全麻非插管可视喉镜下杓状软骨复位术疗效分析  

Analysis of curative effect of closed reduction of cricoarytenoid joint with visual laryngoscope under nonintubated general anesthesia

作　　者：徐博怀 余璐洁 朱斌斌[3] 高彬[3] 韩东园 裘奇阳 何勇[1,2] XU Bohuai;YU Lujie;ZHU Binbin;GAO Bin;HAN Dongyuan;QIU Qiyang;HE Yong(Department of Otolaryngology,the Affliated Hospital of Medical School of Ningbo University,Ningbo,Zhejiang,315020,China;Ningbo Key Laboratory of Hearingand Balance Medicine,Ningbo,Zhejiang,315020,China;Department of Anesthesiology,the Affiliated Hospital of Medical School of Ningbo University,Ningbo,Zhejiang,315020,China)

机构地区：[1]宁波大学医学院附属医院耳鼻咽喉科,浙江宁波315020 [2]宁波市听觉和平衡医学重点实验室,浙江宁波315020 [3]宁波大学医学院附属医院麻醉科,浙江宁波315020

出　　处：《中国耳鼻咽喉头颈外科》2022年第7期446-450,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：浙江省医药卫生科技计划项目(2020KY874)。

摘　　要：目的 探讨全麻非插管可视喉镜下杓状软骨复位术的手术方式和疗效。方法 回顾性分析2015年1月~2021年9月就诊于宁波大学医学院附属医院行杓状软骨复位术20例患者的临床资料,根据治疗方法不同分为观察组和对照组,观察组患者行全麻非插管可视喉镜下杓状软骨复位术,对照组患者行局麻下杓状软骨复位术。收集患者一般情况、喉镜检查、手术次数、嗓音嘶哑分级(GRBAS)、自评语音障碍指数(voice handicap index,VHI)、最大发声时间(maximum phonation time,MPT)及术后并发症情况。随访6个月,观察患者术后声带运动情况,对比治疗前后GRBAS、VHI、MPT变化情况。结果 治疗后观察组所有患者术后声音嘶哑、饮水呛咳症状改善,术后喉镜复查见杓部关节活动对称;对照组患者治疗6个月后,9例患者症状明显改善,2例患者仍有声音嘶哑。GRBAS、VHI评分两组术后均明显降低,观察组降低大于对照组,差异有统计学意义(P<0.05);两组患者术后MPT均明显升高,观察组升高大于对照组,差异有统计学意义(P<0.05)。结论 全麻非插管可视喉镜下杓状软骨复位术是治疗环杓关节脱位的一种安全性高、成功率高的手术方法,治疗效果优于传统局麻下杓状软骨复位术,特别适合无法耐受局麻手术的患者。OBJECTIVE To discuss the operative method and postoperative efficacy of closed reduction of cricoarytenoid joint with visual laryngoscope under non intubated general anesthesia.METHODS The clinical data of 20 patients with closed reduction of cricoarytenoid joint treated in the Affiliated Hospital of Medical College of Ningbo University from January 2015 to September2021 were analyzed retrospectively.According to different treatment methods,they were divided into observation group(n=9) and control group(n=11).Patients in the observation group underwent closed reduction of cricoarytenoid joint with visual laryngoscope under non intubated general anesthesia,and patients in the control group underwent closed reduction of cricoarytenoid joint under local anesthesia.The general condition,laryngoscopic findings,operation times,GRBAS scores,voice handicap index(VHI),maximum phonation time(MPT) and postoperative complications were collected.The patients were followed up for 6 months.We observed the postoperative vocal cords movement,and compared the changes of GRBAS,VHI and MPT before and after treatment.RESULTS After treatment,the symptoms of hoarseness and aspiration after drinking water were improved in all patients in the observation group.Postoperative laryngoscopy showed that the movement of the vocal cords were symmetrical.In the control group,the symptoms of9 patients were significantly improved after 6 months of treatment,and 2 patients still had hoarseness.In terms of GRBAS and VHI scores,both groups decreased significantly after operation,and the decrease in the observation group was greater than that in the control group,the difference was statistically significant(P<0.05).In terms of MPT,both groups increased significantly after operation,and the increase in the observation group was greater than that in the control group,the difference was statistically significant(P<0.05).CONCLUSION Closed reduction of cricoarytenoid joint with visual laryngoscope under nonintubated general anesthesia is a safe and feasibl

关 键 词：杓状软骨 外科手术 环杓关节 脱位 全身麻醉 非气管插管 

分 类 号：R614.2[医药卫生—麻醉学]