McGrath可视喉镜与Macintosh直接喉镜显露颈椎手术患者喉部结构的比较

目的 比较McGrath可视喉镜与Macintosh直接喉镜显露颈椎手术患者喉部结构的效果. 方法 50例颈椎手术患者采用随机数字表法随机分为McGrath组和Macintosh组,每组25例.麻醉诱导后,McGrath组先用Macintosh直接喉镜显露喉部结构并记录Cormack-Lehane分级(C/L分级),不插管,再改用McGrath可视喉镜显露喉部结构并插入气管导管.Macintosh组先用McGrath可视喉镜显露声门,再使用Macintosh直接喉镜显露喉部结构并插管.记录患者一般情况、气道评估指标(甲颏间距、张口度、Mallampati分级、颈部活动度)、喉镜显露C/L分级和插管并发症. 结果 两组间患者一般情况和气道评估指标差异无统计学意义(P＞0.05).McGrath可视喉镜的C/L分级(Ⅰ级∶Ⅱ级∶Ⅲ级为34∶14∶2)显著优于Macintosh直接喉镜(Ⅰ级∶Ⅱ级∶Ⅲ级为13∶32∶5,P＜0.01). 结论 McGrath可视喉镜对喉部结构的显露优于Macintosh直接喉镜,提示该可视喉镜有助于颈椎手术患者的气管插管处理.     

Ectodermal dysplasia-skin fragility syndrome due to a new homozygous internal deletion mutation in the PKP1 gene

Ectodermal dysplasia-skin fragility syndrome (ED-SFS) is a rare autosomal recessive genodermatosis resulting from mutations in the PKP1 gene, encoding the desmosomal plaque protein plakophilin-1 (PKP1). Mutations in PKP1 may manifest with skin fragility and erosions, patches of scale crust on the trunk and limbs, peri-oral cracking and inflammation, hypotrichosis, palmoplantar keratoderma with painful fissuring and other somewhat variable ectodermal anomalies. Ten cases of the syndrome have been reported. We report a further case of this desmosomal genodermatosis. A 14-month old child, born to consanguineous parents, presented with a history of neonatal bullae and subsequent development of dystrophic nails, sparse eyelashes and eyebrows, woolly scalp hair, abnormal dental development and a desquamating erythematous rash at sites of trauma. A clinical diagnosis of ED-SFS was supported by skin biopsy findings of suprabasal intraepidermal clefting and a loss of immunoreactivity for PKP1. Sequencing of genomic DNA revealed a homozygous 5 base pair deletion in exon 5 of the PKP1 gene, designated c.897del5 (CAACC). This new mutation creates a frameshift, leading to a downstream premature termination codon, p.Pro299fsX61. This case highlights the clinicopathological consequences of inherited mutations in the PKP1 gene and illustrates the key role of desmosomes in skin biology.     

舒芬太尼抑制老年患者McGrath视频喉镜下气管插管反应的半数有效浓度

目的 测定舒芬太尼抑制老年患者McGrath视频喉镜气管插管反应的半数有效浓度(median effectiveconcentration,EC50).方法 选择全身麻醉下气管插管行外科手术的老年患者29例,年龄66岁～75岁.患者入室建立静脉通路后给予咪达唑仑0.02 mg/kg.诱导同时以效应室靶浓度(target effect-site concentration,Ce)靶控输注(target-controlled infusion,TCI)丙泊酚和舒芬太尼,丙泊酚的初始Ce为1.5 mg/L,2 min后调至2.5 mg/L;舒芬太尼的Ce浓度为0.3 μg/L.当镇静/警醒评分≤2时,给予罗库溴铵0.6 mg/kg.待舒芬太尼Ce与血浆浓度(plasma concentration,Cp)平衡后McGrath视频喉镜下气管插管.观察患者的气管插管反应,若插管反应呈阳性,按序贯法依次升高下一例舒芬太尼的Ce,若插管反应呈阴性,则降低下一例舒芬太尼的Ce,各相邻浓度间比例为1.2.结果 舒芬太尼TCI抑制老年患者McGrath视频喉镜下气管插管反应的EC50为0.194 μg/L,95％置信区间(confidence interval,cI)为0.174 μg/L～0.212 μg/L(P＜0.01).麻醉诱导过程中舒芬太尼的平均用量为(0.211±0.039) μg/kg(P＜0.01).结论 丙泊酚Ce为2.5 mg/L时,舒芬太尼抑制50％老年患者McGrath视频喉镜下气管插管反应的Ce为0.194 μg/L.     

The validation of visual analogue scales as ratio scale measures for chronic and experimental pain

Visual analogue scales (VAS) of sensory intensity and affective magnitude were validated as ratio scale measures for both chronic and experimental pain. Chronic pain patients and healthy volunteers made VAS sensory and affective responses to 6 noxious thermal stimuli (43, 45, 47, 48, 49 and 51 degrees C) applied for 5 sec to the forearm by a contact thermode. Sensory VAS and affective VAS responses to these temperatures yielded power functions with exponents 2.1 and 3.8, respectively; these functions were similar for pain patients and for volunteers. The power functions were predictive of estimated ratios of sensation or affect produced by pairs of standard temperatures (e.g. 47 and 49 degrees C), thereby providing direct evidence for ratio scaling properties of VAS. Vas sensory intensity responses to experimental pain, VAS sensory intensity responses to different levels of chronic pain, and direct temperature (experimental pain) matches to 3 levels of chronic pain were all internally consistent, thereby demonstrating the valid use of VAS for the measurement of and comparison between chronic pain and experimental heat pain.     

Alternative techniques for tracheal intubation

Conventional direct laryngoscopy with the curved Macintosh blade is a fundamental skill for all anaesthetists and has been the cornerstone of airway management for many years. This technique relies on the operator aligning the oro-pharyngo-laryngeal structures and inserting an endotracheal tube into the trachea under direct vision. There is a recognized failure rate with this technique and thus alternative techniques for tracheal intubation should be available for use in difficult situations. Awake fibreoptic intubation (AFOI) remains the ‘gold standard’ method for securing the airway in an anticipated difficult intubation. Advances in optical technology over recent years have lead to the development of several rigid indirect devices, which improve glottic visualization by enabling the operator to ‘see around the corner’. With improved views at laryngoscopy these videolaryngoscopes are emerging as important tools in airway management and useful teaching and training aids.