瑞芬太尼复合丙泊酚静脉麻醉在小儿扁桃体摘除术中的应用

目的探讨瑞芬太尼复合丙泊酚静脉麻醉在小儿扁桃体摘除术中的应用效果。方法选择ASAⅠ～Ⅱ级、择期行扁桃体切除术的患儿80例,随机分为观察组和对照组,每组40例,观察组为瑞芬太尼复合丙泊酚麻醉组,对照组为常规芬太尼麻醉组,比较两组插管前后血流动力学变化、术后恢复和不良反应情况。结果两组插管前及插管后5min心率、血压无显著变化;插管后20min观察组心率低于对照组,差异具有显著性（P〈0.05）,但血压比较差异无统计学意义（P〉0.05）;插管后lh观察组心率、血压均低于对照组,差异有统计学意义（P〈0.05）,自主呼吸恢复时间、苏醒时间、清醒时间及停药至气管导管拔除时间均短于对照组,差异具有显著性（P〈0.05）。术后不良反应发生率观察组为27.5%,对照组为52.5%,两组比较差异有统计学意义（χ2=5.21,P〈0.05）。结论瑞芬太尼复合丙泊酚静脉麻醉能很好地满足小儿扁桃体摘除术的要求,麻醉深度可控性强,术中循环平稳,术毕苏醒迅速、完全,不良反应较少,是一种理想的小儿全身麻醉方法。     

“预防性缝扎法”在扁桃体切除术中的止血效果

＂预防性缝扎＂是外科手术中比较有效、可靠的止血方式。一般的扁桃体手术都是先切除扁桃体,再止血。但是扁桃体下极的出血,再合并小颌、肥胖等特殊口腔结构的患者,会给止血带来很大的困难。我们应用＂预防性缝扎法＂,并配合电刀应用,在扁桃体切除术中止血效果良好,且预防了术后出血,报道如下。1资料与方法1.1临床资料2012年2月至2015年2月,烟台市北海医院耳鼻喉科共收治慢性扁桃体炎患者60例,其中男32例,女28例;5～68岁,平均28岁;病程1～6年;分成研究组（30例）和对照组（30例）。     

吞咽表面肌电图评估扁桃体切除术后患者疼痛程度的可能性研究

目的 探讨吞咽表面肌电图用于评估扁桃体切除术后患者疼痛程度的可能性.方法 选取行扁桃体切除术的患者32例,分别于术前、术后1 d和术后2 d行吞咽的表面肌电图检查.同时对所有患者术后行吞咽疼痛的视觉模拟评分,连续2 d, 1次/d.结果 所有的吞咽方式中,术后1 d和术后2 d干咽时间和振幅皆 < 术前,吞咽20 mL水所需时间 > 术前,而振幅 < 术前.术后1 d与术后2 d的干咽时间、干咽振幅、20 mL水吞咽时间、20 mL吞咽振幅和视觉模拟评分法(VAS)都没有明显差别.术后表面肌电图振幅变化、时间变化程度与VAS评分无明显相关性(P>0.05).结论 吞咽表面肌电图能够观察到扁桃体切除术后患者因疼痛导致的吞咽时的肌肉活动变化,今后有可能根据这些变化来指导是否需要镇痛药物,但其不能用于判定疼痛的程度.     

Prevalence of Fusobacterium necrophorum in tonsils from patients with chronic tonsillitis

Conclusion: There was a high prevalence of Fusobacterium necrophorum (FN) in patients with chronic tonsillitis in the age group 15–23 years. This indicates that FN might play an important role in the pathogenesis of chronic tonsillitis in this age group, which is also the age group in which chronic or recurrent tonsillitis is most common.

Objectives: The role of FN in patients with acute and chronic tonsillitis is unclear. Thus, this study investigated the occurrence of FN in tonsils of patients with chronic tonsillitis. The aim of the study was to determine the prevalence of FN in patients that underwent tonsillectomy due to chronic tonsillitis. This study also investigated if FN was found at different areas in the tonsils.

Method: One hundred and twenty-six consecutive patients undergoing tonsillectomy due to chronic tonsillitis were included from the ENT clinics at Sunderby Hospital and Gällivare Hospital, Sweden. Both children and adults were included to encompass various age groups (age =2–57 years). Culture swabs were taken from three different levels of the tonsils – the surface, the crypts, and the inner core of the tonsils. Selective agar plates for detecting FN were used for culture. Culture was also made for detecting β-hemolytic streptococci, Haemophilus influenzae, and Arcanobacterium.

Results: FN was the most common pathogen (19%). The highest prevalence of FN was found in the age group 15–23 years (in 34% of the patients). FN was detected both at the surface and in the core of the tonsils. Furthermore, in the few patients where FN was not detected in all three areas, FN was always detected at the tonsillar surface, in spite of being an anaerobic bacterium. Streptococci group G and C also occurred most frequently (30%) in the same age group as FN (15–23 years), whereas Streptococci group A was more evenly spread among the age groups.     

The comparison of bleeding and pain after tonsillectomy in bipolar electrocautery vs cold dissection

ObjectiveAlthough tonsillectomy is one of the most common surgeries performed in pediatric, it has potential major complications such as pain and bleeding. This study aimed to compare the bleeding and pain after tonsillectomy in bipolar electrocautery tonsillectomy versus cold dissection.MethodsThis double blind clinical trial was conducted on 70 pediatric patients who were candidate of tonsillectomy. Patients were divided into two groups of including bipolar cautery (BC) and cold dissection (CD). operation time, intraoperative blood loss, and postoperative bleeding and pain were evaluated in the current study.ResultsIn both of the CD and BC groups, no significant difference was found in terms of sex and age. The average amount of the intraoperative blood loss in BC group was 14.086 ± 5.013 ml and in CD group was 26.14 ± 4.46 ml (p. v = 0.0001). The mean time of operation in BC group was 19 ± 2.89 min and in CD group was 29.31 ± 5.29 min (p. v = 0.0001).patients were evaluated in terms of pain on the first, third, fifth, and seventh days after the operation. No statistically significant difference was found between two groups.Moreover, Compared pain scores in all times across two groups, no significant difference was found.In terms of postoperative bleeding, none of the patients in both groups had bleeding during follow-up.ConclusionOur study showed that bipolar electrocautery tonsillectomy can significantly reduce the operation time and intraoperative blood loss; however, postoperative pain and blood loss were similar in both techniques. We recommend bipolar electrocautery as the most suitable alternative method for tonsillectomy, especially in children.     

Does subjective tonsillar grading reflect the real volume of palatine tonsils?

Objectives

The aim of this prospective clinical study was to compare the subjective tonsil size (grade) with real palatine tonsil volume, body mass index, body surface area, age, and gender.

Patients and methods

Two hundred and ninety-two patients with the diagnosis of recurrent acute tonsillitis, ages 3-15 years, (156 male and 136 female) who underwent tonsillectomy were enrolled into this study. The correlation of subjective tonsil size to objective tonsil volume, body mass index, body surface area, age, and gender size was investigated. The statistical correlations were evaluated by Pearsons’ bivariate correlation method.

Results

There was statistically significant correlation between objective volume of tonsils and subjective grading of tonsils (p < 0.001). There was statistically significant correlation between objective volume of tonsils (both right and left tonsil) and body mass index (p = 0.008 and 0.013) respectively. There was statistically significant correlation between objective volume of tonsils and body surface area (p = 0.009). There was statistically significant correlation between volume of tonsils and age (p = 0.017).

Conclusions

Objective tonsil volume is correlated with subjective tonsil size, body mass index, body surface area and age in patients with recurrent acute tonsillitis. Follow-up of palatine tonsil status (volume) of patients with recurrent acute tonsillitis may be decided according to the subjective tonsil size. The correlations of aforementioned parameters to objective tonsil volume should be searched for other pathologies of palatine tonsils.     

地佐辛复合帕瑞昔布钠在小儿扁桃体切除术的超前镇痛作用

目的探讨地佐辛复合帕瑞昔布钠在小儿扁桃体切除术超前镇痛的作用。方法 80例择期行扁桃体切除术患儿,随机分为对照组(C组)、地佐辛组(D组)、帕瑞昔布钠组(P组)、地佐辛复合帕瑞昔布钠组(DP组),每组20例,分别于麻醉诱导前5min给予生理盐水、地佐辛0.1 mg/kg、帕瑞昔布钠0.8 mg/kg及地佐辛0.1 mg/kg复合帕瑞昔布钠0.8 mg/kg静脉注射。记录术后患儿拔管后0.5、1、2、4、8、12、24h(T1-7)校正面部疼痛评分(FPS-R评分),观察术后不良反应。结果 D组、P组、DP组术后FPS-R评分均低于C组(P<0.01),DP组术后FPS-R评分低于D组、P组(P<0.01),诱导期间C组、P组患儿呛咳多于D组、DP组(P<0.01),C组患儿术后烦躁多于其他各组(P<0.01)。未见其它不良反应。结论地佐辛、帕瑞昔布钠在小儿扁桃体切除术有超前镇痛作用,二者复合应用效果更佳。