鼻内窥镜鼻窦手术临床经验总结

<正>自1996年以来行鼻内窥镜鼻窦手术150例对其中120例进行了临床随访,疗效满意,总结如下。临床资料一、一般资料120例中,男78例,女42例;年龄15~56岁。术前常规作鼻窦CT扫描和鼻内窥镜检查。按FESS-95广州标准进行临床分型。其中I型1期10例,2期22例,3期9例;Ⅱ型1期20例,2期41例,3期8例;Ⅲ型10例。二、手术方法手术均采用自前向后法即Messerklinger式。根     

鼻内窥镜鼻窦手术186例临床疗效观察

为进一步评估鼻内窥镜鼻窦手术的临床疗效 ,现将我院耳鼻喉科 1998年 2月至 2 0 0 1年 1月 ,采用鼻内窥镜鼻窦手术 186例临床资料作一回顾性总结分析。报告如下。1　临床资料1 1　一般资料 :慢性鼻窦炎患者 186例 (2 90侧 ) ,男12 0例 ,女 6 6例 ,年龄 14～ 6 2岁 ,平均 32岁。病程 6个月至 30年 ,平均 1 8年。主要临床症状为鼻阻、流脓涕、头痛。术前常规鼻窦CT扫描 ,结合鼻镜检查 ,按照海口 (1997年 )会议标准进行分型分期 :Ⅰ型 1期12例 (14侧 ) ,2期 2 6例 (38侧 ) ,3期 2 3例 (30侧 ) ;Ⅱ型 1期 18例 (2 4侧 ) ,2期 36例 (5 4侧 ) ,3…     

鼻内窥镜鼻窦手术治疗鼻窦霉菌病

目的 :探讨鼻内窥镜鼻窦手术治疗鼻窦霉菌病的疗效。方法 :回顾性分析 30例鼻窦霉菌病的临床资料及随访结果。结果 :2 9例为非侵袭型鼻窦霉菌病 ,采用鼻内窥镜鼻窦手术均治愈。另 1例为侵袭型鼻窦霉菌病 ,鼻内窥镜鼻窦术后 2月复发 ,采用鼻侧切开术治愈。结论 :鼻内窥镜鼻窦手术治疗非侵袭型鼻窦霉菌病 ,疗效肯定 ,患者痛苦小 ,术后不易复发     

鼻内窥镜手术治疗鼻窦炎疗效观察

目的 :观察鼻内窥镜手术治疗鼻窦炎的效果 ,研究提高鼻内窥镜鼻窦手术的疗效。方法 :对鼻窦炎患者进行鼻内窥镜手术及随访观察。结果 :参照FESS - 97海口标准 ,治愈 5 3例 (5 3.9% ) ,好转 30例(2 8 9% ) ,无效 2 1例 (2 0 2 % )。结论 :术前仔细研究鼻窦CT片 ,术后加强术腔清洁处理 ,是防止手术并发症和提高疗效的关键     

鼻内窥镜手术的护理体会

鼻内窥镜手术是目前治疗鼻、鼻窦及鼻颅底、鼻眼相关疾病的先进手术方法。其优点是微创、副损伤少 ,利于生理功能恢复。我科自 1999年 2月～ 2 0 0 1年 12月间 ,开展鼻内窥镜手术治疗慢性鼻窦炎、鼻息肉等疾病 ,取得良好效果 ,现将临床护理体会总结如下 :1　临床资料本组病例 10 4例 ,其中男 5 9例 ,女 45例 ,年龄最小 10岁 ,最大 73岁 ,病程最短半年 ,最长 14年。根据术前鼻内窥镜检查、鼻窦冠状位ＣＴ扫描结果 ,并按照 1997年海口会议标准[1]诊断为慢性鼻窦炎、鼻息肉Ⅰ型 13例 (含 1期 3例 ,2期 10例 ) ;Ⅱ型 85例 (含 1期 2 3例 ,2期 45…     

鼻内窥镜鼻窦手术326例报告

目的 :探讨鼻内窥镜鼻窦手术治疗鼻息肉和慢性鼻窦炎的疗效及影响手术疗效的相关因素。方法 :32 6例鼻内窥镜鼻窦手术进行临床分析。结果 :Ⅰ型治愈率为 95 .5 % ,Ⅱ型治愈率为84 .9% ,Ⅲ型治愈率为 62 .5 %。三型之间治愈率差异有显著 (P <0 .0 1)。结论 :鼻内窥镜鼻窦手术是治疗鼻息肉和慢性鼻窦炎的有效方法 ,手术疗效与其临床分型密切相关。     

功能性内窥镜鼻窦手术40例报告

近年来 ,随着功能性内窥镜鼻窦手术 ( FESS)在国内各大中城市普遍开展 ,其优越性已得到肯定 ,但各家报道的疗效不一。1 997年 5月至 1 998年 9月我科开展此项手术 40例 ,随访半年 ,疗效较好。为对功能性内窥镜鼻窦手术进行全面评价 ,分析影响疗效的相关因素 ,现报告如下。1　临床资料1 .1　一般资料 :慢性鼻窦炎患者 40例 ,男 2 1例 ,女1 9例 ;年龄 1 5～ 48岁。术前均经鼻窦 CT证实 ,按慢性鼻窦炎鼻息肉临床分型分期 (1) , 型 2期 2例 , 型 2期 2 9例 , 型 3期 6例 , 型 3例。1 .2　方法 :用杭州市桐庐医疗光学仪器总厂的生产的鼻内窥镜…     

鼻内窥镜鼻窦手术288例分析

对 2 8 8例鼻内窥镜鼻窦手术进行临床分析 ,术后随访 6个月～ 1年。结果 ,Ⅰ型治愈率为 92 .8% ,Ⅱ型治愈率为 71.1% ,Ⅲ型治愈率为 5 5 .0 %。 3型之间治愈率差异有显著性 (P <0 .0 1)。认为鼻内窥镜手术是治疗慢性鼻窦炎和鼻息肉的有效方法 ,手术疗效与临床分型、麻醉选择、手术操作熟练程度与术后局部处理密切相关     

鼻内窥镜行鼻窦手术240例临床分析

目的：探讨鼻内窥镜行鼻窦手术治疗慢性鼻窦炎和鼻息肉的疗效及影响手术疗效的相关因素。方法：对1998／2001年完成随访的240例行内窥镜鼻窦手术进行临床分析，240例中I型81例（33．7％），Ⅱ型120例（50．1％），Ⅲ型39例（16．2％），术后随访6－8mo,平均12mo.结果：I型治愈率为90．1％，Ⅱ型治愈率为80．8％，Ⅲ型治愈率为66．7％，三型之间治愈率差异有显性（P＜0．01），手术并发症发生率为3．3％。结论：鼻内窥镜行鼻窦手术是治疗慢性鼻窦炎和鼻息肉的有效方法，手术疗效与其临床分型密切相关，规范的手术操作与细致的术后处理是保证疗效的重要因素。     

鼻内镜下手术治疗慢性鼻窦炎、鼻息肉67例

目的:探讨鼻内镜手术治疗慢性鼻窦炎、鼻息肉的疗效及相关影响因素。方法:对实施内窥镜鼻窦手术并完成术后随访6个月以上的67例患者进行病例资料分析。其中I型1期8例,II型1期6例、2期35例、3期12例,III型6例。结果:治愈率I型100%I、I型81.1%I、II型50.0%。结论:鼻内镜手术治疗慢性鼻窦炎、鼻息肉切实有效,疗效与临床分型密切相关,规范的术后处理是提高治愈率的关键。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.