上颌窦穿刺致眼球外突护理1例

慢性上颌窦炎是耳鼻咽喉科的常见病、多发病,多由于周围组织炎症迁延、窦口引流阻塞、全身抵抗力减弱、齿源性感染等因素造成。其发病主要是由于周围组织炎性迁移所致,常用上颌窦穿刺冲洗治疗慢性上颌窦炎。穿刺时向窦内注入抗生素,或注入替硝唑、甲硝唑溶液,甚至一些中成药制剂。作为一种传统治疗慢性上颌窦炎的方法,既有助于诊断,又可以用于治疗,     

兔急性上颌窦炎早期一氧化氮合酶的表达及意义

目的 :探讨一氧化氮合酶 (NOS)在兔急性上颌窦炎 (AMS)窦粘膜中的表达及其意义。方法 :健康新西兰白兔 36只 ,分为空白、阴性对照组和AMS组。通过阻塞窦口并注入 1.0ml的肺炎链球菌悬液 (10 9CFU)建立AMS模型 ,观察时间点为自手术第 5、10天。应用黄递酶———NADPH组织化学技术 ,以NADPH脱氢酶特异性测定NOS在空白、阴性对照组和AMS组兔上颌窦粘膜中的分布及不同时间点AMS组NOS活性表达。结果 :正常和急性上颌窦炎兔窦粘膜酶化学染色均有反应 ,主要分布于粘膜上皮、血管内皮和腺体细胞 (染色程度与正常组相比 ,P<0 .0 5或P <0 .0 1)。结论 :正常兔上颌窦粘膜存在NOS ,一氧化氮 (NO)与上颌窦急性炎症有关 ,炎症时NOS活性明显增高 ,过多的NO会对组织或细胞产生损伤 ,提示NO在AMS发病机制中有重要意义     

急性上颌窦炎粘膜上皮表面凝集素受体的表达及意义

目的：探讨凝集素受体在急性上颌窦炎粘膜上皮表面的表达及意义。方法：利用已建立的实验动物模型将急性炎症标本及正常鼻窦粘膜标本行凝集素亲合组织化学ABC法染色。结果：正常鼻窦粘膜上皮表面欧州白脉根凝集素(LTL)和花生凝集素(PNA)染色基本阴性，而炎症粘膜呈弱阳性；双花扁豆凝集素(DBA)在炎症粘膜染色阳性减弱；N—PNA(预先经神经氨酸酶处理后再进行PNA染色)染色其阳性均显著加深。结论：上颌窦急性炎症期，粘膜上皮表面糖复合物糖链发生改变，这种改变可能一方面是致病菌侵袭的结果，另一方面也是机体局部抵抗炎症的重要防御因素之一。     

上颌窦炎及咽炎患者肺炎链球菌带菌及耐药性调查

目的 调查急慢性上颌窦炎及咽炎患者肺炎链球菌带菌及耐药情况。方法 用E—test法及纸片扩散法测定耐药情况．结果 86株肺炎链球菌中，对青霉素敏感64株(74.4％)，低度耐药18株(20．9％)，高度耐药4株(4．7％)，青霉素耐药菌株对红霉索、氯霉素、复方新诺明及四环素的耐药率比青霉素敏感株高，所有菌株对万古霉素敏感．结论 了解细菌耐药性的变化是合理应用抗生素的重要依据。     

临床分离肺炎链球菌的毒力基因及血清型分析

目的 了解肺炎链球菌的5种常见毒力基因(psaA、pspA、nanA、ply、lytA)在临床分离株中的分布情况.方法 以2006-2008年从临床分离133株肺炎链球菌为研究对象,采用PCR法对5种常见的毒力基因进行检测.结果 lytA、psaA、nanA、pspA、ply这5种基因在133株菌中的检测阳性率分别为94.7%、85.0%、84.2%、60.2%、82.7%;5种毒力基因在87株常见血清型菌中的阳性率分别为100%、87.4%、89.7%、67.8%、86.2%.结论 5种毒力基因在本地区肺炎链球菌中的阳性检测率均较高,在常见血清型菌株中的阳性检测率较其他血清型高.这5种基因是肺炎链球菌致病的主要毒力基因,可能作为新刑肺炎蛋白疫苗的候选基因.     

鼻内镜术后联合置管冲洗治疗真菌性上颌窦炎的疗效观察

目的 探究鼻内镜术后联合置管冲洗治疗真菌性上颌窦炎安全性和临床效果。方法 选择2013年3月~2017年3月我院用鼻内镜术后行鼻腔冲洗的真菌性上颌窦炎患者840例,随机分为实验组440例和对照组400例。实验组术后配合常规治疗的同时给予生理盐水500 ml置管冲洗术腔,1次/d,持续14 d;对照组则在术后配合常规治疗的同时给予生理盐水500 ml常规冲洗术腔,1次/d,持续14 d。比较两组患者鼻内镜术后1月、2月、3月及6月鼻腔恢复情况。结果 实验组术后第1、2、3及6月痊愈率与对照组比较,差异有统计学意义（P＜0.05）,第6月实验组痊愈率为45.45%,显著高于对照组的27.50%,差异有统计意义（P＜0.05）。结论 真菌性上颌窦炎患者在鼻内镜手术术后,采用常规综合治疗配合置管冲洗术腔,能够很好地把术腔分泌物及痂皮冲出,减轻鼻腔、鼻窦的炎性反应,缩短鼻窦上皮化的时间,恢复保护和防御功能。     

干槽症合并急性上颌窦炎一例

干槽症为拔牙2～3日后拔牙创剧烈疼痛,并可向耳颞部、下颌区、或头颈部放散,一般镇痛药物不能止痛;拔牙窝空虚,或有腐败变性的血凝块,腐臭味强烈。罹患慢性根尖周炎的上颌牙齿,因长期炎症致根尖骨质的吸收,牙根与上颌窦之间仅剩薄层粘膜相隔,拔除后往往可出现口腔上颌窦交通导致急性上颌窦炎。笔者遇见1例左上第二磨牙干槽症并发左急性上颌窦炎的患者,现报告如下：     

与鼻内窥镜术有关的中鼻道及窦口应用解剖

目的:为上颌窦和额窦冲洗及内窥镜术提供解剖学基础。方法:作者对60侧成人尸体头部正中矢状切面标本进行解剖,观测了中鼻道、额隐窝、额鼻峡(管)、上颌窦口、半月裂孔的形态、大小、位置、及上颌窦口和额鼻管口的角度及与周围结构的关系。结果:上颌窦口内径3.0±0.2mm,距鼻小柱前下缘46.0±4.0mm,鼻小柱至上颌窦口与鼻腔底平面之间的夹角为38.4±6.2°,鼻额管外口(额鼻峡)内径2.8±0.3mm,距鼻小柱前下缘47.9±3.4mm,鼻小柱至额鼻管外口与鼻腔底平面之间的夹角为56.7±7.3°。结论:经窦口行额窦及上颌窦冲洗及功能性鼻内窥镜术时应注意额鼻管、上颌窦口的位置、角度及毗邻关系。     

上颌窦炎及咽炎患者肺炎链球菌带菌及耐药性调查

目的调查急慢性上颌窦炎及咽炎患者肺炎链球菌带菌及耐药情况. 方法用E-test法及纸片扩散法测定耐药情况. 结果 86株肺炎链球菌中,对青霉素敏感64株(74.4%),低度耐药18株(20.9%),高度耐药4株(4.7%),青霉素耐药菌株对红霉素、氯霉素、复方新诺明及四环素的耐药率比青霉素敏感株高,所有菌株对万古霉素敏感. 结论了解细菌耐药性的变化是合理应用抗生素的重要依据.     

ClpP粘膜免疫预防小鼠发生肺炎链球菌性肺炎和败血症

目的:肺炎链球菌毒力蛋白ClpP鼻腔粘膜免疫BALB/c小鼠,探讨其作为肺炎链球菌候选蛋白疫苗的价值.方法:利用制备的ClpP多克隆抗体,分析ClpP 在肺炎链球菌表面表达情况;ClpP蛋白粘膜免疫小鼠,TIGR4型肺炎链球菌分别经腹腔和鼻腔攻击,分析肺炎链球菌小鼠肺内定植情况并监测小鼠生存时间.结果:流式细胞技术证实了TIGR4肺炎链球菌表面表达ClpP毒力蛋白,粘膜免疫ClpP可以特异产生系统性和粘膜性的ClpP抗体,并可减少TIGR4肺炎链球菌在小鼠肺内的定植,延长小鼠生存时间.结论:ClpP粘膜免疫可预防小鼠发生肺炎链球菌性肺炎和败血症,进一步证实ClpP蛋白可作为肺炎链球菌的候选蛋白疫苗.     

Serum and mucosal nitric oxide levels and efficacy of sodium nitroprussid in experimentally induced acute sinusitis

Experimental acute sinusitis was induced in 21 New Zealand hybrid rabbits by occluding the ostium and inoculating them with Streptococcus pneumonia. While a group of rabbits with sinusitis was left untreated, two other groups were administered parenteral sodium nitroprussid (SNP) and oral levofloxacin for ten days. While staphylococci species, non-hemolytic streptococcus and contaminated flora were isolated from the sinuses of controls, Streptococcus pneumonia was re-isolated in two of six untreated rabbits, in one of six SNP administered rabbits and none of the levofloxacin treated rabbits. Serum and maxillary sinus mucosal nitric oxide (NO) levels were correlated. While the mean maxillary sinus NO level of controls was significantly higher than that of untreated rabbits, the mean maxillary sinus and serum NO levels were significantly higher in SNP administered rabbits than in the others. Although goblet cell hyperplasia and squamous cell metaplasia were detected in some slides, edema and neutrophil infiltration were the prominent findings. The most severe inflammatory changes were found in the untreated sinusitis group on the third and fifth days. The earliest improvement was observed in the levofloxacin treated rabbits. It was concluded that NO level is decreased during acute sinusitis and that SNP administration hastens the bacteriological and histological recovery.     

Comparison of the nasal bacterial floras in two groups of healthy subjects and in patients with acute maxillary sinusitis.

The nasal bacterial flora was studied in 183 healthy men entering military service (entry group), 103 healthy recruits in service (service group), and 185 recruits with acute maxillary sinusitis. The 267 nasal and ipsilateral sinus aspirate findings in the same patients with acute maxillary sinusitis were compared pairwise. In the entry group presumed sinus pathogens were only rarely isolated from the nasal cavities: Haemophilus influenzae in 4%, Streptococcus pneumoniae in 1%, Branhamella catarrhalis in 3%, and Streptococcus pyogenes in 0%. The corresponding isolation frequencies in the service group were 19, 13, 3, and less than 1%, respectively, and those in the group with acute maxillary sinusitis were 61, 25, 7, and 6%, respectively. Suppression of the major components of the normal nasal flora, Corynebacterium sp., coagulase-negative staphylococci, Propionibacterium acnes, and Staphylococcus aureus, was seen in the group with acute maxillary sinusitis and also occasionally in the service group. When a sinus aspirate culture yielded a presumed sinus pathogen, the same pathogen was found in the nasal samples in 91% of the cases. The predictive value of a pathogen-positive nasal finding was highest (93.8%) for S. pyogenes, followed by 77.7% for H. influenzae and 68.7% for S. pneumoniae, and lowest (20%) for B. catarrhalis.     

内镜经泪前隐窝入路治疗上颌窦前内下壁病变

目的　探讨鼻内镜下经泪前隐窝径路治疗上颌窦病变的临床效果。 方法　回顾性分析了2008年1月~2018年1月三家医院耳鼻咽喉头颈外科收治的采用内镜辅助下经泪前隐窝入路治疗的各种上颌窦病变患者67例的临床资料。 结果　上颌窦内下壁囊肿20例,上颌窦内下壁息肉6例,内翻性乳头状瘤2例,真菌球性鼻-鼻窦炎23例,变态反应性真菌性鼻-鼻窦炎13例,慢性侵袭性真菌性鼻-鼻窦炎1例。所有患者术后定期随访半年以上未见复发。 结论　鼻内镜下泪前隐窝入路能够充分显露上颌窦腔,彻底切除上颌窦内的病变,手术操作方便,能够有效治疗上颌窦各种良性病变,如有明显的泪前隐窝及齿槽隐窝存在,可作为上颌窦前内下壁病变的首选手术入路。     

内镜经泪前隐窝入路治疗上颌窦前内下壁病变

目的　探讨鼻内镜下经泪前隐窝径路治疗上颌窦病变的临床效果。 方法　回顾性分析了2008年1月~2018年1月三家医院耳鼻咽喉头颈外科收治的采用内镜辅助下经泪前隐窝入路治疗的各种上颌窦病变患者67例的临床资料。 结果　上颌窦内下壁囊肿20例,上颌窦内下壁息肉6例,内翻性乳头状瘤2例,真菌球性鼻-鼻窦炎23例,变态反应性真菌性鼻-鼻窦炎13例,慢性侵袭性真菌性鼻-鼻窦炎1例。所有患者术后定期随访半年以上未见复发。 结论　鼻内镜下泪前隐窝入路能够充分显露上颌窦腔,彻底切除上颌窦内的病变,手术操作方便,能够有效治疗上颌窦各种良性病变,如有明显的泪前隐窝及齿槽隐窝存在,可作为上颌窦前内下壁病变的首选手术入路。     

Allergy in patients with acute maxillary sinusitis

The occurrence of allergy was studied in 224 patients with verified acute maxillary sinusitis by means of an allergy questionnaire, skin testing, and nasal smears. Allergy was found in 56 patients (25%). In addition, allergy was considered probable in 14 patients (6.5%). The corresponding percentages in the control group were 16.5 and 3, respectively. The difference is statistically significant P less than 0.05). However, the frequency of allergy is lower in the present series than in those previously reported on chronic sinusitis. There were no differences between allergic and non-allergic patients in the number of prior acute sinusitis episodes or of previously performed sinus irrigations. Bacteriological and radiological findings did not differ significantly between the groups.     

Symptoms and signs in culture‐proven acute maxillary sinusitis in a general practice population

The objective of this study was to assess symptoms and signs in patients with maxillary sinusitis and a bacteriological diagnosis obtained by sinus aspiration or lavage. Designed as a prospective cohort study in general practice, the study included 174 patients, aged 18–65 years, suspected of having acute maxillary sinusitis by their general practitioner. The main outcome measures were the independent association of symptoms, signs, erythrocyte sedimentation rate (ESR), and C‐reactive protein (CRP) concentration and confirmed infection with the predominant bacterial pathogens Streptococcus pneumoniae and Haemophilus influenzae. The predominant organisms found in patients with acute maxillary sinusitis were S. pneumoniae and H. influenzae. Body temperature >38 °C and maxillary toothache were significantly associated with the presence of S. pneumoniae and H. influenzae. Positive bacteriological culture results were significantly associated with increasing ESR and CRP values. None of the symptoms and signs, with the exception of body temperature >38 °C and maxillary toothache, were particularly sensitive indicators of the specific aetiology in patients with acute maxillary sinusitis. Elevated ESR and CRP values were significantly associated with positive bacteriological culture results. On the other hand, absence of these symptoms and signs did not exclude the presence of acute maxillary sinusitis.     

Microbiology of sinusitis and the predictive value of throat culture for the aetiology of sinusitis

A prospective study of throat cultures and maxillary sinus aspirates from children with chronic sinusitis (n = 21), acute sinusitis (n = 28) or a clinical diagnosis of chronic adenoiditis (n = 41) was performed. Seventy-two bacterial pathogens were isolated from sinus aspirates from 52% of the study population. Haemophilus influenzae was most common pathogen, followed by Moraxella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and group A streptococci. Quantitative throat cultures had positive predictive values of 41%, 53% and 75% for H. influenzae, Strep. pneumoniae and M. catarrhalis, respectively, while negative predictive values were 93-98%, indicating that these three pathogens do not cause sinusitis when absent from the throat.