鼻腔冲洗在变应性鼻炎治疗中的临床疗效

目的分析变应性鼻炎(AR)患者接受鼻腔冲洗治疗的临床疗效。方法将2019年6月~2020年8月作为研究时间段,选取期间我院接诊的78例AR患者,另将随机数字表法作为分组依据,将全部病例分为对照组(行常规治疗,纳入39例)、研究组(加用鼻腔冲洗治疗,纳入39例),对组间气道反应性、症状消失时间展开分析。结果(1)组间气道反应性指标在治疗前无明显差异,P>0.05;研究组共振频率(Fres)、中心气道阻力(R20)、气道总阻力(R5)在治疗后低于对照组,P<0.05;(2)研究组鼻塞、流涕、喷嚏、鼻痒消失时间均少于对照组,P<0.05。结论鼻腔冲洗对改善AR患者气道反应、临床症状均有明显效果,值得推广。     

鼻腔冲洗治疗变应性鼻炎的疗效观察

目的：比较鼻腔冲洗及鼻用激素治疗对变应性鼻炎（AR）患者鼻部症状及气道炎症相关指标的影响,探讨鼻腔冲洗在AR治疗中的意义。方法：将61例经变应原皮肤点刺试验诊断为AR的患者随机分为3组：A组17例（单纯鼻用激素治疗）,B组21例（单纯鼻腔冲洗）,C组23例（鼻腔冲洗联合鼻用激素）。观察各组治疗前、治疗3个月后鼻部症状视觉模拟量表（VAS）评分和鼻炎结膜炎生活质量（RQLQ）评分及下气道呼出气一氧化氮（FENO）值。结果：3组患者治疗前VAS、RQLQ评分及FENO值比较差异无统计学意义（P〉0.05）,具有可比性。治疗3个月后3组患者VAS、RQLQ评分及FENO值均明显降低（P〈0.05）。治疗3个月后3项指标减少差值比较,VAS、RQLQ评分3组间差异无统计学意义,FENO值A、C组与B组比较均差异有统计学意义（均P〈0.05）。结论：鼻腔冲洗能改善AR患者的鼻部症状,提高患者的生活质量,降低下气道炎症。鼻腔冲洗治疗AR有效,与鼻用激素联合使用能取得更明显的效果。     

低温等离子消融术治疗慢性鼻炎的疗效观察

目的探讨低温等离子消融术治疗对以鼻塞为主要症状的成人慢性鼻炎患者主观症状、鼻腔黏膜纤毛清除功能及鼻阻力的影响。方法将门诊诊断为慢性鼻炎的62例患者分为治疗组和对照组,分别行低温等离子消融术治疗和等渗盐水鼻腔冲洗加鼻内类固醇激素治疗,治疗1年后检测患者主观症状、黏膜纤毛清除时间及鼻阻力变化,并与治疗前进行对比分析。结果治疗前患者平均糖精清除时间为17.42 min;治疗后治疗组患者平均糖精清除时间为17.26 min,对照组患者平均糖精清除时间为16.82 min,治疗组与对照组比较差异无统计学意义(P>0.05)。鼻阻力检测示,治疗组鼻阻力明显减小,且其减小程度与对照组比较差异具有统计学意义(P<0.01)。与治疗前相比,视觉模拟量表(VAS)评分示治疗组患者鼻塞症状明显改善(P<0.05),且改善程度优于对照组。结论低温等离子下鼻甲消融术治疗对慢性鼻炎患者鼻腔黏膜清除功能影响不明显,但可显著减小鼻阻力,且对患者主观症状改善显著。     

鼻声反射与鼻阻力检查在原发性萎缩性鼻炎诊断中的应用

目的探讨鼻声反射和鼻阻力检查在原发性萎缩性鼻炎患者诊断中的应用价值。方法31例实验者中选取25例正常成年受试者为对照组,6例原发性萎缩性鼻炎患者为实验组,分别行鼻声反射(acoustic rhinometry,AR)和鼻阻力(rhinomanometry,RM)测量,获得单侧鼻腔第1狭窄面积、单侧鼻腔第2狭窄面积、单侧鼻腔最小截面积、单侧及总的0～5 cm和2～5 cm鼻腔容积(UV5、UV2～5、TV5、TV2～5)、单侧吸气阻力、单侧呼气阻力及鼻气道总阻力参数,比较两组间的差异并进行相关性分析。结果实验组单侧鼻腔第1狭窄面积明显小于对照组(T=9.189,P<0.05),其余各参数差异无统计学意义。结论鼻阻力与鼻声反射检查可为原发性萎缩性鼻炎的诊断和治疗提供客观参数。     

变应性鼻炎患者外周血Th1/Th2型细胞因子表达意义及其对气道高反应性的预测价值研究

目的 分析变应性鼻炎(AR)患者外周血Th1/Th2型细胞因子表达意义及其对气道高反应性的预测价值。方法 选定海安市人民医院2020年1月—2022年1月接诊的50例AR患者,同期选取海安市人民医院门诊体检的50例健康体检者作为对照组,检测、比较两组血清Th1细胞因子[干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)]、Th2细胞因子[白细胞介素-5(IL-5)、白细胞介素-4(IL-4)],对比AR患者中轻度、中重度组血清Th1、Th2细胞因子;根据气道反应是否正常将AR患者分为两组,27例气道反应正常的患者设为气道反应正常组,23例气道高反应的患者设为气道反应异常组,比较两组血清Th1、Th2细胞因子,绘制受试者工作曲线(ROC),计算曲线下面积(AUC),分析血清Th1、Th2细胞因子对气道高反应的预测价值。结果 AR患者血清IFN-γ均低于对照组(P<0.05),AR患者血清TNF-α、IL-4、IL-5均高于对照组(P<0.05)。中重度AR患者血清IFN-γ均低于轻度组、对照组(P<0.05),中重度AR患者血清TNF-α、IL-4、IL-5均高于...     

变应性鼻炎患者肺功能改变及临床意义探讨

目的:探讨变应性鼻炎(AR)患者肺功能的改变及其临床意义.方法:应用UNICAP100变应原测定仪检测64 例无哮喘症状AR患者(AR组)的血清特异性IgE值,并应用荧光酶联免疫法检测患者吸入物变应原,同时检测其肺通气功能并行支气管激发试验.检测64例无AR症状患者(对照组)的肺功能,对两组患者肺功能进行比较.结果:AR组患者肺功能异常37例(57.81%),其中阻塞性肺通气障碍8例,小气道功能异常12例,气道阻力增高31例;对照组中肺功能异常15例(23.44%),其中阻塞性肺通气障碍2例,小气道功能异常4例,气道阻力增高11例.两组间肺功能变化差异有统计学意义(P＜0.05).AR患者中肺功能异常患者支气管激发试验阳性率明显高于肺功能正常的AR患者,两组差异有统计学意义(P＜0.05).结论:测定无哮喘症状的AR患者的肺功能,可筛查出异常患者并及时行支气管激发试验,对AR并发哮喘患者的早期发现与治疗具有重要的临床意义.     

复方辛夷滴鼻液鼻腔冲洗治疗变应性鼻炎疗效观察及对鼻腔分泌物嗜酸性粒细胞的影响

目的观察复方辛夷滴鼻液鼻腔冲洗对变应性鼻炎患者的临床疗效及对鼻腔分泌物嗜酸性粒细胞影响。方法选取变应性鼻炎患者60例,随机均分为研究组和对照组。研究组采用复方辛夷滴鼻液冲洗鼻腔,对照组采用布地奈德鼻喷雾剂喷鼻,每组均治疗4周(1个疗程2周)。每个患者治疗前与治疗后均取鼻腔分泌物并检测其嗜酸性粒细胞的含量,并用SPSS 19.0统计学软件分析其差异。结果治疗2个疗程后两组患者鼻腔分泌物嗜酸性粒细胞均明显降低,且研究组与对照组比较在改善流涕这一症状上有统计学差异(P0.05)。结论复方辛夷滴鼻液鼻腔冲洗可以有效治疗变应性鼻炎,且在改善流涕症状方面更具有优势。     

舌下含服粉尘螨滴剂治疗过敏性鼻炎患儿的临床效果及安全性分析

目的 评估舌下含服粉尘螨滴剂应用在过敏性鼻炎（AR）患儿中的临床效果及安全性。方法 纳入2021年1月—2022年1月的86例AR患儿,参照随机数字表法划分对照组（纳入43例,行常规抗过敏治疗）、观察组（纳入43例,行舌下含服粉尘螨滴剂治疗）,评价组间症状积分、实验室指标、药物不良反应（ADR）。结果（1）治疗前,组间症状积分、实验室指标[免疫球蛋白E(IgE)、干扰素-γ(IFN-γ)、白细胞介素-4(IL-4)]无差异,P>0.05;治疗4个月后,观察组症状积分、实验室指标（IgE、IFN-γ、IL-4）更佳,P<0.05;(2)在ADR方面,观察组（2.33%）与对照组（9.30%）无差异,P>0.05。结论 对AR患儿行舌下含服粉尘螨滴剂治疗,安全性高,并且可以减轻炎症程度,减弱变态反应,促进症状消失,值得推广。     

PM2.5与变应性鼻炎患者上气道阻力的相关性研究

目的 探讨变应性鼻炎(AR)患者上气道阻力与其周边环境PM_2.5浓度的关系。 方法 随机选取60例在临床上确诊为AR的患者行鼻声反射和鼻阻力测量,并连续监测其生活地区的PM_2.5浓度,使用SPSS 20.0统计软件,采用多元线性回归模型,对所纳入患者的鼻腔总阻力、鼻腔容积和鼻腔最小横截面积与空气污染暴露水平的关联进行分析。 结果 鼻声反射和鼻阻力测量结果显示,受试者鼻腔总阻力、鼻腔最小横截面积、鼻腔容积随着PM_2.5浓度的变化动态改变,差异具有统计学意义。 结论 PM_2.5的浓度变化影响AR患者的上气道阻力,PM_2.5的浓度越大、暴露时间越长,AR患者的上气道阻力越大。     

手术室联合耳鼻喉科优质护理应用于鼻内镜鼻窦手术患者的效果观察

目的探究手术室联合耳鼻喉科优质护理应用于鼻内镜下鼻窦手术患者的应用效果。方法选取2020年1月~2021年11月,我院收治的86例慢性鼻窦炎患者,视为研究对象,按随机数字法分为对照组(43例)和研究组(43例),分别予以开展常规护理和手术室联合耳鼻喉科优质护理,对比两组患者的临床疗效、护理前后鼻腔恢复状况和生活质量。结果研究组患者治疗有效率(100%)显著高于对照组的治疗有效率(86.05%)(P<0.05);护理前两组患者的主观症状评分和鼻腔黏膜形态评分对比均无明显差异(P>0.05),护理后研究组患者主观症状评分和鼻腔黏膜形态评分明显低于对照组患者(P<0.05);护理前两组患者SNOT-22评分对比无明显差异(P>0.05),护理后研究组患者SNOT-22评分显著低于对照组患者(P<0.05);研究组护理满意度(97.67%)显著高于对照组护理满意度(81.39%),差异具有统计学意义(P<0.05)。结论对鼻内镜下鼻窦手术患者开展手术室联合耳鼻喉科优质护理能够保证手术顺利完成,有助于治疗效果的提升,也促进患者鼻腔黏膜的恢复,患者生活质量得以有利改善,是一种有效的围手术期护理方法,适用于鼻内镜下鼻窦手术患者,值得临床推广应用。     

Comparing the effectiveness of “plasma knife” tonsillectomy with two well-established tonsillectomy techniques: Cold dissection and bipolar electrocautery. A Prospective randomized Study

Objective

To evaluate the effectiveness of a new device “plasma knife” for tonsillectomy by comparing to two well-established tonsillectomy techniques: cold dissection, and bipolar electrocautery.

Methods

A prospective, randomized study conducted on 110 patients undergoing tonsillectomy. Subjects were randomized to plasma knife (PKT), cold dissection (CDT) and bipolar electrocautery (BET) groups. Operative time, intraoperative blood loss and postoperative complications were recorded. Pain/discomfort level of patients and healing time of the tonsillar fossae were assessed postoperatively. Data were recorded and statistically analyzed.

Results

Operative time with plasma knife and bipolar electrocautery were associated with a significant decrease in operative time compared to cold dissection (p < 0.05). Intraoperative blood loss was significantly decreased with plasma knife, compared to cold dissection and bipolar electrocautery (p < 0.05). Less postoperative pain was observed with plasma knife compared to bipolar electrocautery but more postoperative pain was observed with both compared to CDT (p < 0.05). Postoperative healing time was longer with plasma knife and bipolar electrocautery, compared to cold dissection (p < 0.05).

Conclusion

Plasma knife is a useful and safe device in tonsillectomy. Its use reduces intraoperative blood loss and provides a fast tonsillectomy with acceptable morbidity.     

双极电凝镊在扁桃体摘除术中的应用

目的：通过比较采用双极电凝镊与传统的剥离法实施扁桃体摘除的手术效果,探讨双极电凝镊在扁桃体摘除术中的应用效果。方法：选取行扁桃体手术摘除的患者100例,前瞻性地分为两组,比较手术时间、术中出血量及术后患者并发症、疼痛程度及恢复时间。结果：用双极电凝镊行扁桃体摘除与普通法扁桃体摘除相比,手术时间短,术中出血少,术后并发症发生率低,患者痛苦轻。结论：采用双极电凝镊扁桃体摘除手术效果明显优于普通剥离法扁桃体摘除,两方法术后恢复时间无统计学差别。     

低温等离子刀扁桃体切除术与传统扁桃体剥离术疗效的比较

目的:比较分析低温等离子刀扁桃体切除术与传统扁桃体剥离术的疗效。方法:将64例慢性扁桃体炎患者随机分为传统扁桃体剥离术(传统手术组)和低温等离子刀扁桃体切除术(等离子手术组)2组。传统手术组39例采用传统扁桃体剥离术治疗,等离子手术组25例采用低温等离子刀扁桃体切除术治疗。分析2组手术方式在手术时间、术中出血量、术后疼痛时间、术后出血发生概率上有无差异。结果:传统手术组与等离子手术组在手术时间、术中出血量、术后疼痛时间上差异有统计学意义(P<0.05);2组术后出血发生概率差异无统计学意义(P>0.05)。结论:低温等离子刀扁桃体切除术较传统扁桃体剥离术手术时间短,术中出血少,术后疼痛轻,恢复快,安全性高。     

等离子扁桃体切除术与常规剥离法扁桃体切除术之比较

目的:比较等离子扁桃体切除术与常规剥离法扁桃体切除术对患者术中、术后的影响。方法:随机将56例患者分为等离子组和对照组,等离子组用低温等离子射频消融系统连接EVac70刀头,能量设置为6,切除扁桃体;对照组则采用常规剥离法扁桃体切除术,手术均由同一术者完成。记录两侧扁桃体切除所需时间和出血量;术后第1天至第10天患者每日记录咽部疼痛情况,恢复正常活动时间和正常饮食时间;术后第10天,医师观察并记录扁桃体窝内的白膜状况。结果:等离子组手术时间比对照组短,术中总出血量<10ml,而对照组平均出血量为(119±43)ml;等离子组患者术后疼痛轻于对照组,且比对照组更早恢复正常饮食;2组患者恢复正常活动时间的差异无统计学意义;等离子组较对照组白膜脱落慢。等离子组有1例患者于术后第7天口咽部有活动性出血,需缝扎止血。结论:等离子扁桃体切除术与剥离法相比,患者术后疼痛明显减轻,出血量极少,手术方法容易掌握,但扁桃体窝愈合的时间较长。     

咽腭弓肌黏膜瓣闭合扁桃体等离子术后创面的临床疗效

目的 对扁桃体等离子切除术的术式进行改进,分析咽腭肌黏膜瓣闭合扁桃体等离子术创面对术后疗效的改善情况。 方法 对需行扁桃体等离子切除术患者进行随机分组。105例行常规扁桃体等离子切除术(大多数囊内切除),94例在扁桃体等离子切除后制作局部咽腭肌黏膜瓣闭合扁桃体窝创面。对两组患者的术后疼痛、创面反应及出血情况进行分类统计,分析比较应用咽腭肌黏膜瓣修复的临床效果。 结果 在术后第1至第7天,实验组与对照组患者间的疼痛程度、创面反应情况及出血并发症的发生均有差异。实验组不同层次疼痛程度的病例数明显少于对照组,术后创面反应观察中,实验组白膜脱落时间较对照组明显缩短,出血概率明显减低。 结论 应用咽腭肌黏膜瓣闭合扁桃体等离子切除后创面操作简便,可明显改善患者术后疼痛,促进创面愈合,减少创面术后出血概率。     

Effect of modern fibrin glue on bleeding after tonsillectomy and adenoidectomy

We performed a prospective randomized study in 179 patients to examine the second-generation surgical fibrin sealant Quixil as an effective substitute for different types of electrocautery in tonsillectomy and adenoidectomy. We compared the rates of hemorrhagic complications in a group with bipolar or needle point electrocautery and in a group in whom fibrin glue was used to stop intraoperative bleeding and to prevent postoperative bleeding. The operations were performed under general anesthesia in typical fashion with sharp dissection. For the control group, hemostasis was achieved by bipolar or needle point electrocautery. For the fibrin glue group, hemostasis was achieved by spraying Quixil fibrin glue approximately 0.5 mL to each tonsillar fossa and 0.5 mL to the nasopharynx (in adenoidectomy). The results were excellent in all the patients of the fibrin glue group, with complete hemostasis and resolution of the major symptoms. In this group, the intraoperative blood loss averaged 15 mL in tonsillectomy and 9 mL in adenoidectomy. There were no cases of postoperative hemorrhage or any other complications. The electrocautery group required a longer time for healing, and its intraoperative blood loss (tonsillectomy) averaged 29 to 33 mL. The incidence of posttonsillectomy bleeding in this group was 4.35% (4 patients). Three patients (3.26%) had primary hemorrhage (bleeding that occurs within the first 24 hours of surgery), and 1 patient (1.09%) had secondary hemorrhage (bleeding that occurs after the first 24 hours). We conclude that Quixil fibrin glue application to the operative sites in tonsillectomy and adenoidectomy provides effective hemostasis and sealing with good systemic and local compatibility. With the help of Quixil, we minimized surgical trauma and achievedabsolute hemostasis at the same time. We found this fibrin glue to be a more convenient and effective hemostatic sealant than bipolar or needle point coagulation.     

低温等离子射频消融治疗小儿鼾症的临床分析

目的：探讨低温等离子射频消融切除扁桃体及腺样体在治疗小儿鼾症中的临床疗效。方法将54例小儿鼾症患者随机分为实验组与对照组,实验组用低温等离子射频消融刀同时切除扁桃体及腺样体,对照组用电凝刀切除扁桃体的同时用动力切割系统切除腺样体。结果两组患儿均在全麻下行扁桃体及腺样体摘除术,实验组较对照组手术时间短,术中出血量少,术后疼痛轻。术后三月复查两组患儿临床症状均完全缓解。结论低温等离子射频消融是治疗小儿鼾症的有效方法,具有手术时间短、术中出血少、术后疼痛轻等优点,值得临床推广。     

Argon plasma coagulation versus cold dissection tonsillectomy in adults: a clinical prospective randomized study

PURPOSE: Argon plasma coagulation (APC) is a new surgical procedure based on a conductive plasma of ionized argon between an activating electrode and a tissue surface. It is a good alternative for tonsillectomy because of its effective hemostasis and limited penetration depth of the coagulation beam. The aim of this prospective, randomized trial was to evaluate operative time, intraoperative bleeding, and postoperative morbidity of the "hot" APC tonsillectomy as with regard to with a traditional "cold" dissection tonsillectomy in adults. MATERIALS AND METHODS: Two hundred twenty six adult patients (age, >18 years) were randomized into 2 groups: TA (tonsillectomy with APC, n = 113) and TB (conventional tonsillectomy, n = 113). The outcome measures were (1) operative time; (2) intraoperative blood loss; (3) postoperative pain (evaluated using a Visual Analogue Scale with a range score 0-10 on postoperative days 1, 3, 5, 8, and 15); and (4) postoperative primary and secondary hemorrhage. Statistical analysis was carried out using the Student t test. RESULTS: In the TA group, the mean duration of operative time and the intraoperative blood loss were significantly reduced (P < .001). There was no statistically significant difference between 2 groups in the intensity of postoperative pain and the incidence of postoperative hemorrhage (P > .05). CONCLUSIONS: Tonsillectomy with APC is a safe technique and offers an innovative procedure as with regard to the conventional cold dissection. It significantly reduces the operative time and the intraoperative blood loss without increasing the postoperative morbidity.     

Tonsillektomie mit dem ultraschallaktivierten Skalpell Erste Ergebnisse zur Technik mit dem Ultracision Harmonic Scalpel®

BACKGROUND: Tonsillectomy requires an efficient intra- and postoperative hemostasis. The ultrasonically activated scalpel (UAS) uses high-frequency ultrasonic energy to perform tissue dissection and coagulation simultaneously. The present prospective study represents the first published results of UAS in tonsillectomy. METHOD: 60 patients with tonsillectomy were examined in regard of intra- and postoperative hemostasis, wound healing and postoperative pain. Also, the quality of the histopathological specimen was evaluated. RESULTS: In 90% of tonsillectomies by UAS efficient intraoperative hemostasis did not require suture ligature. In 10% additional ligation was required for reason of arterial bleeding. Postoperative bleeding did not occur at all, wound healing was uneventful. Surgery related postoperative pain was not intensified. The histopathological evaluation of specimen was not impaired. CONCLUSION: The UAS offers a tissue dissection with efficacious intra- and postoperative hemostasis. Compared to the conventional tonsillectomy the ultrasonical technique of tonsillectomy has especially in children, in anaemic patients and in the surgery of tonsillar malignomas significant advantages.     

Multiparametric comparison of cold knife tonsillectomy, radiofrequency excision and thermal welding tonsillectomy in children

OBJECTIVE: This is a prospective study evaluating certain intraoperative and postoperative parameters, comparing the relatively new technique of thermal welding tonsillectomy with cold knife tonsillectomy, and radiofrequency excision in pediatric population. METHODS: Ninety children aged from 5 through 13 years were enrolled a randomized prospective trial comparing cold knife tonsillectomy, radiofrequency excision, and thermal welding tonsillectomy. Indications included recurrent acute tonsillitis and/or obstructive sleep apnea syndrome. All techniques were compared by means of length of surgery time, blood loss, postoperative bleeding and postoperative pain. RESULTS: Sixty-eight patients underwent tonsillectomy for obstructive sleep apnea, whereas 22 children underwent tonsillectomy due to recurrent acute tonsillitis. Median values of all variables tested, length of surgery time, blood loss, postoperative bleeding and postoperative pain, were found to differ significantly among the three surgical techniques (P<0.001). Particularly, a statistically significant higher median duration (P<0.001) and intraoperative blood loss (P<0.001), as well as, a statistically significant lower median pain score in each day tested (P<0.001) of the cold knife group, compared to each one of the other two groups, were found. Tissue welding and radiofrequency groups did not differ significantly in any aspect tested. CONCLUSIONS: Both thermal welding and radiofrequency excision techniques have shown comparable results regarding intraoperative blood loss, postoperative hemorrhage, and pain. Compared with cold knife tonsillectomy, welding and radiofrequency excision techniques were associated with less intraoperative blood loss and duration, though cold knife tonsillectomy seems to prevail over the two techniques in terms of the postoperative pain.