光棒引导经鼻插管在张口困难患者中临床应用

目的:探讨光棒引导经鼻气管插管在张口困难患者中应用的可行性.方法:选择82例口腔颌面外科张口困难(张口度＜2.5 cm)患者,在快诱导麻醉下由光棒引导经鼻气管插管.记录患者麻醉诱导前后、插管过程中和插管后的SBP、DBP和HR.记录插管成功时的插管次数、插管时间及术后24 h并发症发生率.结果:82例患者中,53例(64.6％)一次性插管成功,29例(35.4％)经2～3次插管成功.插管操作时间(75.4-±26.4)s.与诱导前相比,插管时的BP和HR差异无显著性.术后随访2例有轻微咽部不适,1例主诉咽喉疼痛.结论:光棒引导经鼻气管插管对血流动力学影响轻微,口咽部损伤小,成功率高,在张口困难患者中值得推广应用.     

Hemodynamic and catecholamine responses during tracheal intubation using a lightwand device (Trachlight) in elderly patients with hypertension

Purpose.Tracheal intubation using a lightwand device (Trachlight) should minimize hemodynamic change by avoiding direct-vision laryngoscopy. We evaluated hemodynamic and catecholamine responses during tracheal intubation using a Trachlight in elderly patients with hypertension.Methods.Twenty-six hypertensive patients aged over 65 years undergoing orthopedic surgery were randomly divided into two groups, group L (n = 13) and group T (n = 13). Anesthesia was induced with fentanyl (2g·kg^–1) and propofol (1.5mg·kg^–1), and then muscle relaxation was obtained with vecuronium (0.15mg·kg^–1). The trachea was intubated with either a Macintosh laryngoscope (group L) or a Trachlight (group T). Hemodynamics, plasma catecholamine concentrations, and arterial blood gases were measured before the induction of anesthesia (T0), before tracheal intubation (T1), immediately after tracheal intubation (T2), and 3min after tracheal intubation (T3).Results.The intubation time was shorter in group T than in group L (12.6 ± 1.7 vs 23.5 ± 2.9s, mean ± SE; P 0.01). Compared with the preinduction (T0) value, systolic blood pressure (SBP) showed a significant decrease at T1 and T3 in group L and at T1, T2, and T3 in group T. The heart rate (HR) and plasma norepinephrine (NE) concentration showed no change in either group throughout the time course, whereas the plasma epinephrine (E) concentration showed a significant decrease at T2 and T3 in both groups. The mean values of the rate-pressure product (RPP: HR × SBP) were less than 15 000 after tracheal intubation in both groups. There was no significant difference in hemodynamic or catecholamine responses between groups at any point. No patient had ischemic ST-T changes in either group.Conclusion.A lightwand has no advantage over a laryngoscope in terms of hemodynamic and plasma catecholamine responses to tracheal intubation in elderly patients with hypertension, despite a shorter intubation time.     

A modified lightwand-guided nasotracheal intubation technique for oromaxillofacial surgical patients

Study ObjectiveTo investigate the efficiency of a double curve nasotracheal tube on lightwand-guided nasotracheal intubation.DesignProspective, randomized, controlled trial.SettingUniversity medical center hospital.Patients60 ASA physical status I and II patients undergoing oromaxillofacial surgery.Interventions and MeasurementsPatients undergoing surgery with nasotracheal intubation and general anesthesia were randomly enrolled in the laryngoscopy group or the lightwand group. The same type of double curve nasotracheal tube was used in both groups. In the laryngoscopy group, intubation was assisted with a Macintosh No. 3 standard curved blade and Magill forceps. In the lightwand group, intubation was aided with a flexible lightwand device (without the inner stiff stylet). Intubation time was divided into two parts: Part one, from selected naris to oropharynx; Part two, from oropharynx into trachea. Part one, Part two, and total intubation time, hemodynamic responses to nasotracheal intubation, and adverse events or complications were recorded.Main ResultsTotal intubation times in the lightwand group and the laryngoscopy group were 22.8 ± 8.0 sec vs 30.3 ± 8.2 sec (P < 0.001), respectively. The lightwand group had comparable hemodynamic responses to those of the laryngoscopy group. Adverse events and complications were all self-limited, with similar occurrence in both groups.ConclusionFor patients undergoing oromaxillofacial surgery, modified lightwand-guided nasotracheal intubation is feasible with a double curve nasotracheal tube and is an efficient alternative technique.     

光棒在快速诱导经鼻气管内插管中的应用研究

目的探讨快速诱导麻醉下光棒引导经鼻气管内插管临床效果。方法60例全麻患者随机均分为光棒(LW)组和纤维支气管镜(BF)组,比较两组插管时间、置管成功率和导管通过声门顺利率。结果在规定的3min内,LW组插管成功率显著高于BF组(96.7%vs.70.0%,P<0.05);LW组插管时间明显短于BF组[(38.9±16.2)svs.(133.0±37.9)s,P<0.01]。LW组导管通过声门顺利率高于BF组(96.6%vs.66.7%,P<0.05)。结论光棒引导经鼻气管内插管,是口腔颌面部手术全麻快速诱导建立气道安全、有效、快捷的方法之一。     

Touch and feel? Using the rubber hand paradigm to investigate self-touch enhancement in right-hemisphere stroke patients

Following stroke, a patient may fail to report touch administered by another person but claim that she feels touch when it is self-administered. We investigated three explanations for self-touch enhancement: (1) proprioceptive information from the administering hand, (2) attentional modulation, and (3) temporal expectation. Tactile sensation was assessed with vision precluded, and with the affected hand positioned in the left and right hemispace. In four of six experiments, the somatic rubber hand paradigm was used: the Examiner administered stimulation to the patient's affected left hand while guiding the patient's right hand to administer synchronous stimulation to a prosthetic hand. Even though the patient's two hands were not in contact, patients detected the same number of stimulations as when they touched their own hand directly (self-administered condition). Moreover, there was no decline in rates of detection when potentially informative movements of the administering hand were restricted. This demonstrates that patients feel rather than infer stimulation under conditions of self-touch. When patients received stimulation to the affected hand in the opposite hemispace to the hand administering touch to the prosthetic hand, all but one showed self-touch enhancement. Thus, neither proprioceptive information nor attentional modulation at the spatial region of the administering hand provided a sufficient explanation for self-touch enhancement. A follow-up experiment indicated an important role for temporal expectation: a delay, between the patient's stimulation of the prosthetic hand and the Examiner's stimulation of the patient's affected hand, eliminated the self-touch enhancement effect.     

光纤引导技术在快速建立人工气道中的应用

目的探讨光纤引导技术在紧急情况下快速建立人工气道的有效方法,评价光纤引导技术在快速建立人工气道方面的临床应用价值。方法回顾分析2009年1月～12月在我院急诊科紧急建立人工气道的所有患者（共60例）,并分为光导组（n=30）,常规盲插组（n=30）比较2组患者建立人工气道的时间、成功率及相关并发症发生率。结果光导组及常规盲插组建立人工气道的时间有显著差异性（29.1±4.8）svs（41.8±9.9）s,P〈0.01,光导组减少相关并发症（6.7%vs20%,P〈0.05）方面显著优于常规组。2组插管成功率（90%vs83.3%,P〉0.05）无显著统计学差异。结论光纤引导技术应用于快速建立人工气道具有操作迅速,相关并发症少,成功率亦高的优点,有较高的临床应用价值。     

Characteristics, diagnosis and treatment of hypoglossal canal dural arteriovenous fistula: report of nine cases

INTRODUCTION: We report the characteristics, diagnosis and treatment of dural arteriovenous fistula (DAVF) of the hypoglossal canal in nine patients with this relatively rare vascular disorder. METHODS: Of 248 patients with intracranial DAVFs managed at our institution, nine patients (3.6%; four men, five women; mean age 62 years) were diagnosed with hypoglossal canal DAVF. We investigated patient characteristics with respect to clinical symptoms, neuroradiological findings, efficacy and complications related to endovascular treatment. RESULTS: Seven patients had experienced head injury. All patients presented with pulsatile tinnitus. One patient displayed ipsilateral hypoglossal nerve palsy before treatment. MR angiography showed a "magic wand" appearance between the affected hypoglossal canal and the internal jugular vein in four patients. Angiography demonstrated an AV fistula on the medial aspect of the superior jugular bulb, mostly arising from the bilateral occipital, ascending pharyngeal and vertebral arteries with drainage to the internal jugular vein via the anterior condylar vein. Contralateral carotid injection accurately clarified the shunting point. Five patients underwent endovascular treatment: transarterial embolization (TAE; n = 2), transvenous embolization (TVE; n = 2), and TAE/TVE (n = 1). Complete shunt obliteration was achieved in four patients and shunt reduction in one. The remaining four patients were treated conservatively and the shunt had disappeared at follow-up. Postoperative hypoglossal nerve palsy occurred in one patient after TVE, possibly due to coil overpacking. CONCLUSION: The incidence of hypoglossal canal DAVF was not very low in our series. Contralateral carotid injection is an essential examination to provide an accurate diagnosis. TVE should be considered when access is available, although TAE is also appropriate for shunt reduction.     

引光器联合呼吸末 CO2在强直性脊柱炎合并插管困难患者中应用的效果分析

目的 评价强直性脊柱炎（AS）合并困难气管插管时用气管插管引光器（引光器）结合呼吸末二氧化碳（PetCO2）经右侧磨牙气管插管的效果及心血管应激反应.方法 选择42例AS合并困难插管拟施全身麻醉患者,入选AS均伴有颈椎侵犯、颈椎前屈后伸受限符合困难插管,随机分为Ⅰ、Ⅱ两组,每组21例,Ⅰ组为引光器插管组,Ⅱ组引光器联合PetCO2插管,两组均用镇静慢诱导方法,咽喉部表麻用气管插管引光器插管引导配合PetCO2经右侧磨牙插管.比较两组插管成功率,插管时间等情况.结果 Ⅰ组一次插管成功率为90.48％,二次插管成功率为9.52％,Ⅱ组一次成功率为95.24％,二次插管成功率为4.76％.插管时间Ⅰ组（45.43±5.23）s,Ⅱ组（40.62±4.75）s,两组插管时间差异有统计学意义（P＜0.05）.两组插管即刻收缩压相比,差异有统计学意义（P＜0.05）.结论 气管插管引光器用于AS困难插管具有良好的插管效果,引光器加PetCO2比单独用引光器更适合于困难插管中,并可缩短插管时间.     

光棒在困难气道患者经鼻气管插管中的应用

目的探讨光棒在困难气道患者经鼻气管插管中的应用效果。方法选取困难气道且拟行经鼻气管插管患者131例,男62例,女69例,年龄18～60岁,ASAⅠ或Ⅱ级,采用随机数字表法分为纤维支气管镜组(F组,n=66)和光棒组(L组,n=65)。比较两组插管成功率、插管时间及术后插管并发症发生率。结果与F组比较,L组第一次插管成功率[54(83.1%)vs 57(86.4%)]差异无统计学意义,第一次插管时间明显延长[(106.9±29.8)s vs(94.6±26.9)s,P0.05];第二次插管成功率[7(63.6%)vs 4(44.4%)]差异无统计学意义,插管时间明显缩短[(107.1±21.5)s vs(137.3±19.5)s,P0.05];插管总成功率[61(92.4%)vs 61(93.8%)]差异无统计学意义。两组患者术后并发症的发生率差异均无统计学意义。结论光棒引导是困难气道患者行经鼻气管插管时的有效技术,可以作为一个应急工具。     

Lightwand光棒在困难气管插管中的应用效果

目的：观察Lightwand光棒在困难气管插管中的应用效果。方法随机选择南平市第一医院2015年3月＿2016年3月接诊的60例患者作为研究对象,全身麻醉诱导后,按喉镜暴露分级(Cormch-Lehane分级﹚Ⅲ-Ⅳ级患者60例患者随机均分为普通Macintosh喉镜组(M组﹚和Lightwand光棒组(L组﹚,记录两组患者插管前后平均动脉压和心率的变化、插管成功率、插管时间及插管后咽喉部并发症发生情况。结果插管成功率 L组96.67％,M组73.33％;L组插管时间(45.7±16.2﹚s,M组插管时间(90.0±15.3﹚s(P﹤0.05﹚。L组插管前后MAP、HR无明显变化,M组MAP、HR在插管后较插管明显上升(P<0.05),两组患者插管前HR、MAP的差异无统计学意义(P>0.05)。术后咽部疼痛,声嘶哑M组12例, L组2例。结论Lightwand光棒对于喉镜暴露分级(Cormch-Lehane分级﹚Ⅲ-Ⅳ级患者插管成功率高、血流动力学平稳、插管并发症少,喉镜暴露分级(Cormch-Lehane分级﹚对困难气管插管的评级不适用于Linghtwand光棒引导的气管插管。 Linghtwand光棒是解决困难气管插管的简单有效的工具。