南京地区社区成年健康人群鼻咽部机会致病菌携带情况调查

目的了解南京地区社区成年健康人群鼻咽部机会致病菌携带情况。方法对南京地区社区1019例成年健康者进行非感染状态下鼻咽拭子菌种鉴定。结果鼻咽部检出率较高的机会致病菌依次为凝固酶阴性葡萄球菌、金黄色葡萄球菌、嗜血杆菌属、肺炎链球菌和肺炎克雷伯杆菌;单一菌群携带率为30.7%,复合致病菌携带率为3.4%,总携带率为34.2%;随年龄增长,金黄色葡萄球菌、嗜血杆菌属的检出率显著降低(P<0.05)。结论南京地区社区健康成年人群鼻咽部普遍存在大量凝固酶阴性葡萄球菌,同时金黄色葡萄球菌、嗜血杆菌属、肺炎链球菌和肺炎克雷伯菌等亦有较高检出率。     

直视下小切口胃肠胆囊切除术护理配合的研究

目的探讨直视下小切口胃肠胆囊切除术护理配合。方法分析直视下小切口胃肠胆囊切除术护理配合全过程。结果患者经治疗及护理后平均6d痊愈出院,术后无严重并发症发生。结论直视下小切口胃肠胆囊切除术全过程护理配合,疗效确切,治愈率高,手术时间短,创伤小,患者痛苦轻,恢复快,住院时间短。是一种比较受欢迎的手术方式。     

骨性Ⅲ类错患者双颌手术后鼻咽及口咽部气道及其周围软硬组织的变化

目的:通过锥形束CT(cone beam computer tomography,CBCT)观察骨性Ⅲ类错患者双颌手术后鼻咽及口咽部气道及其周围软硬组织的变化。方法:纳入双颌手术治疗的骨性Ⅲ类错患者19例,女性12名,男性7名,平均年龄23.8岁。分别于术前1周及术后3个月拍摄CBCT扫描照片,通过Mimics 10.01建立术前及术后鼻咽、口咽气道三维影像并进行测量。结果:术后患者口咽部容积与气道总容积(包括鼻咽与口咽)均显著减小(P<0.05),口咽部气道容积平均减小8.37%,气道总容积平均减小6.91%。术后软腭处气道横截面积平均减小19.83%(P<0.05)。舌骨位置、软腭形态均有明显变化(P<0.05)。术后气道分别与舌骨位置(H-X,H-Y)、软腭形态变化(PNS-UT,U-T,UT/ANS)有显著相关性(P<0.05),软腭形态变化与舌骨位置变化也具有显著相关性(P<0.05)。结论:骨性Ⅲ类错患者双颌术后气道容积减小。     

麻醉状态下拔除气管导管-置入鼻咽通气道预防高血压患者拔管反应的效果

目的 评价麻醉状态下拔除气管导管-置入鼻咽通气道预防高血压患者拔管反应的效果.方法 择期全麻下行腹腔镜胆囊切除术的高血压患者80例,随机分为气管导管组(Ⅰ组)和气管导管-鼻咽通气道组(Ⅱ组),每组40例.两组麻醉诱导气管插管后行机械通气,术中靶控输注异丙酚(血浆靶浓度3～4 μg/L)和舒芬太尼(血浆靶浓度0.2～0.4 ng/L)维持麻醉,维持脑电双频指数40～50.术毕调整异丙酚血浆靶浓度至1 μg/L、舒芬太尼靶浓度至0.1 ng/L,待呼吸恢复后停止输注,Ⅱ组拔除气管导管,置入鼻咽通气道辅以面罩给氧,待患者完全苏醒后拔除;Ⅰ组待患者完全苏醒后拔除气管导管;于麻醉诱导前即刻(T_0)、置入鼻咽通气道后即刻(T_1)、2 min(T_2)、拔除后即刻(T_3)、2 min(T_4)时记录收缩压(SP)、舒张压(DP)、心率(HR)、脉搏血氧饱和度(SpO_2),记录拔管过程中血液动力学指标的最大值(SP_(max)、DP_(max)及HR_(max)),计算拔管前后的差值(△SP、△DP及△HR),并测定血浆肾上腺素(AD)、去甲肾上腺素(NE)浓度,观察呛咳、躁动的发生情况.结果 与T_0时比较,Ⅰ组T_(3,4)时SP、DP、HR、血浆AD及NE浓度升高,Ⅱ组T_(1,3,4)时SP和DP,T_(2,3)时HR降低(P<0.05);与Ⅰ组比较,Ⅱ组T_(2～4)时SP、DP、HR、血浆AD及NE浓度降低,SP_(max)、DP_(max)、HR_(max)及△SP、△DP、△HR降低.拔管反应发生率降低(P<0.05).结论 麻醉状态下拔除气管导管-置入鼻咽通气道可有效预防高血压患者全麻恢复期的拔管反应.     

Nasopharyngeal Foreign Body in an Young Child

A number of articles on foreign body (FB) ingestion and inhalation have been reported in the literature. Of these, reports of foreign bodies lodging in nasopharynx after inhalation/ingestion are rare. A case of FB inhalation/ingestion presented with history of respiratory distress was admitted for suspected FB bronchus and kept for observation. On examination the child was not distressed and chest examination and X-ray were normal. After 2 days, however, X-ray nasopharynx was taken for rhinorrhoea, nose block and snoring since admission. A large metal nut was found in the roof of the nasopharynx. This case is reported for its rarity, unusual presentation and misleading history.     

Impact of thirteen-valent pneumococcal conjugate vaccine on nasopharyngeal carriage in healthy children under 24 months in Okinawa,Japan

In November 2013, a 13-valent pneumococcal conjugate vaccine (PCV13) for all infants aged younger than 5 years was incorporated into the Japan national immunization program. An annual survey of nasopharyngeal carriage rates was performed on healthy infants aged 2–24 months from Okinawa, Japan to evaluate the effect of PCV13 on pneumococcal colonization. Of 756 evaluable infants, 203 pneumococcal strains were detected in 193 infants. The overall nasopharyngeal carriage rate was 25.5%, which was not different from our previously reported isolation rate before the introduction of PCV13. The main serotypes of the Streptococcus pneumoniae strains are 15A (18.2%), non-typeable (14.8%), and 15B (11.8%). The carriage rates of pneumococcal strains with 7-valent pneumococcal conjugate vaccine serotypes and PCV13 serotypes were 3.0% and 9.9%, respectively. These values were significantly lower than we reported before the introduction of PCV13. However, the carriage rates of non-PCV13 serotypes have increased. Multivariate logistic regression analysis suggested that siblings and day care attendance are risk factors for pneumococcal carriage.     

利用时间质谱检出312例6月龄内健康婴儿鼻咽部微生态菌群的分布特征

目的 利用基质辅助激光解吸电离飞行时间质谱(MALDI-TOF MS)技术研究济南地区6月龄内健康婴儿鼻咽部微生态菌群分布特征,为鼻咽部微生态研究提供样本库信息。 方法 采集2019年11月至2020年4月济南地区312例6月龄内健康婴儿鼻咽拭子,增菌后,分离培养获得纯菌株;利用MALDI-TOF MS技术鉴定分离株到种置信水平;312例婴儿分为月龄≤2组、3月龄组、4月龄组和5月龄组,组间比较采用SPSS 22.0统计学软件,卡方或Fisher确切概率法统计分析。 结果 312例健康婴儿鼻咽拭子获得纯菌株741株,分属于25个属74种细菌。优势菌属为葡萄球菌属(31.6%)、棒杆菌属(30.8%)、链球菌属(18.9%)、莫拉菌属(8.6%)和狡诈球菌属(2.0%)。同时发现一些不常见菌种,例如缺陷乏氧菌、放射根瘤菌等。金黄色葡萄球菌检出率男婴(40.5%)高于女婴(26.4%),接近棒杆菌女婴(42.4%)高于男婴(27.4%)。4个年龄组中,假白喉棒杆菌检出率依次升高(10.8%、17.7%、18.9%、46.7%);肺炎链球菌检出率依次升高(2.2%、2.3%、4.1%、20.0%)。 结论 济南地区健康6月龄内婴儿鼻咽部微生态菌群以优势菌为主呈现多样化,MALDI-TOF MS是鉴定常见和不常见微生物菌种的快速、高通量技术手段。本研究可为济南地区儿童鼻咽部微生态研究提供有价值的样本库资料。     

儿童腺样体肥大的CT表现及测量方法研究

目的：探讨儿童鼻咽部腺样体肥大的CT表现、测量方法及临床应用价值。材料与方法：对50例9个月-14岁经临床确诊为腺样体肥大且行刮除手术治疗的儿童术前分别进行鼻咽部CT扫描和同层动态CT电影扫描（CINE）。通过蝶-枕骨结合部层面，测量正中矢状面腺样体最大厚度与鼻咽气腔前后径的比值（A/N）、鼻咽气腔有效气道的前后径D值、鼻咽气腔有效截面面积（Sn）、同层动态CINE扫描鼻咽气腔截面面积改变差值（△S），并与同龄同性别健康儿童进行比较。结果：①腺样体肥大在鼻咽部CT轴位上主要表现为3种形态：弥漫性肿块形、单侧肿块形、嵌入鼻后孔肿块形；②肥大组50例，A/N：0．61-0．86；D：1-2．8mm；Sn：0-97．86mm^2；△S：0—32．54mm^2；正常组50例，A/N：0．34—0．61；D：7．5—12．2mm；Sn：217．87-623．98mm^2；△S：175．87—274．02mm^2。结论：腺样体CT检查方法较X线侧位平片信息量大、鼻咽腔结构显示清晰，尤其是CINE可以帮助了解鼻咽腔随呼吸时动态变化。正中矢状面腺样体厚度与鼻咽气腔前后径的比值、鼻咽气腔有效气道的前后径D值是评价腺样体肥大的重要依据，当A/N≥0．71，D≤3mm时可视为儿童腺样体病理性肥大指征。     

Improved inspection of the lateral pharyngeal recess using cone-beam computed tomography in the upright position

Objectives  To evaluate the structure of the lateral pharyngeal recess (LPR) and surrounding structures in computed tomography (CT) images obtained from subjects in the supine and upright positions. Methods  Six subjects were evaluated using cone-beam CT (CBCT) in the upright position, and with a four-row multidetector helical CT (MDCT) in the supine position. All of the voxel sizes were adjusted to 0.3 × 0.3 × 0.3 mm³ in the x, y, z coordinate system. The posterior nasal spine and basion were used as references. The LPR and surrounding structures were measured and compared in the two different modalities. Results  In 83% of the cases, the LPR was deeper when the position was changed from supine to upright. Conclusions  Our results suggest that imaging of the LPR using CBCT with the subject in the upright position is superior to that using MDCT with the subject in the supine position.