山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (6): 77-81.doi: 10.6040/j.issn.1673-3770.0.2020.043

• • 上一篇    下一篇

支撑喉镜下喉显微手术患者的体位改进

顾晓娜1,2,程向荣1,2,张鹏1,2,朱亮1,2,滕华1,2,王勇1,2,胡晓燕1,2,刘晓静1,2   

  1. 1. 南京中医药大学附属中西医结合医院 耳鼻咽喉科, 江苏 南京 210028;
    2. 江苏省中医药研究院, 江苏 南京 210028
  • 发布日期:2021-01-11
  • 通讯作者: 程向荣. E-mail:entrong@aliyun.com

Improvement of the sniffing position for microlaryngoscopic surgery with a self-retaining laryngoscope

GU Xiaona1,2, CHENG Xiangrong1,2, ZHANG Peng1,2, ZHU Liang1,2, TENG Hua1,2, WANG Yong1,2, HU Xiaoyan1,2,   

  1. LIU Xiaojing1, 21. Department of Otolaryngology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu, China;
    2. Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210028, Jiangsu, China
  • Published:2021-01-11

摘要: 目的 探讨嗅物位对支撑喉镜下喉显微手术术野暴露的优势。 方法 选择拟行支撑喉镜下喉显微手术的嗓音疾病患者60例,随机分为嗅物位组(A组)及去枕仰卧位组(B组)2组,每组30例。A组患者予以枕下垫自制头枕,肩背部紧贴于手术台面,再将其头部伸展于寰枕关节;B组患者摆放去枕仰卧位。评价声门暴露情况,根据声带病变范围及性质行喉显微手术。 结果 (1)暴露声门耗时:A组(2.42±1.04)min明显短于B组(3.20±0.95)min,两组比较差异具有统计学意义(P<0.05);(2)手术并发症:A组术后喉部疼痛VAS评分低于B组,两组比较差异具有统计学意义(P<0.05);A组术后咽喉部黏膜损伤发生率(6.7%)明显低于B组(30.0%),术后舌部麻木及术中术后牙齿损伤情况基本无发生,与B组比较,术后恢复良好、手术并发症少。 结论 嗅物位较去枕仰卧位更有利于支撑喉镜下的声门暴露,耗时更短、手术并发症更少。

关键词: 嗅物位, 支撑喉镜, 声门暴露, 喉显微手术

Abstract: Objective To explore the advantages of the sniffing position during exposure to the surgical field in microlaryngoscopic surgery with a self-retaining laryngoscope. Methods Sixty patients with voice disorders who were enrolled for microlaryngoscopic surgery with a self-retaining laryngoscope under general anesthesia were selected and randomly divided into two groups: the sniffing position group(group A)and the horizontal recumbent position group(group B). Thirty patients were in each group. The time to glottis exposure and VAS scores for postoperative laryngeal pain, tongue numbness, pharyngeal or laryngeal mucosal injury and intraoperative or postoperative tooth injury were observed and recorded in all patients. The exposure of the visual field during the surgery was evaluated. Results (1) The time to glottis exposure was significantly shorter in group A(2.42±1.04 minutes)than in group B(3.20±0.95 minutes), and the difference was statistically significant(P<0.05). (2) Surgical complications: the VAS scores for postoperative laryngeal pain was significantly lower in group A than in group B(P<0.05). The incidence of pharyngeal or laryngeal mucosal injury was significantly lower in group A(6.7%)than in group B(30.0%). Postoperative tongue numbness and intraoperative or postoperative tooth injury did not occur almost. Overall, the postoperative recovery of group A was better, and surgical complications were less compared with those in group B. Conclusion Compared with the horizontal recumbent position, the sniffing position is more conducive for glottis exposure in microlaryngoscopic surgery using a self-retaining laryngoscope, as it takes less time and causes fewer surgical complications.

Key words: Sniffing position, Self-retaining laryngoscope, Exposure of glottis, Microlaryngoscopic surgery

中图分类号: 

  • R767
[1] 王天铎. 喉科手术学[M]. 北京: 人民卫生出版社, 2007: 54.
[2] Tong BS, Fang R, Smith BL. Study of the head and neck position in microlaryngoscopy using magnetic resonance imaging[J]. Eur Arch Otorhinolaryngol, 2013, 270(1): 243-247. doi:10.1007/s00405-012-2168-3.
[3] Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics[J]. Anaesthesia, 1984, 39(11): 1105-1111. doi: 10.1111/j.1365-2044.1984.tb08932.x.
[4] Hsiung MW, Pai L, Kang BH, et al. Clinical predictors of difficult laryngeal exposure[J]. Laryngoscope, 2004, 114(2): 358-363. doi:10.1097/00005537-200402000-00033.
[5] RUI Fang, HAO Chen, SUN Jingwu. Analysis of pressure applied during microlaryngoscopy[J]. Eur Arch Otorhinolaryngol, 2012, 269(5):1471-1476. doi:10.1007/s00405-012-1929-3.
[6] 宋颖, 潘忠, 傅敏仪. 喉镜评分预测支撑喉镜手术暴露的临床意义[J]. 山东大学耳鼻喉眼学报, 2019, 33(6): 81-84. doi: 10.6040/j.issn.1673-3770.0.2019.303. SONG Ying, PAN Zhong, FU Minyi. Clinical significance of laryngoscope scoring system in predicting the laryngeal exposure[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(6): 81-84. doi: 10.6040/j.issn.1673-3770.0.2019.303.
[7] 黄晨, 莫江. 影响显微支撑喉镜下声门暴露的相关因素研究[J]. 中国耳鼻咽喉颅底外科杂志, 2016, 22(4): 317-319, 322. doi: 10.11798/j.issn.1007-1520.201604015. HUANG Chen, MO Jiang. Study on affect factors related to laryngeal exposure in self-retaining microscopic surgery[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2016, 22(4): 317-319, 322.doi: 10.11798/j.issn.1007-1520.201604015.
[8] 邓小明, 姚尚龙, 于布为. 现代麻醉学[M]. 北京: 人民卫生出版社, 2014: 975.
[9] 魏薇, 黄施伟, 裘毅敏, 等. 3种气管插管头位上气道CT三维图像的比较分析[J]. 复旦学报(医学版), 2015, 42(2): 239-244. doi: 10.3969/j.issn.1672-8467.2015.02.017. WEI Wei, HUANG Shiwei, QIU Yimin, et al. The comparative analysis for 3D CT images of upper airway in 3 different head positions for tracheal intubation[J]. Fudan University Journal of Medical Sciences, 2015, 42(2): 239-244. doi: 10.3969/j.issn.1672-8467.2015.02.017.
[10] El-Orbany MI, Getachew YB, Joseph NJ, et al. Head elevation improves laryngeal exposure with direct laryngoscopy[J]. J Clin Anesth, 2015, 27(2): 153-158. doi:10.1016/j.jclinane.2014.09.012.
[11] Akhtar M, Ali Z, Hassan N, et al. A randomized study comparing the sniffing position with simple head extension for glottis visualization and difficulty in intubation during direct laryngoscopy[J]. Anesth Essays Res, 2017, 11(3): 762-766. doi:10.4103/0259-1162.204206.
[12] Acharya P, Shrestha A, Gurung A, et al. Effect of head elevation to different heights in laryngeal exposure with direct laryngoscopy[J]. J Nepal Health Res Counc, 2019, 17(2): 168-172. doi:10.33314/jnhrc.v0i0.1721.
[13] Takenaka I, Aoyama K, Iwagaki T, et al. The sniffing position provides greater occipito-atlanto-axial angulation than simple head extension: a radiological study[J]. J Can D'anesthesie, 2007, 54(2): 129-133. doi:10.1007/BF03022009.
[14] 柴茂, 汪小海. 患者头部后仰角度对声门暴露的影响: 基于CT上呼吸道矢状面图像的模拟评估方法[J]. 医学研究杂志,2017, 46(8): 169-171. doi:10.11969/j.issn.1673-548X.2017.08.042. CHAI Mao, WANG Xiaohai. Effect of head extension angle to glottis exposure: a simulation evaluation based on CT reconstruction images of upper airway[J]. Journal of Medical Research, 2017, 46(8): 169-171. doi:10.11969/j.issn.1673-548X.2017.08.042.
[1] 龙婷,刘雨薇,王生才,张杰,李艳珍,张雪溪,刘悄吟,刘志勇,孙念,倪鑫. 内镜CO2激光烧灼术治疗273例儿童先天性梨状窝瘘的临床分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 125-130.
[2] 冯世强,姜宪. 可调式支撑喉镜辅助治疗难治性扁桃体术后出血[J]. 山东大学耳鼻喉眼学报, 2021, 35(5): 67-69.
[3] 孙浩,张杰,杨扬,倪树仁,吴宇华,刘原虎,倪鑫. 宫腔镜在声门暴露困难喉部手术中的应用[J]. 山东大学耳鼻喉眼学报, 2021, 35(3): 92-95.
[4] 徐进敬,胡京华,吴元庆,邓毅,喻唯唯. CO2激光显微手术在喉癌前病变和早期声门型喉癌中的应用[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 129-133.
[5] 鞠丽娴,李井成,夏克玉,董伟达. 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[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 116-118.
[6] 许雯,汤玮,余少卿,李少辉,葛荣明. 平阳霉素治疗咽喉部血管瘤[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 62-64.
[7] 马玲国,郑朝攀,周敬淳,张博,龚桃根,张云静. CO2激光治疗声门型喉癌远期疗效分析[J]. 山东大学耳鼻喉眼学报, 2016, 30(5): 98-100.
[8] 罗松. 胸外科长柄电刀在会厌囊肿切除术中的应用[J]. 山东大学耳鼻喉眼学报, 2014, 28(6): 40-42.
[9] 任庆,王景和. 鼻内镜引导下支撑喉镜治疗声带息肉研究(附114例)[J]. 山东大学耳鼻喉眼学报, 2011, 25(4): 69-70.
[10] 吴光灿,顾能荣. 支撑喉镜下声带白斑显微手术39例[J]. 山东大学耳鼻喉眼学报, 2011, 25(3): 80-81.
[11] 李创伟,林歆胜,王双乐. 鼻窦内镜在喉显微手术中的应用[J]. 山东大学耳鼻喉眼学报, 2010, 24(3): 50-.
[12] 万京明. 支撑喉镜下联合鼻内镜手术治疗声带囊肿50例[J]. 山东大学耳鼻喉眼学报, 2010, 24(3): 60-.
[13] 李德生 李红霞. 支撑喉镜手术并发味觉异常的临床分析[J]. 山东大学耳鼻喉眼学报, 2009, 23(3): 65-.
[14] 娄 锋 . 喉上神经阻滞预防喉显微手术心血管反应[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 173-175 .
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 杨长亮,黄治物,姚行齐,诸勇,孙艺 . 正常气骨导听性脑干反应及其应用[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 9 -13 .
[2] 曹忠良 . 颌面复合伤155例临床分析[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 89 -89 .
[3] 毕景云 . 鼻中隔矫正术后血肿的处理[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 90 -91 .
[4] 刘大昱,潘新良,雷大鹏,许风雷,张立强,栾信庸 . 梨状窝内侧壁癌的手术治疗[J]. 山东大学耳鼻喉眼学报, 2007, 21(1): 8 -11 .
[5] 楼正才 . 掌拳击伤鼓膜损伤机制及临床特点分析[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 188 -188 .
[6] 刘 艳,刘新义,王金平,李大健 . 后鼓室解剖结构测量观察及临床意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 218 -221 .
[7] 赵 敏,王守森,甄泽年,陈贤明,王茂鑫 . 鼻内镜联合显微镜行蝶窦及经蝶鞍区微创手术[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 244 -245 .
[8] 伦 杰,吕心红 . 鼻部脂溢性角化病1例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 252 -252 .
[9] 王红霞,王鹏程 . NSE、S100及GFAP在视网膜母细胞瘤中的表达及意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 263 -264 .
[10] 黄 方,黄海琼,黄建强,何荷蕃 . 支气管内镜视频监视系统在小儿气管-支气管异物诊治中的应用[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 276 -277 .