The Callender modification of the Macintosh laryngoscope blade reduces the risk of tooth-blade contact in children

Background: Dental injury is well recognized as a potential complication of laryngoscopy and tracheal intubation. The flange of the Macintosh blade may contact teeth during laryngoscopy causing damage. The Callander modification of the Macintosh blade (Callander blade) with a shortened heel at the proximal end has been shown to increase the blade–tooth distance and reduce contact rates in adults. Aim: This study was designed to evaluate the effectiveness of the Callander blade on reducing dental contact in children. Methods: One hundred children, aged 4–14 years, scheduled for general anesthesia requiring endotracheal intubation were studied prospectively. The children were preoperatively evaluated for Mallampati score and dental defects, looseness, and avulsions. Following induction of anesthesia, laryngoscopy was performed twice on each child in succession, once with a standard Macintosh blade and once with a Callander blade of the same size in a random order. The blade–tooth distance and contact rate were compared between the two blades. Results: With the Callander blade, the blade–tooth distance was greater than with the Macintosh (1.78 ± 1.77 vs 0.28 ± 0.76 mm, P = 0.001). The frequency of direct contact was less with the Callander blade than it was with the Macintosh blade (33% vs 86%, respectively, P = 0.008). However, difficult laryngoscopy rate did not differ between the blades. Tracheal intubation was successful in all children and there was no dental injury. Conclusion: Our findings suggest that the Callander blade decreases the risk for dental injury and provides tracheal intubating conditions in children with normal airways similar to those obtained with a traditional Macintosh blade.     

纤维喉镜下半导体激光治疗喉肿物30例

目的 探讨半导体激光治疗包括声带良性肿瘤、癌前病变等在内的喉肿物优点, 分析疗效。方法 表面麻醉, 在纤维喉镜引导下利用半导体激光切除声带或者喉室小结、息肉及声带白斑、乳头状瘤等喉肿物。术后采用口服药物或者雾化治疗消除手术水肿, 禁声1个月, 吸烟患者强制戒烟。结果 1个月后患者声嘶症状基本解决, 声带黏膜恢复良好。结论 纤维喉镜引导下半导体激光治疗喉肿物疗效好, 患者花费少, 痛苦小。     

咽鼓管导管的研制与临床应用

目的:研制一种能通过纤维鼻咽镜活检孔导入在纤维鼻咽镜直接观察下插入咽鼓管咽口的一种导管,并研究其治疗中耳疾病的疗效.方法:使用Olympas公司生产的T3型纤维咽喉镜及冷光源系统及自行设计研究的塑料咽鼓管扩张、冲洗导管,为中耳疾病患者行咽鼓管扩张、冲洗、吸引、注药治疗.结果:118例154耳中耳疾患中,有126例咽鼓管通畅,症状痊愈,19例症状改善,9例效果不明显,治愈率达81.9%.结论:此导管在纤维鼻咽镜引导下,可直接对准咽鼓管咽口,插入准确,不伤及咽鼓管粘膜,治疗成功率高,可扩张、探查、吸引、冲洗、注药一次性完成治疗.     

直接喉镜与电子喉镜下手术治疗会厌囊肿疗效比较

目的:探讨直接喉镜和电子喉镜下会厌囊肿摘除术的手术方法及各自的优缺点.方法:会厌囊肿患者72例,随机分为两组,治疗组38例行电子喉镜下手术,对照组34例行直接喉镜下手术.两组患者均在术前及术后1个月、5个月行电子喉镜检查,观察并比较两组术后疗效.结果:术后随访1～3 a,治疗组治愈34例、好转2例、未愈2例,治愈率89.4％;对照组治愈23例、好转6例,未愈6例,治愈率64.7％.两组患者治愈率比较,差异有统计学意义(P＜0.01).结论:电子喉镜下会厌囊肿摘除属微创手术,具有视野清晰、操作准确、创伤小、痛苦少、花费少等优点,值得临床推广.     

鼻内镜辅助支撑喉镜下新生儿咽喉部肿物的手术治疗

目的 探讨新生儿咽喉部肿物患者的临床表现及手术方式。方法 通过回顾2020—2022年就诊于兰州大学第二医院的3例新生儿咽喉部肿物患者的临床资料,总结分析3例新生儿咽喉部肿物患者的临床表现及治疗方法。3例患者中,咽喉部囊肿1例,咽部毛息肉1例,咽部畸胎瘤1例。结果 3例患儿均表现为呼吸或吸吮困难,均在鼻内镜辅助下顺利进行支撑喉镜咽喉部肿物切除手术。随访10个月以上,均无复发。结论 鼻内镜的运用可以帮助明确肿物基底部及其与周围组织的关系,确定手术切除范围,在鼻内镜辅助的支撑喉镜下行咽喉部肿物切除,可以完整切除肿瘤,充分止血,并发症少,应用于新生儿患者具有一定的优势。     

鼻内窥镜联合支撑喉镜手术治疗声带息肉疗效分析

目的：分析鼻内窥镜与支撑喉镜联合应用于声带息肉患者临床治疗中的效果。方法整群选取2014年9月—2015年9月期间,该院接收的声带息肉92例,以随机方式将其分为A组与B组,各46例,A组单纯采支撑喉镜进行手术治疗,B组采用鼻内窥镜联合支撑喉镜进行手术治疗,观察两组患者治后的临床治疗效和不良反应情况。结果治疗后,B组患者的临床治疗总有效率是95.6%,A组患者的临床治疗总有效率是82.6%,B组患者的不良反应发生率是2.1%,A组患者不良反应发生率是19.5%,B组患者的临治疗总效率与不良反应率显著优于A组(P<0.05)。结论支撑喉镜联合鼻内窥镜的声带息肉患者的临床治疗中的应用效果十分显著,且不良反应较低,具有在临床上进一步推广与应用的价值。     

循证护理在留置导尿中的应用研究

目的探讨循证护理思维方法在留置尿管护理中的作用。方法将160例留置导尿的患者随机分成研究组和对照组进行研究。研究组（n=80）从“尿管插入深度、气囊注水量、尿管护理、膀胱冲洗、拔除尿管”等方面进行循证,获取最佳的证据,指导临床护理;对照组（n=80）给予会阴擦洗、呋喃西林膀胱冲洗、每日更换集尿袋等常规护理。比较2组患者的留置尿管并发症情况。结果研究组留置尿管并发症的预防效果明显优于对照组（P〈0.05）。结论运用循证护理能减少留置尿管并发症的发生。     

Glidescope视频喉镜在头颈外科手术老年患者气管插管中的应用

目的评价Glidescope视频喉镜用于头颈外科手术老年患者气管插管的临床效果。方法择期行头颈外科手术的老年患者40例,随机分为Glidescope视频喉镜组(G组20例)和直接喉镜组(L组20例)。全部患者均于麻醉前进行改良Mallampati分级评估,分析比较两组患者声门暴露情况(Cormark-Lehane分级)、插管时间,记录麻醉诱导前(T0)、诱导后(T1)、插管后不同时点(T2～T5)的血流动力学变化。结果与L组比较,G组患者获得较好的声门暴露,且插管时间缩短(P<0.05)。两组患者T1时点MAP、HR较T0时点有所降低(P<0.05),T2～T5不同时点MAP、HR较T0时点有不同程度增加(P<0.05),两组比较差异无统计学意义(P>0.05)。结论 Glidescope视频喉镜可以为头颈外科手术老年患者创造更好的插管条件,提高插管成功率。     

帝视内镜与Macintosh喉镜在小儿气管插管中应用效果的比较

目的 探讨帝视内镜在小儿扁桃体切除术中气管插管的应用效果,并与Macintosh喉镜作比较。方法 选择该院择期行扁桃体切除术的患儿60例,年龄6～9岁,美国麻醉医师协会（ASA）分级Ⅰ至Ⅱ级,Mallampati气道分级Ⅰ至Ⅱ级,扁桃体肿大Ⅰ至Ⅱ度,随机分为帝视内镜组（DE组）和Macintosh喉镜组（MA组）。全麻诱导后,分别使用帝视内镜和Macintosh喉镜行气管插管。记录两组的声门暴露时间、气管插管总时间、声门暴露分级、气管插管次数、插管并发症发生例数、各麻醉诱导时相的心率（HR）、平均动脉压（MAP）和患儿与麻醉医师口对鼻距离（MN间距）。结果 DE组声门暴露时间、气管插管总时间短于MA组（P = 0.000）;DE组声门暴露分级优于MA组（P < 0.01）;DE组均一次插管成功,MA组有3例需二次插管;DE组插管并发症发生率低于MA组（P < 0.05）;DE组MN间距明显大于MA组（P = 0.000）;两组患儿麻醉诱导前（T₀,记为基础值）、麻醉诱导后插管前即刻（T₁）和气管插管后3 min（T₄）的HR和MAP比较,差异均无统计学意义（P > 0.05）;DE组患儿气管插管后即刻（T₂）和气管插管后1 min（T₃）的HR和MAP均低于MA组（P < 0.01）。结论 相比Macintosh喉镜,在小儿扁桃体切除术气管插管时使用帝视内镜,能明显改善声门显露效果、缩短气管插管操作时间、减少插管并发症和减轻血流动力学波动,并增大MN间距。     

Nasotracheal tube placement over the fibreoptic laryngoscope

We have assessed the effectiveness of three tracheal tube rotational movements in assisting nasotracheal tube placement over the fibreoptic laryngoscope. Ninety ASA grade 1 or 2 oral surgery patients undergoing fibreoptic nasotracheal intubation under general anaesthesia were studied. After the fibrescope had been positioned in the trachea, patients were randomly allocated to one of three groups. In group 1, no rotation was used and the tube was advanced towards the trachea in the neutral position. In group 2, the tube was rotated by 90° anticlockwise. In group 3, the tube was rotated by 180° anticlockwise, then rotated back to 90° anticlockwise (overcorrected rotation). If resistance to the advance was encountered, up to two more attempts were allowed, after further rotational manoeuvres had been made, in accordance with a standard, graduated sequence. There were significantly more successful tube placements at the first attempt in groups 2 and 3 (93% and 100% respectively) than in group I (63%). It is therefore recommended that 90° anticlockwise or overcorrected 90° anticlockwise tube rotation is used to facilitate nasotracheal tube placement during fibreoptic intubation.