Clinical analysis of complications in OSAHS patients with delayed extubation after surgery / 中国耳鼻咽喉头颈外科

OBJECTIVE To analyze the varieties,causes and preventions of severe complications in OSAHS patients with delayed extubation after surgery.METHODS The clinical dates of 548 OSAHS patients with delayed extubation after surgery were retrospectively analyzed,in order to explore the incidence,reasons,and the prevention and control of severe complications.RESULTS There were 14 cases with severe complications in 548 OSAHS patients,including 1 case of septicemia,one case of nasal alar scar formation,one case of cerebral infarction,2 cases of massive hemorrhage,2 cases of tube dislocation,2 cases of ventilator resistance,2 cases of apnea,3 cases of ventilator-associated pneumonia.All of the14 cases recovered after dealing with the corresponding measures.No dead happened.CONCLUSION The incidence of complications in OSAHS patients with delayed extubation is relatively high.In order to improve the prognosis,more attentions should be paid to the airway care and manipulation in the course of treatment.When the complications happened,corresponding treatments should be done in time.If the patients' respiratory function and airway patency were normal,extubation as early as possible could reduce the incidence of complications.

Relationship between the miR-96 expression in the cochlea and ABR threshold and cochlear morphology of BALB/c mice / 中国耳鼻咽喉头颈外科

OBJECTIVE Through researching the ABR threshold, the cochlear morphology and miR-96 expression in the cochlear of BALB/c mice at different month's age, to find out if the miR-96 can regulate the age related hearing loss of BALB/c mice.METHODS ABR testing, AO/PI staining and scanning electron microscope were used to observe the ABR threshold and cochlear morphology of the BALB/c mice at the ages of 3 months, 6 months, 12 months and 18 months. Real-time PCR was used to detect the expression of miR-96 in the cochlea of BALB/c mice at the ages of 3 months, 6 months, 12 months and 18 months.RESULTS The ABR thresholds of BALB/c mice were (18.5±8.3), (45.8±7.8), and (85.6±15.6) dB SPL separately at the age of 3, 6 and 12 months. At the age of 18 months, no response was observed in the ABR testing with 120 dB SPL acoustic stimulation. In the AO/PI staining, we found that the outer hair cells was apparently lost since the age of 6 months and the loss of hair cells aggravated as the month's age increased. At the age of 12 months, no outer hair cells was left, inner hair cells was lost apparently too. With the scanning electron microscope, we found the changes of deficiency, lodging, fusion, shortening and inversion in the hair cell cilia. And these changes were aggravated as the month's ages increased. At the age of 3 months, the relative expression of miR-96 (2-△CT) was 0.0225±0.0073. The relative expression of miR-96 (2-△CT) in the cochlea were 0.0162±0.0048, 0.0116±0.0048, and 0.0050±0.0014 at the age of 6 months, 12 months and 18 months separately, comparing with the relative expression of miR-96 at the age of 3 months, the differences were significant(P<0.05).CONCLUSION The hearing loss, hair cells loss, and cilia damage aggravated as the month's age increased, but the miR-96 expression in the cochlea decreased. Which suggest that miR-96 might play an important role in the age related hearing loss.

Clinical research of transoral endoscopic adenoidectomy on the treatment of the adenoid hypertrophy children with chronic sinusitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To determine the clinical value of transoral endoscopic adenoidectomy for the pediatric sinusitis.@*METHOD@#Patients with chronic sinusitis and adenoid hypertrophy were divided into two group by undertaken with or without adenoidectomy, the operation group with 43 cases and the control group with 40 cases. Evaluation was performed in pretherapy and after 3 months therapy. Evaluation index included symptom scale for nasal obstruction and rhinorrhea, endoscopy score and CT score for chronic sinusitis.@*RESULT@#There was a positive correlation (0.38) between the adenoid size and the symptom of nasal obstruction (P 0.05). Whether in the operation group or the control group, all index scores in pretherapy were higher than in post-therapy (P < 0.05). After 3 month therapy, all index scores in the operation group were lower than the control group (P < 0.01). The decreased amplitude of all index scores in the the operation group were higher than the control group (P < 0.01).@*CONCLUSION@#Adenoidectomy combined with topical nasal treatment is one effective method for the pediatric sinusitis. Adenoidectomy play an important role in the treatment of pediatric rhinosinusitis.

Exercise pharynx and genioglossus to treat obstructive sleep apnea and hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To discuss the method and effect of exercising larynx and genioglossus to treat obstructive sleep apnea hypopnea syndrome (OSAHS).@*METHOD@#Fifty-four patients who were diagnosed as OSAHS and exercised larynx and genioglossus were defined as treatment group. We took Epworth sleep scale, check patient's PSG, and took computer tomography (320CT) before treatment, 6 months and 12 months later. We made a record of AHI, LSaO2, BMI, the shortest sagittal diameter and transverse diameter. Compared with 30 patients who had taken UPPP surgery (control group 1) and the 21 patients without any treatment (control group 2) at the same time. SPSS 10.0 was used to analyze the data.@*RESULT@#According to Chinese OSAHS construction in 2009, 6 months and 12 months later, the effective rates of treatment group were 31.48% and 44.44%, among which the effective rates in mild and moderate patients of treatment group were 44.74% and 63.16%. Before treatment the mark of Epworth sleep scale was 7.67, 6 month and 12 month later the marks were 3.54 and 3.25. AHI were up to 15.45 after 6 months and 13. 60 after 12 months from 22. 84 at the beginning. LSaO2 were up to 81.18% after 6 months and 81.93% after 12 months from 74.05% at the beginning. The effective rate of control group 1 was 66.67%, and was much higher than the treatment group 6 months later (P 0.05). The effective rates of treatment group were much higher than control group 2 (P < 0.01). After 12 months, the sagittal wall compliance of retropalatal area was lower (P < 0.01). There was no significant change of BMI in every group.@*CONCLUSION@#Exercising larynx and genioglossus is one kind of non-invasive and effective method without payment to treat part of OSAHS patients, especially the patients who is old, without surgical condition, and especially mild and moderate OSAHS patient that do not want to take surgery and CPAP treatment. Besides, exercising larynx and genioglossus can be considered as remedial treatment of OSAHS to surgery and other therapy.

Evaluation of upper airway resilience under Müller respiration by non-endoscopic method / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate diagnostic significance of the noninvasive and objective 320-slice CT scan in the high pharynx resilience in the patients with obstructive sleep apnea/hypopnea syndrome.@*METHOD@#Fifty patients with OSAHS and 10 patients with pharyngeal paraesthesia were included in the study. 320 slice CT scan was used to measure the sagittal diameters, transverse diameters and sectional area of the retropalatal region, retroglossal region. Calculating the pharynx wall resilience. Analyzing the correlativity of pharynx wall resilience, BMI and AHI. Fiber endoscope was used to assess the subsidence percentage of the pharynx wall.@*RESULT@#Between OSAHS patients and pharyngeal paraesthesia patients, there was obviously difference in the retropalatal region and retroglossal region upper airway. The pharynx wall resiliences of retropalatal region were much more than that of retroglossal region. The later pharynx wall resiliences were much more than the fore-to-aft pharynx wall resiliences in the retropalatal region. BMI, AHI and the pharynx wall resilience were positive correlative to each other. But AHI and the pharynx wall resilience was nonlinear correlative. There was a good concordance between the pharynx wall resilience detected by 320CT and subsidence percentage of the pharynx wall detected by fiber endoscope.@*CONCLUSION@#320 slice CT is a kind of simple, rapid and objective method to localize the high resilience area of upper respiratory tract, which can be benefit to the clinical diagnosis, the etiological study and the treatment of OSAHS. Based on physical examination, we propose that only one time of CT scan to the patients' upper airway at the Muller' stage is enough to localize the stenosis area, which can reduce radiation dosage dramatically.

The localization diagnosis of OSAHS patients / 临床耳鼻咽喉头颈外科杂志

The obstruction localization methods of OSAHS patients were reviewed in this article. And the advantages and disadvantages of each method were analyzed. Clinical doctors need to choose suitable method according to patients situation.