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Objective To investigate the application value of local anesthesia with lidocaine carbonate and tetracaine in the prevention of tracheal intubation and extubation response in nasal endoscopy. Methods From January 2016 to March 2017, 90 patients scheduled for endoscopic sinus surgery were randomly divided into 3 groups,with 30 cases in each group.Before endotracheal intubation,1%tetracaine was used for endotracheal surface anesthesia,and air was filled into tracheal intubation airbag(group T). The intratracheal surface was sprayed with physiological saline and 1.73%lidocaine carbonate was filled into tracheal intubation airbag (group C).The 1%tetracaine was used for endotracheal surface anesthesia,and 1.73%lidocaine carbonate was filled into tracheal intubation airbag(group TC).The mean artery pressure(MAP)and heart race(HR)were recorded before induction(T1), immediately after intubation(T2),immediately after extubation(T3),and 5 min after extubation(T4).The scoring of cough during extubation was recorded.Sore throat scores were recorded by using Visual Analogue Scale(VAS)at 30 min,1 h,2 h,6 h and 24 h after extubation,respectively. Results The MAP and HR were less in the group T and TC than those in the group C at T 2(F=8.384,P=0.000;F=6.154,P=0.003), less in the group C and TC than in the group T at T 3(F=14.112, P=0.000; F=3.514,P=0.034).The cough scores were the lowest in the group TC(0.9 ±0.7), median in the group C(1.3 ±0.7), and the highest in the group T(1.7 ±0.5)(F=10.307, P=0.000).The VAS scores of pharyngalgia were the lowest in the group TC (2.1 ±0.8),median in the group C(3.0 ±1.2),and the highest in the group T(3.8 ±1.3)(F=17.961,P=0.000)at 30 min after surgery,and lower in the group TC(1.8 ±0.7)than in the group T(2.5 ±1.0)(F=5.058,P=0.008)at 1 h after surgery.Conclusion Local anesthesia combined with lidocaine carbonate and tetracaine can effectively reduce the cardiovascular response of endotracheal intubation and extubation and relieve the incidence of postoperative cough and sore throat.
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Objective To evaluate the analgesic efficiency and safety of patient-controlled intravenous analgesia ( PCIA) with both flurbiprofen and sufentanil after Han-uvulopalatopharyngoplasty ( H-UPPP) surgery. Methods Patients undergoing H-UPPP surgery ( n=60 ) were randomly divided into four groups with 15 cases in each group .They received PCIA after operation with a loading dose of 2 ml, lockout time of 15 minutes, background infusion rate of 2 ml/h and liquid volume of 100 ml.The PCIA formulation in each group was as follows:sufentanil 3.0 μg/h in group A;sufentanil 3.0 μg/h+flurbiprofen 4.0 mg/h in group B;sufentanil 2.0μg/h+flurbiprofen 4.0 mg/h in group C;sufentanil 1.0μg/h+flurbiprofen 4.0 mg/h in group D.The visual analogue scale (VAS) and Ramsay sedation scale were recorded at 2, 6, 12, 24, and 48 h after surgery (T1 -T5 time points).Patient pressing times and the adverse effects within 48 h after surgery were counted . Results The VAS scores of the group D were higher than those in the other three groups at T1 and T2 time points (P<0.05).The Ramsay scores of the group D were lower than those in the other three groups at T1 and T2 time points (P<0.05).The numbers of pressing times in the group D were more than those in the other three groups (P<0.05). Conclusion PCIA with both flurbiprofen 4.0 mg/h and sufentanil 2.0 μg/h is effective for postoperative analgesia after H-UPPP.
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OBJECTIVE@#To observe the histopathologic and morphological changes of palatopharyngeal soft tissues in patients with different degrees of obstructive sleep apnea hypopnea syndrome (OSAHS) patients.@*METHOD@#Thirty-eight male OSAHS patients were divided into 3 groups according to AHI, namely mild group (n = 10), moderate group (n = 13),and severe group (n = 15). The soft palate tissues with partial palatopharyngeal arch and palatoglossal arch tissues were obtained from surgery and processed with conventional paraffin embedding. The sections were stained by HE and observed under a light microscope. The histological quantitative changes of the specimens were measured by analyzing the constituent ratios of glandular tissue, fat tissue and interstitial elements. Statistical analysis was performed.@*RESULT@#1) Optical microscope showed that (100 times), as the aggravation of the OSAHS, the soft palate squamous epithelial cells are swollen and irregular, exhibiting hyperkeratosis, accompanied by liquefied degeneration of basal cell; The mucous membrane and submucosal connective tissue contain a certain number of lymphocytes infiltration. The mucosa and submucosal layer of loose connective tissue contain inflammatory cells and a lot of fat vacuoles can be observed; The soft palate mucous acini have inconsistent and irregular shape, among which there are a certain amount of fat cells infiltration. Some mucous acini are replaced by serous acini with dark stained cytoplasm; The palatoglossal muscle and palatopharyngeus muscle fibers can't be identified with disordered arrangement of structure, showing pleomorphic changes including swelling, atrophy and degeneration. Some of elastic fibers were disrupted and a lot of fat cells infiltration was observed. (2) The constituent ratios of the three kinds of tissues in soft palate from different degrees of OSAHS patients show that quantitative changes of glandular tissue and interstitial elements among the mild, moderate and severe OSAHS group patients exhibit statistically significant differences (P 0.05).@*CONCLUSION@#With the rising of severity of OSAHS, the soft palate squamous epithelial cells are swollen and irregular, exhibiting hyperkeratosis. Between acinar cell we could see a certain amount of fat cells infiltration. Some mucous acini are replaced by serous acini. Muscle fibers of palatopharyngeal tissue have pleomorphic changes of swelling, atrophy and degeneration.