甲状腺切除病例喉返神经损伤的分析

目的：研究甲状腺切除术的主要并发症－－喉返神经（ＲＬＮ）麻痹的相关因素。方法：回顾性研究１５６３例甲状腺手术患者的临床资料,重点分析ＲＬＮ损伤与术式、ＲＬＮ在术中是否被分离保护以及与甲状腺疾病的病理关系。结果：ＲＬＮ损伤率是７．８％,与组织病理恶性程度明显相关（Ｐ〈０．０１）,但术中如明确找到ＲＬＮ并加以保护,术后则无ＲＬＮ永外性损害,暂时麻痹仅１．６％。结论：术中对ＲＬＮ的保护应该强调避免医源性     

京剧嗓音的声学分析及音域特征

目的　从声学角度客观地检测京剧的嗓音特征 ,为京剧演唱者嗓音的训练和保护提供参考。方法　对 73名 1 6～ 5 7岁不同行当的专业京剧演员或学员 ,利用Dr Speech计算机频谱分析系统对元音 /a/、/i/歌唱舒适音和唱段进行声学参数的检测和分析。结果　各行当元音 /a/、/i/歌唱舒适音的基频 (fundamentalfrequency,F0 )分别是 :丑角 (2 72 6± 42 0 )Hz( x±s ,下同 )、(30 4 2± 2 2 1 )Hz;小生 (499 3± 34 0 )Hz,(485 4± 1 8 7)Hz;老生 (335 6± 6 0 0 )Hz,(31 7 9± 45 1 )Hz ;花脸 (31 9 0±6 1 3)Hz,(34 0 1± 6 8 8)Hz;老旦 (42 7 6± 47 2 )Hz,(437 7± 45 8)Hz ;花旦 (5 35 8± 48 8)Hz,(5 6 1 6± 2 9 2 )Hz ;青衣 (5 48 0± 6 9 5 )Hz,(5 43 5± 79 3)Hz;其它声学参数 :频率微扰 (pitchperiodperturbation,或Jitter)、振幅微扰 (amplitudeperturbation ,或Shimmer)和声门噪声能量 (也称标准化噪声能量级 ,normalizednoiseenergy ,NNE)均在软件提供的正常值范围内 ;京剧演员歌唱音域的跨度为 1 7～ 2 8个八度 ,最低音和多数最高音均比西洋唱法的高音声部相应的值高。结论　京剧嗓音有着独特的声学特征 ;结果对其嗓音的训练和保护有一定的临床参考     

声带息肉和声带小结的治疗与发声效率

[目的 ]研究声带息肉和声带小结的治疗方法 .[方法 ]对 30例声带息肉患者和 2 0例声带小结患者进行了喉显微外科手术或激光喉显微外科手术 ,并在术前及术后分别测量了其发声效率 .[结果 ]在声带息肉组中 ,手术前后发声效率有显著性差异 ;在声带小结组中 ,手术前后发声效率无显著性差异 .[结论 ]对于声带息肉患者喉显微外科手术 (包括激光 )是较好的治疗方法 ,对于声带小结患者 ,当各种保守治疗无效时 ,考虑选择喉显微外科手术     

Vocal cord paralysis associated with difficult gastric tube insertion

Many clinical reports have described vocal cord paralysis after general anaesthesia. In most cases, paralysis was attributed to tracheal tube insertion. In this report we describe one patient in whom gastric tube insertion was strongly suspected as the cause of paralysis. The patient was a 47-yr-old man who underwent left hepatic lobectomy. Just after the operation he complained of hoarseness and a diagnosis of complete right vocal cord paralysis was made, from which he recovered after eight weeks. In this patient, insertion of the gastric tube seemed to have injured the anterior ramus of the right recurrent laryngeal nerve directly. Although there have been several reports of vocal cord paralysis induced by gastric tubes, none has noted such an acute onset and direct nerve injury. Therefore we would like to report this rare case and elucidate the mechanism of vocal cord paralysis. Careful attention should be paid in inserting a gastric tube to patients under general anaesthesia and, sometimes, the use of the soft tube may be indicated. Plusieurs publications portent sur la paralysie des cordes vocales après une anesthésie générale. Dans la plupart des cas, on attribue la paralysie à l’insertion du tube endotrachéal. Ce compte-rendu se rapporte à un cas où l’insertion d’une sonde gastrique est fortement mise en cause dans l’étiologie de la paralysie. Un patient de 47 ans subit une hépatectomie. Immédiatement après l’intervention, il se plaint de raucité de la voix et une paralysie de la corde vocale droite est diagnostiquée. La récupération s’effectue en huit semaines. Chez ce patient, la sonde gastrique semble avoir endommagé directement le rameau antérieur du nerf récurrent laryngé. Bien que plusieurs observations identiques de paralysie des cordes vocales provoquée par une sonde gastrique aient été publiées, aucune ne rapporte un début aussi soudain avec lésion nerveuse directe. Nous décrivons ici ce cas rare et tenterons d’expliquer le mécanisme de la paralyse de la corde vocale. Il faut être très prudent lorsqu’on insère un tube gastrique sous anesthésie générale et il est parfois préférable d’utiliser un tube mou.     

颈部粗短或颈椎病患者的喉动态内镜直视法声带息肉摘除术

目的：探讨喉动态内镜直视下声带息肉摘除术对体胖颈部粗短或颈椎病患者的疗效。方法：对42例体胖颈部粗短或颈椎病患者在喉动态内镜直视下，以弯形声带息肉钳经口咽部行声带息肉摘除术，术中并以喉动态镜观察其声带的对称性、规律性、黏膜波动度及声带闭合度，若发现残留息肉，即时可再次修整摘除。结果：手术均一次成功，无一例发生并发症。术后随访未见复发，音声恢复良好。结论：该术式对体胖颈部粗短或颈椎病患者的声带息肉摘除具有临床应用价值。     

正常与病态下嗓音的客观指标的评价

对158例正常人和136例各种喉疾病患者连续元音[i]发声时的平均气流率、声强、频率、频率微扰商和发声效率同步进行了测定.并对各测定指标间的相互关系进行了探讨.频率微扰商是表示连续元音发声时声带振动相邻周期间的微细变动量;发声效率反映平均气流率与声能的有效转换率.在低、中和高强度发声时.随发声强度的提高,平均气流率.频率和发声效率随之提高而频率微扰商则变小.中等声强发声时.平均气流率与声强,声强与频率均呈正相关;而平均气流率与发声效率.声强(男性)和频率(女性)与频率微扰商均呈负相关.多数喉疾病患者显示出较正常人高的平均气流率和频率微扰商,发声效率则降低.当声强和频率作为参考指标时,平均气流率,频率微扰商和发声效率可作为评价喉发声功能的客观、定量指标.     

纤维喉镜下声带手术及发声矫治

本文探讨了310例声带良性病变施行纤维喉镜下手术方法和治疗价值，跟踪观察了临床近期和远期疗效。认为纤维喉镜治疗声带良性小肿物（尤其是声带小结和带蒂的声带息肉）安全、可靠、治愈率高。同时还提出术后发声矫治对声嘶恢复、疗效巩固及防止病变复发是十分必要的。     

Effects of vecuronium and rocuronium in antagonistic laryngeal muscles and the anterior tibial muscle in the cat

BACKGROUND: Adequate vocal cord paralysis and full recovery of laryngeal muscle function are important when muscle relaxants are used perioperatively. This study was designed to compare the effects of vecuronium and rocuronium at the vocal cord abductor and adductor muscles and the anterior tibial muscle in cats. METHODS: Twelve adult cats were studied under pentobarbitone-N2O/O2-anesthesia. After supramaximal electrical stimulation of the peroneal nerve and the recurrent laryngeal nerve (0.1 Hz and intermittent train-of-four) evoked electromyographic responses were obtained from the anterior tibial muscle, the posterior cricoarytenoid muscle (vocal cord abductor) and two vocal cord adductor muscles, the lateral cricoarytenoid and the vocal muscle. Six cats received bolus doses of increasing size of vecuronium (ED90 22.5 microg x kg(-1)) and six cats rocuronium (ED90 90 microg x kg(-1)). RESULTS: Equipotent doses of vecuronium and rocuronium caused a similar degree of paralysis in all muscles (vecuronium ED90: 70% blockade at the posterior cricoarytenoid, 83% at the lateral cricoarytenoid, 84% at the vocal muscle and 90% at the anterior tibial muscle; rocuronium ED90: 71% at the posterior cricoarytenoid, 67% at the lateral cricoarytenoid, 78% at the vocal muscle and 90% at the anterior tibial muscle; vecuronium 2 x ED90: 93% blockade at the posterior cricoarytenoid, 95% at the lateral cricoarytenoid, 97% at the vocal muscle and 99% at the anterior tibial muscle; rocuronium 2 x ED90: 89% blockade at the posterior and lateral cricoarytenoid, 93% at the vocal muscle and 100% at the anterior tibial muscle). Onset time was significantly shorter at the posterior cricoarytenoid muscle (290 s) compared to the lateral cricoarytenoid muscle (400 s) after vecuronium ED90 and to the vocal muscle (150 s versus 210 s) after rocuronium ED90. Compared to the anterior tibial muscle (interval 25-75%: 6.5 min after vecuronium 2 x ED90 and 3.3 min after rocuronium 2 x ED90 and to the posterior cricoarytenoid muscle (interval 25-75%: 7 min after vecuronium 2 x ED90 and 4.3 min after rocuronium 2 x ED90), recovery of laryngeal adductor muscle function was markedly delayed with both neuromuscular blocking drugs (interval 25-75% at the lateral cricoarytenoid and vocal muscle: 14 min and 15.8 min after vecuronium 2 x ED90 and 10.3 min and 11.6 min after rocuronium 2 x ED90 respectively). CONCLUSION: In cats, the time course of neuromuscular blockade after vecuronium and rocuronium differs in antagonistic laryngeal muscles. The protective laryngeal function of glottis closure recovers later than vocal cord abduction after both vecuronium and rocuronium.     

电声门图测试对声带占位性病变的筛查价值

目的 探讨电声门图(electroglottography，EGG)测试在声带占位性病变中的筛查价值。方法 对134例声门型喉癌、167例声带良性病变(包括113例声带息肉、17例声带囊肿和37例声带白斑)及62名健康志愿者进行EGG测试，进行组间和组内比较，分析EGG测试的敏感性和特异性。结果 声带良性病变和喉癌组EGG波形和参数多数异常，与健康组之间有显著性差异，且良恶性病变组间亦有差异。但良性病变组内即息肉、囊肿和白斑之间，以及喉癌组内不同T分期之间EGG波形和参数差异多数无统计学意义。结论 电声门图测试在声带占位性病变的筛查中具有较高的敏感性，对区分良恶性病变亦有一定的特异性，但对病变类型和期别的划分无价值。     

金喉雾化剂治疗声带小结的临床研究

目的探讨金喉雾化剂治疗声带小结的疗效及安全性.方法122例患者随机分为金喉雾化剂治疗组(62例)和西药对照组(60例),均行超声雾化吸入,比较观察金喉雾化剂有效率及安全性.结果治疗组痊愈率为35.48%,总有效率为91.93%;对照组痊愈率为21.67%,总有效率为73.34%,两组差异有非常显著性意义.金喉雾化剂适宜声带小结各证型.结论金喉雾化剂治疗声带小结的临床疗效确切,安全性高.