生物蛋白海绵应用于鼻内窥镜鼻窦术后鼻腔填塞的疗效观察

目的探讨内窥镜鼻窦手术后术腔应用生物蛋白海绵的临床效果。方法 40例（80侧）接受功能性内窥镜鼻窦手术I型三期慢性鼻窦炎患者,术后分别应用凡士林纱条＋生物蛋白海绵和凡士林纱条填塞术腔,比较术后疼痛程度、抽取时鼻腔出血情况以及鼻腔黏膜的转归时间。结果凡士林纱条组疼痛程度和抽取填塞物后鼻腔创面出血〉5 ml均高于凡士林纱条＋生物蛋白海绵组,差异有统计学意义（P〈0.05）;两组术后上皮化时间差异无统计学意义（P〉0.05）。结论 功能性内窥镜鼻窦手术后应用凡士林纱条＋生物蛋白海绵填塞术腔,虽然上皮化时间无明显提高,但可以减轻术后疼痛,减少抽取填塞物时的出血。     

鼻内镜下鼻窦及鼻眼相关术后四物通窍方滴鼻的临床观察

目的:观察鼻内镜下鼻窦及鼻眼相关术后应用四物通窍方滴鼻对促进术腔黏膜上皮化的作用。方法:对89例双侧鼻内镜下功能性鼻窦手术病人进行同体对照观察,鼻眼相关手术26例随机分为两组。对照组滴用类固醇激素(曲安奈德喷鼻剂)和链霉素,观察组为四物通窍方滴鼻,连续鼻内镜下随访3个月,观察术腔黏膜上皮化过程。结果:观察组治愈率89.2%,好转率5.9%,平均上皮化6.3周;对照组治愈率87.2%,好转率10.8%,平均上皮化7.8周。结论:鼻内镜下功能性鼻窦手术及鼻眼相关手术后局部使用四物通窍方滴鼻,可以促进术腔黏膜上皮化过程。     

塞纳斯对鼻窦手术后术腔黏膜上皮化程度及转归的影响

目的：探讨鼻窦术后患者采用塞纳斯对术腔黏膜上皮化程度及转归的影响。方法：选取2020年2月至2022年6月在涟水县人民医院接受鼻窦手术治疗的患者108例,根据随机数字表法分为研究组（54例）与对照组（54例）。对照组术腔只填塞医用膨胀海绵,研究组术腔予塞纳斯和可吸收止血贴。比较两组临床疗效、鼻黏膜恢复情况（Lund-Kennedy评分）、术腔黏膜上皮化程度及上皮化时间,治疗前后生活质量。结果：研究组治疗总有效率（96.30%）较对照组（83.33%）高（P<0.05）;两组治疗后Lund-Kennedy评分较治疗前降低,且研究组低于对照组（P<0.05）;研究组治疗4周、8周术腔黏膜上皮化程度评分较对照组高（P<0.05）,术腔黏膜上皮化时间较对照组短（P<0.05）;两组治疗后鼻腔鼻窦结局测试（SNOT-20）评分较治疗前降低,且研究组低于对照组（P<0.05）。结论：将塞纳斯应用于鼻窦手术后患者,可提高临床疗效,改善鼻黏膜恢复情况,提高术腔黏膜上皮化程度,缩短术腔黏膜上皮化时间,提高患者生活质量。     

布地奈德鼻喷雾剂对功能性鼻窦内窥镜术后术腔黏膜修复的影响

目的 分析布地奈德鼻喷雾剂对功能性鼻窦内窥镜术后术腔黏膜修复的影响.方法 选取69例鼻窦炎患者的临床资料进行研究分析,并按患者住院尾号将其随机分为治疗组（35例）和对照组（34例）.对照组患者在实施手术治疗后,给予相应的抗生紊及术腔冲洗,局部采用传统的雾灵鼻进行点鼻;治疗组患者实施手术治疗后,除进行常规的抗生素及术腔冲洗外,局部采用布地奈德鼻喷雾剂进行喷鼻治疗.对比两组患者在实施手术治疗后鼻腔黏膜的修复状况.结果 两组患者实施功能性鼻窦内窥镜术后不同时间段中术腔清洁及上皮化时间比较差异有统计学意义（P＜0.05）.结论 布地奈德鼻喷雾剂可有效促进患者在实施功能性鼻窦内窥镜术后黏膜修复状况的改变,提高并巩固患者实施功能性鼻窦内窥镜术的治疗效果,降低患者出现并发症的发生率,具有方便、安全、高效、不良反应少、依从性好等优点.     

泼尼松龙-明胶海绵局部湿敷对慢性鼻窦炎患者功能性内镜术后术腔黏膜的影响

目的:观察应用泼尼松龙-明胶海绵局部湿敷对慢性鼻窦炎患者鼻内镜术后术腔黏膜的影响.方法:62例慢性鼻窦炎患者,随机分为治疗组(32例)和对照组(30例),2组均接受相同的功能性内镜鼻窦手术治疗及常规术后处理.治疗组在术后2、3、4周换药(共3次)后在中鼻道局部应用泼尼松龙-明胶海绵湿敷;对照组未用泼尼松龙-明胶海绵.比较2组患者术后术腔体征总积分及术腔黏膜上皮化所需时间.结果:治疗组术后4周、8周、12周时术腔体征总积分明显低于对照组(P<0.05);术后术腔黏膜上皮化时间明显短于对照组(P<0.01).结论:慢性鼻窦炎鼻息肉患者行功能性内镜鼻窦手术后,术腔局部应用泼尼松龙-明胶海绵湿敷可促进黏膜的恢复.     

局麻和全麻用于鼻内窥镜鼻窦手术的临床效果对比研究

研究比较局部麻醉和全身麻醉用于鼻内窥镜鼻窦手术的临床效果。选取慢性鼻窦炎住院病人120例,按数字随机表法分为全身麻醉组(甲组)和局部麻醉组(乙组)。进行鼻内窥镜鼻窦手术,比较不同麻醉方式术中出血量、术后1hVAS疼痛评分和术后腔黏膜上皮化平均时间。甲组术中出血量明显少于乙组,差异显著(P0.05);术后1hVAS疼痛评分,甲组为6.8±0.32分,乙组为6.3±0.45分,两组无显著差异(P0.05);全身麻醉组鼻腔上皮化时间明显快于局部麻醉组,差异有统计学意义(P0.05)。对于慢性鼻窦炎患者,与局部麻醉比较,采用全麻手术具有术中出血量少、术后鼻腔黏膜上皮化恢复快等优点,全身麻醉是鼻内窥镜下鼻窦手术首选的麻醉方法。     

鼻内窥镜术后经鼻外用复方苍辛液临床分析

目的探讨中药冲洗液对内镜鼻窦手术后疗效的影响。方法鼻内窥镜术后患者280例随机分为治疗组162例和对照组118例。治疗组用复方苍辛液A液行鼻腔冲洗,B液滴鼻;对照组用0.9%氯化钠液冲洗。疗程10周。结果对两组患者术后第10周鼻内镜检查量化评估及治愈率进行统计分析,差异有统计学意义（P〈0.01）。结论复方苍辛液能使鼻内镜术后黏膜创面修复时间缩短、手术治愈率明显提高。     

应用糖皮质激素对促进鼻内镜术后局部上皮化影响

目的:观察留置布地奈德混悬液明胶海棉对鼻内镜手术后中鼻道术腔上皮化的影响.方法:慢性鼻窦炎,鼻息肉患者48例随机分为治疗组与对照组,均给予鼻内镜鼻窦手术及常规术后处理.治疗组鼻内镜清理检查后于中鼻道术腔内留置浸有布地奈德混悬液的明胶海棉,1次/周,共3～6周,对照组仅行常规清理.结果:治疗组术腔黏膜上皮化时间明显短于对照组(P<0.01).结论:慢性鼻窦炎鼻息肉鼻内镜术后术腔局部应用糖皮质激素可取得较好临床疗效.     

表皮生长因子和碱性成纤维细胞生长因子对鼻内镜术后黏膜的影响

目的观察鼻内镜术后局部应用表皮生长因子(EGF)和碱性成纤维细胞生长因子(bFGF)的疗效。方法将56例鼻内镜术后患者随机分为两组,A组(28例)局部喷用EGF和bFGF,B组(28例)仅局部喷用EGF,比较术腔完全上皮化的时间和有效率。结果上皮化时间A组41.7±7.6 d,B组59.7±9.4 d,差异有显著性意义(P<0.01)。总有效率A组92.9%,B组89.3%,差异无显著性意义(P>0.05)。结论EGF和bFGF联合应用能有效促进鼻内镜术后创面上皮化的进程。     

功能性鼻窦内窥镜术后术腔黏膜转归的观察及处理198例分析

目的：观察鼻内镜术后术腔黏膜的转归情况并提出相应处理。方法：对198例功能性鼻窦内窥镜手术患者术腔黏膜进行形态学观察。结果：90%的患者术后1-2周鼻腔清洁,80%的患者术后3-6周局部有囊泡,肉芽及小息肉生长,85%的患者术后十周黏膜完成上皮化。结论：鼻内镜术后术腔黏膜转归可分三个阶段：鼻腔清洁阶段,黏膜转归竞争阶段和上皮化完成阶段。术后合理的处理及严格的随访制度对术腔黏膜的恢复具有重要的作用。     

蝶窦CT解剖与内窥镜鼻窦外科学的对照研究

57例蝶窦CT扫描做以下测量:1.蝶窦的类型:鞍前型14％,半鞍型7％,全鞍型45.6％,枕鞍型17.5％,甲介型14％,未发育型1.7％,2.蝶窦开口:水平宽度平均2.1mm,蝶窦开口与蝶骨嵴的距离平均2.3mm。3.颈内动脉鞍后段隆起出现率为34.2％,视神经隆起出现率为48.3％。CT扫描是内窥镜鼻窦外科中用于诊断,判定病变范围和设计手术方案最重要的方法。     

Antibodies to Human Sinus Node in Sick Sinus Syndrome

The incidence of autoantibodies against human conducting tissue was studied in 45 pacemaker patients with sick sinus syndrome (SSS), in 17 patients with bradyarrhythmia, and jive patients with hypertensitive carotid sinus syndrome. Antibodies against the human sinus node were demonstrated in 29% of patients with SSS and in 24% of patients with bradyarrhythmia; a tenfold risk of SSS could be calculated in patients with this antibody as compared to age-matched controls. At least two subtypes of anti-sinus node antibodies were demonstrated: an antibody absorbable and another one not absorbable with ventricular myocardium. Patients with SSS and prior myocarditis of rheumatic fever have a threefold incidence of that antibody, demonstrating that anti-conducting tissue antibodies are etiologic indicators for former inflammatory heart disease. These antibodies may play a role in the secondary immunopathogenesis of sick sinus syndrome. This hypothesis emerges as an interesting new pathogenetic concept.     

Pacing for Carotid Sinus Syndrome and Sick Sinus Syndrome

BRIGNOLE, M., ET AL: Pacing for Carotid Sinus Syndrome and Sick Sinus Syndrome. The real incidence of pacemaker implants for carotid sinus syndrome (CSS) and the relation between CSS and sick sinus syndrome (SSS) is not precisely known. Patients who needed pacing therapy because of atrial bradyarrhythmias were investigated by means of carotid sinus massage, dynamic ECG, and invasive electrophysiological sinus node evaluation. Of 298 consecutive patients receiving a pacemaker implant, 36 (12%) had a severe cardioinhibitory carotid sinus reflex with reproducible spontaneous symptoms (CSS), 33 (11%) had sinus bradycardia < 50 beat/min or an abnormal electrophysiological evaluation (SSS) and 24 (8%) had both (CSS + SSS). The annual incidence was 40, 37, and 26, respectively, implants per year/million of inhabitants (total incidence 325). Patients affected by CSS, if compared with those affected by SSS, showed: a higher prevalence of syncope (97% vs 42%); more syncopal, episodes per patient (2.9 ± 2 vs 1.8 ± 0.9); a lower prevalence of associated cardiac diseases (53% vs 100%); cardiac enlargement (36% vs 88%); heart failure (6% vs 36%) and paroxysmal atrial fibrillation (0% vs 42%); and a more frequent indication for VVI pacing (75% vs 3%). In patients with CSS + SSS, intermediate characteristics were present. In conclusion, CSS is as frequent an indication to cardiac pacing as SSS; clinical differences justify a distinction between them, even if they are associated in 26% of cases.     

Sinus radiography self-test

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鼻内窥镜手术上颌窦自然开口的处理

目的 :通过对鼻内窥镜手术不同术式的治疗效果的观察 ,探讨慢性上颌窦炎、鼻息肉的治疗方法。方法 :75例慢性鼻窦炎及鼻息肉患者随机分成两组 ,治疗组 4 0例 ,清除中鼻道病变及异常结构不扩大上颌窦自然开口。对照组 35例术中切除中鼻道病变及异常结构的同时扩大上颌窦自然开口。术后随访 1年以上。结果 :两组病例治愈率无明显差异 (χ2 =0 .0 3　P >0 .0 5 ) ,治疗组减少手术操作 ,减少并发症。结论 :慢性鼻窦炎及鼻息肉手术中主要清除窦口周围异常结构及病变 ,上颌窦自然开口如无明显狭窄不必扩大