支撑喉镜喉显微手术治疗声带良性病变临床分析

目的：探讨喉显微手术治疗声带良性病变的效果及并发症。方法：手术在全麻支撑喉镜下进行,采用普通手术显微镜连接300mm聚焦镜头观察病变。结果：87例中声带息肉57例,声带小结24例,声带囊肿6例。71例1次治愈（81．6％）,5例经2次手术治愈（5．8铆,好转11例（12．6％）,无无效病例。结论：支撑喉镜下显敛手术清除病变彻底,并发症少,恢复快,临床疗效满意。     

The combination of a fiberoptic stylet and a McCoy laryngoscope facilitates tracheal intubation in difficult airway cases

Purpose. Fiberoptic stylets are considered useful for difficult airway management. In the present study, we assessed the usefulness of a fiberoptic stylet when the stylet was used with a Macintosh or a McCoy laryngoscope. Methods. Twenty-four patients, whose airways were graded as Cormack grade III, were studied. We compared the times required for tracheal intubation when the fiberoptic stylet was used with a Macintosh direct laryngoscope and when it was used with a McCoy laryngoscope. Cormack grade III was subdivided into IIIa (with distance between the epiglottis and the posterior wall of the pharynx) and IIIb (with no distance between the epiglottis and the posterior wall of the pharynx), according to the view of the vocal cords by the laryngoscope. Results. The intubation time in grade IIIb patients, who were intubated by the concurrent use of the fiberoptic stylet and the McCoy laryngoscope (28 ± 4 s), was not significantly different from that in grade IIIa patients (28 ± 10 s). The intubation time in grade IIIb patients, who were intubated by the concurrent use of the fiberoptic stylet and the Macintosh laryngoscope (52 ± 8 s), was significantly longer than that in grades IIIa (28 ± 10 s; P < 0.01) or IIIb with the McCoy laryngoscope (28 ± 4 s; P < 0.01). Conclusion. The combination of a new handy fiberoptic stylet and a McCoy laryngoscope facilitated tracheal intubation of patients whose airway had no distance between the epiglottis and the posterior wall of the pharynx in laryngoscopic vocal cord view. Received: September 8, 2000 / Accepted: January 22, 2001     

鼻内镜下联合自制角度喉钳切除声门暴露困难声带息肉23例

探讨鼻内镜下联合自制角度喉钳切除声门暴露困难声带息肉的效果。     

光杖联合直接喉镜应用于老年患者气管插管的临床分析

目的:研究光杖联合直接喉镜对老年手术患者气管插管全麻诱导下的血流动力学与气道并发症的影响。方法:选择45例ASAⅠ-Ⅲ级拟行全麻手术的老年患者,男23例,女22例,年龄65-82岁,随机分成光杖组(A组)、直接喉镜组(B组)和光杖联合直接喉镜组(C组)。三组患者采用相同的全身麻醉诱导方法,分别记录麻醉诱导前(T0)、麻醉诱导后(T1)、插管即刻(T2)和插管后1min(T3)的收缩压(SBP)、舒张压(DBP)、心率(HR)和氧饱和度(SpO2)。记录插管时间和插管成功的例数,并观察并发症。结果:插管即刻(T2)HR、SBP、DBP、SpO2在B组与C组之间差异有统计学意义(P<0.05),插管后1min HR、SBP、DBP、SpO2在B组与C组之间差异有统计学意义(P<0.05),C组并发症少于A、B组,插管时间C组短于A、B组(P<0.05)。结论:在老年患者中光杖联合直接喉镜气管插管,成功率高,可以有效减轻气管插管的应激反应,对老年患者血流动力学影响较小。     

显微支撑喉镜下微瓣技术治疗声带囊肿20例临床分析

目的分析在显微支撑喉镜下微瓣技术治疗声带囊肿的手术方法及疗效。方法回顾性分析2008年1月～2011年12月20例在显微支撑喉镜下利用微瓣技术行声带囊肿切除术的患者,分析手术过程及术后疗效。结果随访9个月,20例中治愈19例,占95%,无效1例,占5%,总治愈率为95%。结论显微支撑喉镜下微瓣技术治疗声带囊肿能在完整切除囊肿的同时,最大限度避免损伤声带正常结构,恢复正常的发音功能。     

Comparison of Airtraq optical laryngoscope and Storz video laryngoscope in a cadaver model

BACKGROUND:

Airway management in the emergency department is a critical intervention that requires both standard techniques and rescue techniques to ensure a high rate of success. Recently, video laryngoscope (VL) systems have become increasingly common in many large urban EDs, but these systems may exceed the budgets of smaller rural EDs and EMS services and the Airtraq optical laryngoscope (OL) may provide an effective, low-cost alternative. We hypothesized that laryngeal view and time to endothracheal tube placement for OL and VL intubations would not be significantly different.

METHODS:

This was a prospective, crossover trial. Setting: University-based emergency medicine residency program procedure laboratory utilizing lightly embalmed cadavers. Subjects: PGY1-3 emergency medicine residents. The study subjects performed timed endotracheal intubations alternately using the OL and VL. The subjects then rated the Cormack-Lehane laryngeal view for each device. Statistical analysis: Mean time to intubation and the mean laryngeal view score were calculated with 95% confidence intervals and statistical significance was determined by Student''s t test.

RESULTS:

Fourteen subjects completed the study. The average laryngeal view achieved with the OL vs. the VL was not significantly different, with Cormack-Lehane grade of 1.14 vs. 1.07, respectively. Time to endotracheal intubation, however, was significantly different (P<0.001) with the average time to intubation for the OL 25.49 seconds (95% CI: 17.95-33.03) and the VL 13.41 seconds (10.27-16.55).

CONCLUSION:

The Airtraq OL and the Storz VL yielded similar laryngeal views in the lightly embalmed cadaver model. Time to endotracheal tube placement, however, was less for the VL.KEY WORDS: Airtraq optical laryngoscope, Laryngoscope, Video laryngoscope     

利多卡因在支撑喉镜手术中对血流动力学的影响

目的 观察利多卡因不同给药方式对支撑喉镜手术中患者血流动力学的影响.方法 选择75例择期行支撑喉镜下声带息肉、会厌或喉肿物摘除活检的全麻成年患者.随机分成三组,每组25例.Ⅰ组为对照组;Ⅱ组为喷喉组;Ⅲ组为静脉用药组.观察患者手术期间呛咳的发生率和平均动脉压（MAP）、心率（HR）的变化.结果 Ⅱ组呛咳发生率低于Ⅰ组和Ⅲ组（P＜0.05）.Ⅱ组拔除导管时MAP、HR低于Ⅰ组和Ⅲ组（均P＜0.05）.Ⅰ组和Ⅲ组拔除导管时MAP、HR差异均无统计学意义（均P＞0.05）.结论 利多卡因充分喷喉对预防和减轻支撑喉镜手术中患者呛咳和心血管反应有明显作用,其效果优于利多卡因静脉内用药.     

胸外科长柄电刀在会厌囊肿切除术中的应用

目的 探讨应用胸外科长柄电刀切除会厌囊肿的疗效.方法 将66例会厌囊肿患者随机分成胸外科长柄电刀切除组(实验组)及常规摘除组(对照组),每组33例.两组均在气管插管静脉复合全麻下行支撑喉镜下手术,比较二组术中出血量、手术时间、术后疼痛程度、术后疗效.结果 实验组与对照组比较,前者术中出血量明显减少,手术时间明显缩短,术后疗效明显好,差异具有统计学意义(P<0.05);两者术后疼痛程度比较,差异无统计学意义(P>0.05).结论 采用胸外科长柄电刀在支撑喉镜下切除会厌囊肿具有术中视野清晰、出血量少、手术时间快短、术后疗效好等优点.     

瑞芬太尼全凭静脉麻醉在支撑喉镜手术的应用

目的：观察瑞芬太尼联合异丙酚全凭静脉麻醉在支撑喉镜声带息肉切除术中的麻醉效果。方法：择期行支撑喉镜声带息肉切除术的患者40例,ASAⅠ或Ⅱ级,术前检查均无重要脏器疾病史及药物过敏史。将40例患者随机分为2组,每组各20例：异丙酚-芬太尼全麻组为对照组（F组）,异丙酚-瑞芬太尼全麻组为观察组（R组）。记录两组患者的心血管反应、苏醒拔管时间及苏醒质量。结果：①R组患者血流动力学变化比F组平稳（P〈0.05）;②R组患者苏醒拔管时间明显短于F组（P〈0.05）,拔管即刻及离开手术室送PACU时OAA/S评分R组明显高于F组（P〈0.05）。结论：瑞芬太尼联合异丙酚全凭静脉麻醉在支撑喉镜声带息肉切除术,具有心血管反应轻、苏醒快等优点,是一种较理想的麻醉方法。     

支撑喉镜联合鼻内镜下微型电动切削声带良性肿物

目的观察支撑喉镜联合鼻内镜下微型电动切削器切削声带良性肿物的疗效。方法选择108例临床可确诊为声带良性肿物患者,随机分为支撑喉镜联合鼻内镜下微型电动切削器切除声带良性肿物(观察组56例)与支撑喉联合镜鼻内镜下显微喉器械切除声带良性肿物(对照组52例),术后随访并观察6个月评定比较两组疗效。结果两组治愈率分别为92.86%和50%,有效率分别为98.21%和92.31%,临床治愈率差异有统计学意义(P<0.05)。结论两种术式疗效前者较好,且手术容易操作、时间短。