中耳腔药液灌洗治疗顽固性分泌性中耳炎

我科从1998年3月～2000年10月对52例56耳顽固性分泌性中耳炎采用鼓室穿刺给药冲洗并保留药液的方法治疗,取得良好的效果.     

溴己新辅助地塞米松治疗分泌性中耳炎患者的疗效观察

目的:研究溴己新辅助地塞米松治疗分泌性中耳炎患者的临床疗效.方法:选取2019年1月至2020年3月我院95例分泌性中耳炎(Secretory otitis media,SOM)患者,随机分两组,除常规治疗外,对照组(47例)予以地塞米松治疗,研究组(48例)予以溴己新辅助地塞米松治疗,比较两组疗效、6个月内复发率,治疗前、治疗1周后听力水平与鼓室压,血清炎性因子[白介素-8(Interleukin-8,IL-8)与白介素-1β(Interleukin-1β,IL-1β)]与转化生长因子[转化生长因子-β1(Transforming growth factor-β1,TGF-β1)与转化生长因子-β2(Transforming growth factor-β2,TGF-β2)]水平.结果:治疗1周后,研究组总有效率91.67％高于对照组74.47％(P<0.05);治疗1周后研究组0.5 kHz、1.0 kHz、2.0kHz频率下听力水平与鼓室压均高于对照组(P<0.05);治疗1周后研究组血清IL-8、IL-1β与TGF-β1、TGF-β2水平均低于对照组(P<0.05);研究组6个月内复发率4.65％低于对照组23.53％(P<0.05).结论:溴己新辅助地塞米松治疗SOM患者,可降低血清炎性因子与转化生长因子,明显改善患者听力水平,降低复发率,提高整体治疗效果.     

鼻内窥镜下咽鼓管吹张注药对慢性分泌性中耳炎的疗效观察

目的:评价鼻内窥镜下咽鼓管吹张注药对慢性分泌性中耳炎(OMSC)的治疗效果。方法:将84例(124耳)OMSC患者随机分为二组。A组采用鼻内镜下咽鼓管吹张注药术;B组给予鼓膜穿刺抽液、鼓膜切开排液或鼓膜置管术;对随访半年的临床疗效及不良反应进行比较。结果:A组治愈36耳(58.1%),好转18耳(29.0%),无效8耳(12.9%);B组治愈20耳(32.3%),好转20耳(32.3%),无效22耳(35.4%)。并发症发生率A组为9.7%(6/62),表现为耳闷胀感或短暂眩晕,B组为32.3%(20/62),表现为中耳感染或鼓膜穿孔或耳漏。二组临床疗效及并发症发生率差异均有显著性统计学意义(P<0.05)。结论:鼻内窥镜下咽鼓管扩张注药法治疗OMSC安全、效果好,不良反应少。     

中医辨证疗法治疗对慢性分泌性中耳炎患者临床疗效、炎性因子及免疫指标的影响分析

目的 分析中医辨证疗法治疗对慢性分泌性中耳炎患者临床疗效、炎性因子及免疫指标的影响.方法 选取2019年1月至2020年6月本院收治的74例慢性分泌性中耳炎患者,根据纳入排除标准最终纳入69例作为研究对象.根据治疗方案的差异分为研究组(n=36)和对照组(n=33),对照组患者予以西医治疗,研究组患者予以中医辨证疗法治...     

鼓膜置管术治疗儿童分泌性中耳炎的疗效及术后复发的影响因素分析

目的 探究鼓膜置管术治疗儿童分泌性中耳炎（OME）的疗效并分析患儿术后复发的影响因素。方法 选取2017年7月至2019年6月山西省儿童医院收治的130例OME患儿作为研究对象,随机分为两组,对照组（65例）采取保守治疗,观察组（65例）采取鼓膜置管术治疗,比较保守治疗和鼓膜置管术治疗的临床疗效和术后并发症、各频率骨导听阈等情况;对鼓膜置管术治疗患儿随访1年,根据术后是否复发分为复发组（18例）和未复发组（47例）,比较复发组和未复发组患儿的一般资料;多因素Logistic回归分析影响OME患儿术后复发的因素;构建预测术后复发的列线图预测模型,并评价其预测效能。结果 鼓膜置管术治疗的总有效率明显高于保守治疗,术后并发症发生率明显低于保守治疗,治疗后患儿骨导听阈和临床疗效也明显优于对照组患儿。小龄、通气管保留时间短、反复呼吸道感染、乳突气化不良、过敏性鼻炎均是导致鼓膜置管术治疗OME患儿术后复发的危险因素。构建的列线图预测模型区分度较好,校准度较高。结论 鼓膜置管术治疗儿童OME具有总有效率高、术后并发症少、临床疗效好、见效快等优势,构建OME患儿术后复发的风险预测模型为临床上提高患儿生...     

脾氨肽口服冻干粉治疗小儿反复呼吸道感染的疗效及对免疫功能影响的观察

目的 探讨脾氨肽口服冻干粉治疗和预防小儿反复呼吸道感染(RRI)的临床效果.方法 将216例RRI惠儿随机分为对照组104例.治疗组112例.二组患儿在性别、年龄、临床表现无显著性差异.二组患儿在急性期均予抗感染、化痰、止咳、解痉、平喘及对症支持治疗等常规治疗.治疗组在常规治疗的基础上予以脾氨肽口服冻干粉治疗2个月,观察治疗后效果及治疗前后分别测定患儿T细胞亚群、免疫球蛋白等指标并观察其变化情况.结果 两组总有效率分别为51.9%和96.4%,有显著性差异(P<0.01),观察组的疗效优于时照组.观察组免疫学指标CD3、CD4、CD4/CD8、IgG及IgA均明显升高(P<0.01或P<0.05),CD8及IgM治疗前后无显著性差异(P>0.05).结论 脾氨肽口服冻干粉对治疗和预防小儿RRI有较好疗效.     

复可托治疗小儿反复肺炎支原体感染的疗效及对 免疫功能和肺功能的影响

目的 探讨复可托治疗小儿反复肺炎支原体感染的疗效及对免疫功能和肺功能的影响。方法 选取我院2015年1月~2017年1月收治的88例反复MP感染患儿为研究对象,采用随机数字表法分为两组,各44例。对照组患儿给予常规治疗,观察组在对照组基础上口服复可托,对比两组患儿临床疗效、免疫指标、肺功能指标。结果 观察组总有效率为97.73%,高于对照组的81.82%,差异有统计学意义（P＜0.05）。观察组患儿IgA、IgM、IgG、CD4+、CD8+、CD4+/CD8+等免疫指标优于对照组,差异有统计学意义（P＜0.05）。观察组患儿肺功能指标FVC、FEV1、PEF、FEF25、FEF50、FEF75均优于对照组,差异具有统计学意义（P＜0.05）。结论 复可托治疗小儿反复MP感染临床疗效显著,可有效改善免疫功能和肺功能。     

高压氧治疗对高血压性脑出血患者血清神经元特异性烯醇化酶、转化生长因子β1、血管内皮功能及免疫功能的影响

目的 探讨高压氧治疗高血压性脑出血对患者血清神经元特异性烯醇化酶(NSE)、转化生长因子β1(transforming growth factor,TGF-β1)、血管内皮功能及免疫功能的影响.方法 85例高血压性脑出血患者依据随机数据表法分为对照组(42例)和观察组(43例),对照组患者给予术后常规对症治疗,观察组患者在对照组的基础上给予高压氧治疗.比较治疗前后两组血清NSE、TGF-β1、血管内皮功能及免疫功能水平.结果 治疗前,两组的血清NSE、TGF-β1、一氧化氮(NO)、内皮素(ET)-1、CD3+、CD4+、CD8+、CD4+/CD8+水平比较,差异无统计学意义(P＞0.05).治疗后,两组TGF-β1、NO、CD4+、CD4 +/CD8+水平较组内治疗前均显著升高(P＜0.05),且观察组显著高于治疗后对照组,差异有统计学意义(P＜0.05);两组NSE、ET-1、CD8+水平均显著低于治疗前(P＜0.05),且观察组显著低于对照组,差异有统计学意义(P＜0.05);对照组治疗前后CD3+水平比较,差异无统计学意义(P＞0.05),观察组治疗后水平显著高于治疗前,且显著高于对照组,差异有统计学意义(P＜0.05).结论 高压氧治疗高血压性脑出血,可有效降低血清NSE水平,升高TGF-β1水平,改善患者血管内皮功能及免疫功能,具有重要临床价值.     

Nasopharyngeal secretory immunoglobulins in children with recurrent acute otitis media and secretory otitis media

Secretory IgA (SIgA) and secretory IgM (SIgM), total IgA and total IgM were measured in plasma and nasopharyngeal secretions (NPS) from young children with different degrees of otitis proneness. Significantly higher levels of plasma IgM and lower levels of NPS-SIgM were found in children with recurrent episodes of acute otitis media (rAOM) compared with children suffering from secretory otitis media (SOM) and healthy controls. Both plasma IgA and NPS-SIgA were evenly distributed in the three groups of children investigated, and in most children the levels of NPS-SIgA exceeded plasma IgA levels. Plasma SIgA was significantly increased in children with rAOM and SOM, probably resulting from frequent occurrence of inflammatory events at the nasopharyngeal level. No correlation could be demonstrated between NPS-SIgA and plasma IgA, or between NPS-SIgM and plasma IgM. Also, for both NPS-SIgA and NPS-SIgM, there was no correlation with age. A negative correlation was observed between the transudation index of albumin to the nasopharynx and the ratio of NPS-SIgA to total NPS-IgA. A ratio of 1 (100%) corresponded to a transudation index of 8%. The ratios of NPS-SIgA to total NPS-IgA varied considerably and a range of 39%-88% could only to some extent be explained by transudation of plasma IgA to NPS. The results of the present study show that the children with rAOM and SOM are well furnished with locally produced SIgA antibodies at the nasopharyngeal level. In children with SOM, the nasopharyngeal hypofunction in the case of low NPS-SIgM seems to be less pronounced compared with that of otitis-prone children.     

Changes of intratympanic pressure in secretory otitis media

A thick, gluey effusion was observed to out of the middle ear after myringotomy only in some cases of secretory otitis media. Cytologic analysis of intratympanic transudate in 321 cases of secretory otitis media in children showed the cellular infiltration to result in increased viscosity of the middle ear content. It caused gradual change in the middle ear pressure, from the initially negative to positive pressure in the advanced stages of the disease.     

Cytological and bacteriological aspects of secretory otitis media

Bacteriological and cytological examinations were performed on 105 middle ear secretions from 66 children with middle ear effusion (MEE) of more than 3 months' duration. The secretions were searched for granulocytes and the activity of these cells was judged by their capacity for random locomotion and their ability to reduce nitroblue tetrazolium. The functional characteristics of the granulocytes were compared with the bacteriological findings on cultures from MEE. Bacteria commonly regarded as pathogens in middle ear infections (Hemophilus influenzae, Branhamella catarrhalis or Streptococcus pneumoniae) were found in 25% of the secretions. Granulocytes with activity or lacking activity, virtually dead, were found in all secretions where these bacteria were isolated. In secretions where bacteria commonly regarded as commensals, mainly staphylococci, were isolated, about two thirds of the secretions showed phagocytes with or without activity. No relation between bacterial growth and the functional state of the granulocytes was observed. In contrast, no phagocytes were found in over 60% of MEE lacking bacterial growth. These findings suggest a role for bacteria in the development and maintenance of secretory otitis media.     

儿童腺样体切除与分泌性中耳炎术后的复发

目的 探讨儿童腺样体切除与分泌性中耳炎术后的复发情况.方法 回顾性分析本院耳鼻咽喉-头颈外科自2006年1月至2006年8月收治的100例分泌性中耳炎患儿.所有患儿都行了鼓膜切开置通气管,其中伴腺样体切除者74例,未行腺样体切除者26例,术后均随访3个月.结果 腺样体切除者74例合并分泌性中耳炎有148耳,术后3个月内脱管和复发有27耳(18.24%).腺样体未切除26例合并分泌性中耳炎26耳,术后3个月内脱管和复发17耳(65.38%).腺样体未切除复发的17耳有8耳(8例患儿)接受2次手术,且腺样体均全部切除,术后随访3个月无1耳复发.结论 切除腺样体可有效控制分泌性中耳炎患儿术后复发.     

儿童腺样体切除与分泌性中耳炎术后的复发

目的 探讨儿童腺样体切除与分泌性中耳炎术后的复发情况.方法 回顾性分析本院耳鼻咽喉-头颈外科自2006年1月至2006年8月收治的100例分泌性中耳炎患儿.所有患儿都行了鼓膜切开置通气管,其中伴腺样体切除者74例,未行腺样体切除者26例,术后均随访3个月.结果 腺样体切除者74例合并分泌性中耳炎有148耳,术后3个月内脱管和复发有27耳(18.24%).腺样体未切除26例合并分泌性中耳炎26耳,术后3个月内脱管和复发17耳(65.38%).腺样体未切除复发的17耳有8耳(8例患儿)接受2次手术,且腺样体均全部切除,术后随访3个月无1耳复发.结论 切除腺样体可有效控制分泌性中耳炎患儿术后复发.     

三维步态分析系统在儿童运动功能评价中的运用

背景：三维步态分析系统是一组通过网络将运动分析系统,动态体表肌电图和压力板连接起来的系统。 目的：利用三维步态分析提供的实时力学等数据,对步态进行运动学和动力学方法定量评定,为异常运动儿童患者提供相关客观依据。 方法：应用计算机检索1991-01/2010-02PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed),检索词为“Three-dimensional gait analysis,children”。检索文献量总计136篇,选择三维步态分析系统在儿童运动功能评价中科研及其临床应用方面的文献,排除陈旧及重复实验文章,同一领域文献则选择近期发表或发表在权威杂志的文章,最终纳入28篇符合标准的文献。 结果与结论：三维步态分析系统的可靠性优于视觉步态分析。可诊断并分析异常运动,作治疗前评价,治疗后的效果评价和预后评价。在国外科研和成人运动功能评估中运用广泛,但在儿童运动功能评价中的运用还不是很成熟。     

The role of nasal allergy in chronic secretory otitis media.

BACKGROUND: Chronic secretory otitis media (SOM) has multifactorial causes, and nasal allergy is suspected as one of these causative factors. OBJECTIVES: To investigate the possible role of nasal allergy in SOM in adults and to determine the diagnostic value of nasal challenges with allergens (nasal provocation tests) combined with tympanometry for the diagnosis of this disorder. METHODS: In 69 young adults with chronic or recurrent SOM, 173 nasal challenges with allergens were performed by anterior rhinomanometry combined with tympanometry (pure-tone air conduction tympanometry). In 42 control subjects with only allergic rhinitis and no history of middle ear disease, 42 nasal challenges with allergens were repeated and combined with tympanometry. The study design was a placebo-controlled comparison. RESULTS: Of the 69 patients, 54 developed 129 positive nasal responses of various types (P < .01), 117 of which were accompanied by significant changes in middle ear pressure (P < .01). No significant tympanometric changes (P > .10) were recorded during the 42 positive nasal responses in control subjects. CONCLUSIONS: These results may confirm the occurrence of chronic SOM in some adult patients and the possible involvement of nasal allergy in chronic SOM. The nasal challenges with allergen performed by rhinomanometry, combined with tympanometry, seem to be a valuable supplementary tool for the diagnosis of this disorder.     

儿童骨折治疗应用的可吸收内固定生物材料

背景：可吸收材料作为一种新型的内固定材料,具有无需二次手术取出的特点,近年来得到广泛的使用,并取得较好的疗效。 目的：对可吸收内固定材料与儿童骨折研究的文献进行多层次分析,探讨在儿童骨折中的应用及疗效。 方法：以电子检索方式对CNKI数据库学术期刊2002年1月至2011年12月收录有关可吸收内固定材料与儿童骨折研究的文献进行分析,采用检索词为“可吸收内固定材料;骨折;儿童”。分析可吸收内固定产品类型和规格,不同产品的适用症,将产品的强度和弯曲弹性率进行分析,比较可吸收内固定螺钉、固定棒和张力带在儿童骨折中的应用。 结果与结论：CNKI数据库学术期刊2002至2011年收录可吸收内固定材料与儿童骨折研究的文献共60篇。目前临床应用的可吸收内固定材料为聚乳酸以及该类聚合物,生产的厂家主要有芬兰百优、日本他喜龙、日本刚子和成都迪康。从材料的强度和弯曲弹性率来看,可吸收内固定材料优于不锈钢和钛材料,与人的皮质骨较接近,可吸收内固定螺钉、固定棒和张力带在儿童不同部位骨折中的应用均取得较好的疗效,并发症少,值得推广。     

Effects of misoprostol on uterine contractility following different routes of administration

BACKGROUND: The effect of misoprostol administered by different routes on pregnant uterine contractility was investigated. METHODS: Thirty-two women with a pregnancy between 8 and 11 weeks of gestation requesting termination of pregnancy were recruited. Misoprostol was administered either orally (0.4 mg), vaginally (0.4 mg) or sublingually (0.2 or 0.4 mg) according to consecutive allocation. Intrauterine pressure was recorded using a Grass polygraph connected to a pressure transducer 30 min before misoprostol was given and for 4 h thereafter. At the end of the recording, suction curettage was performed. RESULTS: The first effect observed was an increase in uterine tonus, which occurred after a significantly shorter time following oral (7.8 min) and sublingual (10.7-11.5 min) than after vaginal (19.4 min) treatment. The time to maximum tonus elevation was also significantly shorter (39.5, 47.1-51.7 and 62.2 min for the three groups respectively). Regular uterine contractions developed in all subjects following sublingual and vaginal administration but not after oral administration. The increase in uterine activity measured in Montevideo Units was significantly higher after 2 h and thereafter for sublingual and vaginal treatment than for oral misoprostol. CONCLUSIONS: Based on recording of uterine activity, sublingual misoprostol acts as rapidly as oral treatment, while development of contractions was similar to that seen following vaginal administration.