Effects of Etomidate Combined with Propofol on Painless Gastrointestinal Endoscopy and Cognitive Func-tion of Elderly Patients / 中国药房

OBJECTIVE:To investigate the effects of etomidate combined with propofol on painless gastrointestinal endoscopy and cognitive function of elderly patients. METHODS:Totally 90 elderly patients with painless gastrointestinal endoscopy were ran-domly divided into propofol group(30 cases),etomidate group(30 cases)and combination group(30 cases). Propofol group was given Fentanyl injection 1 μg/kg+Propofol injection 1.5 mg/kg;etomidate group was given Fentanyl injection 1 μg/kg+Etomidate injection 0.3 mg/kg;combination group was given Fentanyl injection 1 μg/kg+Propofol injection 1 mg/kg+Etomidate injection 0.15 mg/kg. The levels of SBP,DBP,HR,MAP and SpO2 at different time points,examination time,anesthesia induction time,recov-ery time and recovery time of orientation were observed in 3 groups. NCSE and MMSE score at different time points,the occur-rence of ADR were also observed in 3 groups. RESULTS:During examination,SBP,DBP,MAP and SpO2 of propofol group were significantly lower than before anesthesia,after examination and those of combination group,with statistical significance(P0.05). The recovery time and recovery time of orientation in combination group were significantly shorter than propofol group and etomidate group,with statistical significance(P0.05). The proportion of patients'memory ability,computing ability,orientation ability passing examination in combination group were significantly higher than propofol group,with statistical significance(P0.05). There was no statistical significance in MMSE score of combination group at different time points (P>0.05);MMSE score of propofol group 15,30 min after anesthesia and that of etomidate group 15 min after anesthesia were significantly lower before anesthesia and combination group,with statistical significance(P0.05). The incidence of apnea,hypotension and injection pain in combination group and etomidate group were low-er than propofol group,the motor response,myoclonus,nausea and vomiting in combination group and propofol group were lower than etomidate group,the tachycardia ease in combination group was lower than propofol group,with statistical significance(P<0.05). CONCLUSIONS:Etomidate combined with propofol anesthesia shows good therapeutic efficacy for painless gastrointestinal endoscopy of elderly patient,can reduce cognitive dysfunction and shortens recovery time,but doesn't increase the occurrence of ADR.

Study on difference of vestibular damage of sudden deafness and vestibular neuritis / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the difference of vestibular damage between sudden deafness and vestibular neuritis.METHODS Patients in otolaryngology head and neck surgery eenterin PLA general hospital from February 25 in 2016 to July 20 in 2016 were included in this research.Among these patients,55 cases were diagnosed as sudden deafness group,including 39 cases With vertigo.And other 46 cases were diagnosed as vestibular neuritis.Vestibular bithermal caloric test,head impulse test(head impulse test,HIT),cervical vestibular evoked myogenic potentials(cervical vestibular evoked myogenic potential,cVEMP),ocular vestibular evoked myogenic potentials(ocular vestibular evoked myogenic potential,oVEMP) were performed to evaluate their vestibular function and were compared.RESULTS The abnormal rate of vestibular bithermal caloric test in sudden deafness group 25.45％,and 97.82％ in vestibular neuritis group.There was significant difference between two groups(x2=54.01,P＜0.001).HIT:the abnormal ratein sudden deafness groupwas 9.09％ and 32.61％ in vestibular neuritis group,there was significant difference between two groups(x2=8.72,P=0.003).VEMP:the abnormal rate of cVEMP in sudden deafness group was 69.10％ and 43.47％ in vestibular neuritis group,there was significant difference between two groups(x2=6.72,P=0.010).But the abnormal rate of oVEMP in sudden deafness group was 54.55％ and 63.04％ in vestibular neuritis group,and there was not statistically significant difference between two groups(x2=0.745,P=0.388).CONCLUSION The vestibular damage of sudden deafness with vertigo was more likely involved with saccule and inferior vestibular nerve,more close to the nerve terminal,and the injury was in a low frequency range;but the vestibular damage in vestibular neuritis was wider,and the injury involved a full band,the damaged part may be higher.

Prevalence of bilateral abnormalities of unilateral Meniére disease / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the abnormal conditions of the affected ear and the contralateral ear of patients with unilateral Meniere's disease and the prevalence of bilateral abnormalities among these unilateral Meniere disease population, providing reference for the clinical treatment strategies for Meniére disease.@*METHOD@#A retrospective analysis of 106 Meni6re disease cases was performed, the abnormal incidence of the affected ears, the contralateral ears and the bilateral abnormalities were calculated, and the disease characteristics were analyzed.@*RESULT@#The bilateral ears abnormal incidence of unilateral Meniére disease was 35. 85% (38/106); the cochlear symptoms of the contralateral ears often occurred 2. 25 years later of the symptoms of Meni6re disease; contralateral cochlear symptoms included at least two symptoms of tinnitus, deafness and ear fullness; 39. 47%(15/38) patients with bilateral abnormalities would appear binaural hearing impairment.@*CONCLUSION@#This study showed that about one-third of unilateral Meniére diseases have binaural symptoms, among which about one-third would occur bilateral hearing loss. Therefore, it is necessary to consider the course of disease and the symptoms of the contralateral ear before taking damage or destructive method for treating Meniére's disease clinically.

The Prevalence of BPPV in Patients with Meniere’s Disease / 听力学及言语疾病杂志

Objective To investigate the prevalence of BPPV in patients with Meniere’s Disease(MD),and to investigate the diagnostic and predictive values of VEMP in patients with MD and BPPV.Methods A total of 1 1 6 patients previously diagnosed MD were followed up through telephone about their BPPV-like attacks.We recorded the detailed history of BPPV-like attacks,and provided them with complete Dix-Hallpike and roll tests if patients were on their BPPV-like attacks.Results In all,4 patients'histories supported BPPV,and 4 patients were found with BPPV.The prevalence of BPPV in patients with MD was 3 .4%(4/1 1 6 ).Meniere's symptoms preceded the on-set of BPPV in 8 patients.In 4 confirmed BPPV patients with Meniere's disease,BPPV was limited to the same ear as the MD in 2 cases,and 1 had contralateral BPPV,and 1 was uncertain.Six histories supported or confirmed BP-PVpatients with high abnormal oVEMP rates (5/6).Four in this 5 (80%)had abnormal oVEMP of the same MD ear.The single repositioning procedures can improve vertigo and eliminated positional nystagmus in cases of BPPV associated with MD.Conclusion In the present study,the prevalence of BPPV in patients with MD was 3 .45%.De-tailed medical histories combined with Dix-Hallpike and roll tests and VEMP tests can identify BPPV in patients with MD.

The hearing and vestibular evoked myogenic potentials test in patients with primary benign paroxysmal positional vertigo / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the result of vestibular evoked myogenic potentials (VEMP) of primary benign paroxysmal positional vertigo(BPPV)and to identify the characteristics in VEMP examination of the primary BPPV and to observe the relevance of patients with primary BPPV and abnormal VEMP with hearing loss.@*METHOD@#Patients with primary BPPV were tested with pure tone audiometry, videonystagmograph and VEMPs test. We analyzed the difference in the two groups with normal hearing and hearing loss, discussed the etiology and pathogenesis.@*RESULT@#Primary BPPV comprised 23.0% with hearing lost, 77.0% hearing normal. The results of oVEMP were abnormal in 79. 7% (59/74) of the cases; and the results of cVEMP were abnormal in 66. 2% (49/74) of the cases; oVEMP and cVEMP differences to the diagnosis of primary BPPV (P<0. 05); oVEMP and cVEMP differences to the diagnosis primary BPPV with hearing lost (P<0. 05).@*CONCLUSION@#oVEMP detection positive rate of primary BPPV is higher than cVEMP,which may be due to otolithic particles falling from the utricle; positive rate of cVEMP in primary BPPV with hearing loss is higher than that of oVEMP, which may related to the cochlear and sacculus occured in the same embryonic tissue structure.

Application of electrocochleography and ABR in the diagnosis of auditory neuropathy / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze and compare the clinical application of alternating click evoked electrocochleography (ECochG) and auditory brainstem response (ABR) in the diagnosis of auditory neuropathy (AN) subjects.@*METHOD@#ECochGs and ABRs were recorded in 16 patients (32 ears) with AN/AD as AN group and 20 patients (26 ears) with sensorineural hearing loss(SNHL) as control group. Test stimuli were alternating polarity clicks. (1) To compare the occurrence rate of ECochGs and ABRs in AN patients. (2) To compare the peak latency of CAPs, absolute amplitude of CAPs, and amplitude ratios of -SP and CAP between AN group and control group.@*RESULT@#ECochGs (--SPs or CAPs) presented in 78.1% (25 among 32 ears) of AN patients. CAPs latency of AN group was shorter than control group (P < 0.05), CAP absolute amplitude of AN group was lower than normal group (P < 0.05), while --SP/CAP was higher than control group (P < 0.01). Deformed ABRs presented in only 5 ears among 32 tested AN ears, while relative good ABR waveforms were evoked in control group. The occurrence rate of ABRs (15.6%) was significantly lower than that of ECochGs in AN patients (P < 0.01).@*CONCLUSION@#Both ECochGs and ABRs play important role in the diagnosis of AN. The capacity of temporal processing is significantly impaired while the intensity perception related capability is intact in AN patients.

Meniere's disease in the elderly / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To focus on the prevalence of rare Meniere's disease in the elderly(> or = 60 yrs) and to investigate its clinical characteristics.@*METHOD@#To observe the elderly with Meniere's disease from 2004-01-2007-7 and to investigate its clinical manifestation, electrocochleography (ECoG), vestibular evoked myogenic potential (VEMP), caloric test and pure tone audiogram.@*RESULT@#There were 13 cases of Meniere's disease in the elderly. And the prevalence of Meniere's disease was 2.22% (13/586). The initial symptoms were as following: 2 cases with cochlear and vestibular symptoms, 9 cases with mere cochlear symptoms, 1 cases with mere spinning vertigo and 1 case with mere drop attack. The audiogram in the elderly were varied: low and high frequency hearing loss, flat, and high-frequency hearing loss. And the high frequency hearing loss had no relation with the duration of Meniere's disease. The results of vestibular function were varied. The percentage of positive result of ECoG was 63.6% (7/11, 2 cases not determined).@*CONCLUSION@#The prevalence of Meniere's disease in children was 2.22%. The initial symptoms was cochlear and vestibular symptoms, mere cochlear symptoms, mere spinning vertigo and mere drop attack, respectively. The audiogram showed prominent high frequency hearing loss. The percentage of positive result of ECoG was high. And the results of vestibular function tests were varied.

Differential diagnosis between vertigo of posterior circulation ischemia and migrainous vertigo / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze two groups of patients with migrainous vertigo (MV )and vertigo resulting from posterior circulation ischemia (PCIV) and investigate the differential diagnosis between them.@*METHOD@#There were 60 patients with MV and 64 patients with PCIV. Clinical tests include high risk factors of posterior circulation ischemia (PCI), cerebral MRI, ocular motion and high stimulating rate ABR.@*RESULT@#Among 64 patients with PCIV, 29 had abnormal blood pressure and 14 had abnormal blood fat and/or pathoglycemia; 37 had abnormality in cervical vascular ultrasound; 14 suffered from amaurosis or dizziness upon fast getting up. Twenty two had abnormal high stimulating rate ABR and 4 had cerebral lacunar infarction in MRI. As for 60 patients with MV, 45 suffered from motion sickness; 20 were sensitive to motion; 32 had photophobia and (or) phonophobia; 45 had migraine; 16 had abnormal ocular motion function; 3 had abnormal cerebral MRI and 40 had abnormal results in high stimulating rate ABR. The percentage of abnormal high stimulating rate ABR in MV and PCIV were 53% (22/42) and 67% (40/60) respectively.@*CONCLUSION@#The mean age of MV is younger than that of PCIV. Female is more prone to MV than male (2.75 : 1. 00); the sex difference in PCIV is lesser (1.46 : 1.00). Motion sickness, motion sensitivity, photophobia and (or) phonophobia are principal differential highlights to MV. The major characteristics of PCIV include abnormal blood pressure, abnormal blood fat, pathoglycemia and arteriosclerosis. Vestibular function tests could not serve as a differential point; Cerebral MRI might be helpful to differential diagnosis. The results of high stimulating rate ABR is not a differential point between PCIV and MV, but it might play a role in differentiating other kinds of vertigo.