支撑喉镜下喉显微手术患者的体位改进  

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

作　　者：顾晓娜[1,2] 程向荣 张鹏 朱亮[1,2] 滕华[1,2] 王勇[1,2] 胡晓燕 刘晓静[1,2] GU Xiaona;CHENG Xiangrong;ZHANG Peng;ZHU Liang;TENG Hua;WANG Yong;HU Xiaoyan;LIU Xiaojing(Department of Otolaryngology,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210028,Jiangsu,China;Jiangsu Province Academy of Traditional Chinese Medicine,Nanjing 210028,Jiangsu,China)

机构地区：[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

出　　处：《山东大学耳鼻喉眼学报》2020年第6期77-81,共5页Journal of Otolaryngology and Ophthalmology of Shandong University

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。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.

关 键 词：嗅物位 支撑喉镜 声门暴露 喉显微手术 

分 类 号：R767[医药卫生—耳鼻咽喉科]