary gaze that alternated on right and left gaze, a large V-pattern esotropia with excyclotorsion that was frequently bilateral, and a compensatory head position with fusion in upgaze. The results of the study indicate that a V-pattern in excess of 25 prism diopters, an excyclotorsion of greater than 10 degrees, or head trauma severe enough to cause loss of consciousness should also signal bilateral involvement. Torsional diplopia was present in only 20% of unilateral palsies vs 75% of bilateral palsies. The Bielschowsky head tilt test was diagnostic in 100% of the patients with unilateral palsy and 83% of the patients with bilateral palsy. It was undiagnostic in the supine position in all patients. Spontaneous resolution occurred in 65% of the unilateral palsies but in only 25% of the bilateral palsies. Surgical correction was successful in relieving persistent symptoms.     

补阳还五汤对高糖环境下miR-21介导的人视网膜微血管内皮细胞自噬的影响

目的 观察补阳还五汤对高糖环境下miR-21介导的人视网膜微血管内皮细胞(HRCECs)自噬的影响,以期为DR自噬调控机制及药物治疗提供依据。方法 HRCECs随机分5组,即正常对照组、高糖组、补阳还五汤组、miR-21 mimic组、miR-21 mimic+补阳还五汤组。除正常对照组外,其余各组细胞于25.0 g·L^-1葡萄糖环境中培养,建立高糖损伤模型,补阳还五汤组加用5 g·L^-1补阳还五汤水提液干预;miR-21 mimic组孵育转染miR-21 mimic的HRCECs; miR-21 mimic+补阳还五汤组用5 g·L^-1补阳还五汤水提液干预转染miR-21 mimic的HRCECs。荧光显微镜下观察转染效率,实时荧光定量PCR检测各组细胞中miR-21的表达,Western blot检测各组细胞中LC3蛋白表达。结果 经转染miR-21 mimic后,大部分HRCECs呈绿色荧光,荧光强度为32.708±1.001。实时荧光定量PCR检测结果显示,miR-21 mimic组HRCECs的miR-21相对...     

Retrolaminar migration as a complication of intraocular silicone oil injection detected on unenhanced CT

AIM: To describe the clinical and radiologic features of retrolaminar migration silicone oil (SiO) and observe the dynamic position of ventricular oil accumulation in supine and prone. METHODS: For this retrospective study, 29 patients who had a history of SiO injection treatment and underwent unenhanced head computed tomography (CT) were included from January 2019 to October 2022. The patients were divided into migration-positive and negative groups. Clinical history and CT features were compared using Whitney U and Fisher''s exact tests. The dynamic position of SiO was observed within the ventricular system in supine and prone. CT images were visually assessed for SiO migration along the retrolaminar involving pathways for vision (optic nerve, chiasm, and tract) and ventricular system. RESULTS: Intraocular SiO migration was found in 5 of the 29 patients (17.24%), with SiO at the optic nerve head (n=1), optic nerve (n=4), optic chiasm (n=1), optic tract (n=1), and within lateral ventricles (n=1). The time interval between SiO injection and CT examination of migration-positive cases was significantly higher than that of migration-negative patients (22.8±16.5mo vs 13.1±2.6mo, P<0.001). The hyperdense lesion located in the frontal horns of the right lateral ventricle migrated to the fourth ventricle when changing the position from supine to prone. CONCLUSION: Although SiO retrolaminar migration is unusual, the clinician and radiologist should be aware of migration routes. The supine combined with prone examination is the first-choice method to confirm the presence of SiO in the ventricular system.     

体位对青光眼患者眼压的影响

目的：研究不同体位对青光眼患者眼压的影响。 方法：选择术前住院患者原发性开角型、闭角型青光眼和正常眼压者各30例,测量其坐位、半坐卧位、仰卧位、侧卧位、俯卧位时眼压的变化;观察30例住院的青光眼患者眼压增高时体位的情况。 结果：三组患者不同体位所测平均眼压值中,均以卧位最高。左右侧卧位时下一侧眼的眼压比上一侧眼的眼压高。两两比较时坐位与半坐卧位、仰卧位与俯卧位之间眼压值无统计学意义（P＞0.05）。仅坐位、半坐卧位与各种卧位之间比较,差异均具有统计学意义（P＜0.05）。观察30例住院的青光眼患者眼压增高时以患侧卧位为主占70%,患者不能躺卧,被迫坐位。 结论：青光眼患者采取头高位及避免患眼侧卧位有利于眼压的控制。     

Intraocular Surgery in Kyphosis: An Easier Approach

We describe a 49-year-old man with advanced kyphosis and dense cataract, who could only recline to about 40° from the vertical axis despite a maximal reverse Trendelenburg position and pillows under the head, neck, shoulders and knees. With a single corneal retraction suture at 6 o''clock, the eye could be rotated horizontally, which enabled the surgeon to perform a complex cataract surgery despite prior glaucoma shunt, posterior synechiae, a small pupil and the need to stain the capsule. As the eye can be brought into any desired position with a retraction suture, patients with kyphosis or other conditions that prevent them from assuming a supine position can still have safe intraocular procedures. This maneuver reduces the need to tilt patients to an uncomfortable position that may cause pain, increased breathing difficulty and elevated posterior vitreous pressure.Key words: Kyphosis, Intraocular surgery, Intraocular complications