9例罕见咽喉肌麻痹诊治体会

单纯以咽喉部肌肉麻痹所致的吞咽困难为主症、且预后良好的咽喉肌麻痹疾病临床少见,作者对9例此类病例进行总结分析,报道如下。1临床资料9例咽喉肌麻痹均为1995～2002年我院收治的男性住院病人,年龄50～70岁,平均56岁。既往身体健康,无高血压、糖尿病史,无颈部外伤、手术史,无咽喉部疼痛、无扁桃体手术史。所有病例均无诱因突然发病,其中1例发病时伴轻度一过性头晕、出汗,随即出现吞咽困难,其他8例均无任何先兆而突然发病。9例病人发病后均无心慌、呼吸困难、肢体无力、意识障碍、视物模糊等症状。首发症状均为吞咽困难、饮水呛咳。发音障碍…     

去细胞喉支架的制备及喉肌细胞再生的可行性研究

Objective To prepare a deeelhilarized whole laryngeal scaffold by utilizing a perfusion-decellularized technique, reseed cells on it, and construct recellularized laryngeal muscles. Methods Perfusion decelluarized larynxes were obtained by common carotid arterious perfusion with detergents. Then they were performed by macroscopic view, histological examination, scanning electron microscopy (SEM) and cartilage viability. Decellularized laryngeal scaffold were then reseeded with inducted mesenchymal stem cells (MSCs). Composites were transferred into greater omentums of rabbits after one day' s adherence and harvested after eight weeks. Macroscopic view, histological examination and immunohistochemistry were performed. Results Perfusion larynxes became transparent after two hours. Histology and SEM indicated that perfnsion method shewed better deculluarized effect. More ventages and collagen fibers but no intact cell or anclei were retained in the decellularized martrix. Porosity measured by Image pro plus 6. 0 was 80. 4% ± 3.2% (x ± s). Chondrocyte vitality assay indicated chondrocyte vitality rate in the perfusion group was 86. 9% ± 1.5% . After eight weeks, vascularization formed and integrated cartilage frameworks still remained. Histological examination could clearly show the presence of muscle bundles and vessels. Immunohistoehemical examination indicated that sarcomeric-α actin expressed positively in corresponding areas. Conclusions It is feasible to reseed MSCs into the decellularized laryngeal muscle matrix for constructing tissue-engineered laryngeal muscles. This in vivo maturation into the omentum could be the first step before in situ implantation of the construct.     

延髓型重症肌无力喉肌电指标变化的临床价值

目的探讨延髓型重症肌无力患者电视胸腔镜下胸腺扩大切除术（video-assisted thoracoscopic extended thymectomy,VATET）后喉肌电指标测定的临床价值。方法回顾分析2002年6月～2011年7月我科36例延髓型重症肌无力（延髓型组）行VATET的临床资料,对术前后喉肌电指标进行分析,选取同期36例健康受试者作为对照组。结果延髓型组术前喉内肌肌电振幅（210．68±75．42）μV,较对照组（309．40±55．33）μV明显缩窄（t=6．332,P=0．000）;时程（7．68±0．57）ms较对照（5．42±0．34）mB明显延长（t=-20．431,P=0．000）;募集相最大电位（1132．18±467．19）μV较对照组（1675．00±532．85）μV明显缩窄（t=4．596,P=0．000）,术后2组比较仅时程有明显差异（t=6．375,P=0．000）。延髓型组喉内肌群术后肌电振幅（312．91±69．43）μV,较术前（210．68±75．42）μV明显变宽（t=-5．983,P=0．000）;术后时程（6．19±0．64）m8较术前（7．68±0．57）m8明显缩短（t=10．431,P=0．000）;术后募集相最大电位（1557．67±521．45）斗V较术前（1132．18±467．1）μV明显变宽（t=-3．646,P=0．000）;喉外肌仅肌电振幅差异显著[（139．36±74．26）μV vs．（102．75±63．22）μV,t=-2．252,P=0．027]。术后喉肌电图正常的患者疗效有效率89．3％（25／28）,喉肌电图异常的患者疗效有效率37．5％（3／8）,2组比较有统计学差异（χ2=6．891,P=0．009）。结论延髓型重症肌无力患者肌电指标异常,VATET可有效改善各项指标,缓解相关的临床症状。     

喉肌电图与喉肌诱发电位在颈前路术后喉返神经麻痹中的评价作用

目的：探讨喉肌电图（LEMG）和喉诱发电位（LSEP）对外伤脊髓型颈椎病颈前路手术引起喉返神经损伤再生程度的评估作用。方法：将18例喉返神经麻痹患者分别在术后1、2、4周3个不同时点进行喉肌电特点的分析,并与18例正常受试者进行对比研究。结果：①发病1周时,受累喉肌可出现失神经电位;2周失神经电位增多,可见再生电位;4周后失神经电位渐少,再生电位渐多。②肌电募集减弱甚至无明显干扰相,干扰相波幅和转折数显著低于正常对照组,其中转折数减低更为明显,未受累喉肌募集电位明显增大。③部分患者受累喉肌诱发电位消失,其他患者可见波幅小、潜伏期长的诱发电位。④与正常对照组比较各病程组波幅均降低,差异均有统计学意义（P〈0.05）。结论：喉肌电图和喉诱发电位对预测喉返神经麻痹预后有一定价值,可较准确地评估颈前路手术喉返神经损伤再生程度。     

鼻饲管置管失败原因分析及对策

鼻饲管置管是临床上常用的护理操作,用于不能由口进食者,以维持患者营养和治疗需要的技术。胃管置入过程中对鼻咽、食管、胃是一种很强的刺激过程,可使患者喉肌痉挛,胃管很难插入,绝大多数患者都对置管产生恐惧、紧张的心理,经多年的临床实践,总结分析如下。1鼻饲管置管失败的原因1·1体位不当:由于疾病影响导致患者身体不适的原因,患者往往不愿意采取要求体位,增加了患者的痛苦。1·2患者不合作:见于老年人及小孩,多由于恐惧所致。1·3各种原因引起的食管狭窄,如:喉头水肿、食管肿瘤所致的食管狭窄;气管切开患者;舌后坠患者等均可导致鼻饲…     

痉挛性发音障碍诊断及治疗的研究

目的对痉挛性发音障碍患者临床特点,喉肌电图表现,疗效进行分析,探讨痉挛性发音障碍诊断及治疗特点。方法对22例痉挛性发音障碍患者治疗前后症状、嗓音声学特征,频闪喉镜下声带状态,喉肌电图特征进行分析;根据不同分型,应用肉毒素A行特定肌肉注射并观察疗效。结果22例痉挛性发音障碍患者中,内收肌型18例(81 8% ),外展肌型4例(18 2% )。内收肌型患者发音嘶哑,音质紧张、言语中断,发音时声带过度内收,杓间区明显,伴局部震颤; 2例患者发音时还同时伴有舌及软腭震颤;肌电图甲杓肌运动单位电位(motorunitpotential,MUP)振幅明显增加(P<0 01),干扰相呈密集束状放电,募集活动异常活跃,幅度明显增大(700~2500μV)。4例外展肌型患者发音低哑、震颤,气息声明显,发音时声门闭合不良;环杓后肌MUP振幅明显增加,在374~538μV间,募集活动异常活跃,幅度增大(3000~5000μV)。内收肌型患者应用肉毒素A进行甲杓肌注射,单侧剂量大于2 5U疗效明显。症状开始改善时间为注射后6h~2d,平均( x±s,下同)为( 1 4±0 8)d, 2周时最为明显,肌电图及喉肌诱发电位显示药物作用完全,注射肌肉失神经支配。疗效维持8~24周,平均维持(15 2±4 9)周,副作用包括不同程度的发音气息声,声门闭合不良,吞咽不适,饮水呛咳。外展肌型患者采用环杓后肌     

去细胞喉支架的制备及喉肌细胞再生的可行性研究

Objective To prepare a deeelhilarized whole laryngeal scaffold by utilizing a perfusion-decellularized technique, reseed cells on it, and construct recellularized laryngeal muscles. Methods Perfusion decelluarized larynxes were obtained by common carotid arterious perfusion with detergents. Then they were performed by macroscopic view, histological examination, scanning electron microscopy (SEM) and cartilage viability. Decellularized laryngeal scaffold were then reseeded with inducted mesenchymal stem cells (MSCs). Composites were transferred into greater omentums of rabbits after one day' s adherence and harvested after eight weeks. Macroscopic view, histological examination and immunohistochemistry were performed. Results Perfusion larynxes became transparent after two hours. Histology and SEM indicated that perfnsion method shewed better deculluarized effect. More ventages and collagen fibers but no intact cell or anclei were retained in the decellularized martrix. Porosity measured by Image pro plus 6. 0 was 80. 4% ± 3.2% (x ± s). Chondrocyte vitality assay indicated chondrocyte vitality rate in the perfusion group was 86. 9% ± 1.5% . After eight weeks, vascularization formed and integrated cartilage frameworks still remained. Histological examination could clearly show the presence of muscle bundles and vessels. Immunohistoehemical examination indicated that sarcomeric-α actin expressed positively in corresponding areas. Conclusions It is feasible to reseed MSCs into the decellularized laryngeal muscle matrix for constructing tissue-engineered laryngeal muscles. This in vivo maturation into the omentum could be the first step before in situ implantation of the construct.     

声门运动障碍喉肌电图研究与应用

本文综述声门运动障碍疾病喉肌电图研究与应用情况,着重介绍喉肌电图在该疾病诊断中的应用价值,认为有利于明确诊断及治疗方法的选择。     

硫喷妥钠应用不当引起意外1例报告

198 9年 6月 2 3日我院收住一肠套叠患儿 ,氯胺酮、安定复合麻醉时应用硫喷妥钠 ,引起麻醉意外 ,报告如下。1　病历报告患儿 ,6个月 ,男 ,体重 8.1ｋｇ ,全身营养状况良好 ,腹部胀满 ,腹肌紧张 ,拒乳 ,哭闹 ,临床诊断为肠套叠 ,拟全麻下行肠套叠复位术。术前 30ｍｉｎ肌注阿托品 0 .15ｍｇ ,鲁米钠 0 .0 3ｇ。麻醉用药 :氯胺酮 ,1～ 2ｍｇ/ (ｋｇ·次 )静注 ,安定 0 .3ｍｇ/ｋｇ。 6月 2 3日下午 3时 15分为患儿实施麻醉 ,术中氯胺酮、安定复合麻醉平稳 ,持续 1ｈ5 0ｍｉｎ ,关腹时 ,因腹肌较紧 ,手术医生要求作相应处理 ,静脉注射硫喷妥钠 …