兔慢性鼻窦炎模型建模方法的比较与优化改良

目的探讨改进慢性鼻窦炎动物模型的制备方法。方法将66只新西兰大白兔制成动物模型，随机分成空白对照组(6只)、假手术Ⅰ、Ⅱ组(各10只)、单纯细菌组(10只)、单纯窦口堵塞组(10只)、窦口堵塞 金黄色葡萄球菌组(10只)、窦口不完全堵塞 窦腔留置棉絮组(10只)，术后42d取上颌窦黏膜标本分别进行形态学观察及细菌学检查。结果各实验组建立慢性鼻窦炎模型成功率：窦口堵塞组为80％，窦口堵塞 金黄色葡萄球菌组为100％，窦口不完全堵寒 窦腔留置棉絮组为100％，单纯细菌组、空白对照组及假手术对照组均为0％。感染鼻窦均表现为中重度慢性炎症，培养的细菌以机会致病菌为主。采用窦口堵塞 金黄色葡萄球菌方法并发上颌窦积脓概率高。结论相对其他建模方法，窦口不完全堵塞 窦腔留置棉絮的建模方法是一种更理想的慢性鼻窦炎动物模型的制备方法。     

兔鼻源性急性鼻窦炎动物模型

目的：建立一种鼻源性急性鼻窦炎动物模型。方法：将32只新西兰大白兔随机分成A组：单纯膨胀海绵条阻塞鼻腔（10只）;B组：浸有金黄色葡萄球菌的膨胀海绵条阻塞鼻腔（10只）;C组：鼻腔滴注金黄色葡萄球菌菌液不阻塞鼻腔（6只）;D组：空白对照组（6只）。术后2周打开上颌窦,用内镜观察,并取出上颌窦、筛窦黏膜标本分别进行细菌学培养及组织病理学检查。结果：各实验组鼻窦炎模型成功率：A组60％,B组100％,C、D组均0。感染的鼻窦除上颌窦外还累及筛窦。结论：用浸有金黄色葡萄球菌的膨胀海绵条阻塞鼻腔能建立鼻窦炎动物模型,该方法简便易行、无创、成功率高,所引起的鼻窦炎是一种鼻源性鼻窦炎,接近人鼻窦炎的发病机制,更适合有关FESS的研究。     

家兔实验性上颌窦炎窦口和窦腔黏膜的不同处理对纤毛运动功能的影响

目的 :探讨家兔实验性上颌窦炎自然窦口和窦腔黏膜的不同处理对纤毛运动功能的影响。方法 :将已制成实验性上颌窦炎的 4 0只新西兰大白兔按术中黏膜处理不同以侧别分为 3组 :不处理黏膜组、部分切除黏膜组和全部切除黏膜组 ;按术中窦口处理不同分 2组 :窦口开放组和窦口扩大组。用活性碳粉末检测上颌窦黏液纤毛传输速度 (MCT) ,将测得的数据分别进行统计学处理。结果 :不处理黏膜组、部分切除黏膜组和完全切除黏膜组MCT检测结果分别为 4 .4 96± 1.0 2 1、3.892± 0 .92 5和 0 .80 9± 0 .14 7,3组间差异均有极显著性意义 (均P <0 .0 1) ;窦口扩大组 (4 .0 86± 1.0 4 2 )与窦口开放组 (3.995± 1.0 17)两组间差异无显著性意义 (P >0 .0 5 )。结论 :用活性碳检测上颌窦黏膜MCT是一种有效判断纤毛运动功能的方法 ;被切除的上颌窦黏膜术后虽会再生 ,但再生的黏膜纤毛运动功能较正常低下。窦口扩大术与窦口开放术对术后纤毛运动功能无明显影响     

上颌窦炎动物模型用窦口开窗及窦内壁低位开窗处理的比较

化脓性上颌窦炎的手术方法颇多,一度下鼻道开窗,柯-陆氏手术被列为常规术式,但因下道窗口封闭率高,上颌窦粘膜的粘纤清除方向均朝向自然窦口,上颌窦炎大多由于窦口鼻道复合体(ostiomeatal complex)狭窄,缩窄或堵塞所引起,因而近年来对经中鼻道开窗的兴趣愈来愈大,认为中道窗口术后通畅率可达90％,且符合粘纤传输功能的生理要求。为对比窦口开窗和低位开窗对上颌窦炎处理的价值,进行了动物造模后     

兔慢性上颌窦炎窦口鼻道复合体不同处理方式对窦黏膜纤毛形态与功能转归影响的观察

目的 观察功能性鼻内镜术后鼻窦黏膜纤毛形态与功能的转归状况,为术中及术后处理策略提供实验依据.方法 新西兰大白兔36只,建立慢性上颌窦炎模型.然后,按术中及术后处理方式的不同分成4组,即窦口开放组12只,窦口扩大组12只,手术对照组6只,空白对照组6只.术后12周处死动物,纤毛传输速率检测,并在相差显微镜下观测纤毛活性,获取标本进行细菌培养及窦腔黏膜纤毛形态学观察.结果 上颌窦分泌物细菌培养结果,窦口开放组阳性率100%(12/12),显著高于窦口扩大组的42%(5/12);窦口开放组纤毛传输速率平均2.2mm/min(0～6.2mm/min),窦口扩大组为5.2mm/min(2.1～10.1mm/min).结论 功能性鼻内镜术后,上颌窦腔黏膜纤毛活性和清除功能转归与黏膜组织结构基本同步.手术的关键应是解决窦口的持续通畅引流,有限度的窦口扩大术式明显优于单纯的窦口开放.     

实验性脆弱拟杆菌性上颌窦炎

研究在兔上颌窦建立了单一的脆弱拟杆菌厌氧感染的动物模型并观察其形态学和超微结构。21只新西兰白兔为实验组,堵塞其一侧上颌窦口,按Johanson等描述的方法将含脆弱拟杆菌NCTC9343的培养肉汤1ml(含菌量为10~6菌落)接种于封闭的上颌窦内。动物分别在接种5天后(n=2)、2周后(n=2)、3周后(n=9)和4周后(n=8)杀死。另选2只动物按同法接种同量脆弱拟杆菌,但不阻塞上颌窦口作为对照组。结果:实验组接种的全部窦肉眼下均显示严重和至少中等程度的炎症,粘膜水肿和窦     

鼻用糖皮质激素治疗兔急性细菌性上颌窦炎的细菌培养观察

目的探讨鼻用糖皮质激素喷雾剂布地奈德(budesonide)对兔急性细菌性上颌窦炎的细菌学的影响。方法健康成年新西兰白兔48只,采用鼻腔置入Merocel高分子膨胀海绵并注入肺炎链球菌的方法建立急性细菌性上颌窦炎模型,10 d后取出鼻腔膨胀海绵,随机分成抗生素治疗组(A组)、抗生素加鼻用激素治疗组(B组)、鼻用激素治疗组(C组)及对照组(D组),每组各12只。分别于治疗2周及4周后每组各处死6只动物,获取上颌窦腔分泌物作普通细菌培养。结果细菌培养结果显示治疗2周后,虽然A、B组上颌窦分泌物细菌培养阳性率低于C、D组,但组间差异无统计学意义(P>0.05)。治疗4周后,A、B组细菌培养阳性率明显低于C、D组,差异有统计学意义(P<0.05),A、B组间差异无统计学意义(P>0.05)。结论鼻用糖皮质激素合并抗生素治疗兔急性细菌性上颌窦炎时,未见影响抗生素的抗菌效果。     

鼻内镜手术中扩大上颌窦自然口的意义

目的：探讨鼻内镜手术中扩大上颌窦自然口对上颌窦炎转归的影响。方法：将慢性上颌窦炎218例随机均分为两组，A组的手术范围是切除钩突、筛泡，开放前、中、后组筛窦，扩大上颌窦自然开口，切除部分肥厚明显的中鼻甲；B组手术范围是切除钩突、筛泡，开放前、中组筛窦，不处理上颌窦自然开口，尽量保留中鼻甲,特别肥厚者也行部分切除。结果：218例均随访1年以上。按海口1997年疗效评定标准，A组治愈100例,治愈率92%，B组治愈99例,治愈率91%；A组好转9例,好转率8%，B组好转10例,好转率9%。结论：鼻内镜手术范围的关键是切除窦口鼻道复合体的解剖变异，是否扩大上颌窦口并不十分重要。     

上颌窦引流支架的临床应用

目的观察内镜鼻窦手术后安装上颌窦引流支架对防止术腔粘连和窦口闭塞的治疗作用。方法对30例（60侧）经鼻内镜鼻窦手术后患者进行同体同期对照观察，左侧为支架治疗组，右侧为空白对照组，定期随访4～6个月，然后取出支架，继续观察临床症状及上颌窦口和筛窦腔开放情况。结果随访观察6个月～2年，根据1997年海口标准评定疗效。治疗组治愈率90．0％。好转率10．0％，总有效率100％；对照组治愈率56．7％，好转率16．7％，总有效率73．3％。两组疗效相比P〈0．05，差异有显著性意义。结论内镜鼻窦手术后安装上颌窦引流支架4～6个月，能有效防止术腔粘连和窦口闭塞，提高治愈率。     

三维图像上颌窦口面积的测量

目的　探讨正常和窦口引流通畅的上颌窦炎症患者上颌窦口、筛漏斗外口面积 ,并比较二者的差异。方法　经过螺旋CT冠状位扫描或轴位扫描的原始数据被传输到SunUltra 10Aw 3 1工作站上 ,然后利用Navigator软件行仿真内镜成像 ,调节CT仿真内镜阈值 ,观察窦口 鼻道复合体(ostium meatuscomplex ,OMC)等解剖结构 ,测量像素面积。在相同物距、视角等条件下 ,测量某一线段在三维图像和二维图像上的像素比 ,计算出面积。对正常组数值与炎症组数值进行比较。结果　鼻甲、鼻道和窦口 鼻道复合体等结构在仿真内镜下能更好地被显示 ,正常组上颌窦口的面积为 (16 45± 1 2 1)mm2 ,炎症组上颌窦口面积为 (18 2 8± 2 12 )mm2 。正常组筛漏斗外口面积为 (15 0 7± 0 78)mm2 ,炎症组筛漏斗外口为 (17 19± 1 5 9)mm2 。结论　正常组与炎症组上颌窦自然口面积无显著性差异 ,而筛漏斗外口面积差异有显著性 ,提示筛漏斗外口的增大可能是窦口非阻塞性上颌窦炎的诱发因素     

家兔实验性上颌窦炎黏膜病理及超微结构变化

目的：探讨家兔实验性上颌窦炎黏膜随病程的迁延而出现的常规和超微病理变化,并根据病理变化初步估计急,慢性上颌窦炎的时间分界。方法：将制成上颌窦炎模型的30只新西兰大白兔按制模时间的长短分成不同组别,分别观察不同时间上颁窦黏膜的病理和超微结构变化。结果：制模3周内以急性炎症表现为主,3周后以慢性炎症表现为主。随病程迁延上皮层纤毛脱落增加、杯状细胞增生、鳞状上皮组织转化、上皮坏死,固有层腺体组织转化、减少、纤维化。结论：上颌窦炎黏膜的病理变化随病程延长而加重,急、慢性上颌窦炎以制模后3周为界。     

Experimental model of fungal sinusitis: a pilot study in rabbits

We have established an experimental model of fungal sinusitis in rabbits to analyze the chronology and the pathogenesis of the development of noninvasive fungal sinusitis due to Aspergillus fumigatus. Thirty-four Pasteurella-free New Zealand white rabbits divided into three groups were included in this study. In the first group (10 rabbits), A fumigatus was inoculated into the maxillary sinus. In the second group (10 rabbits), A fumigatus was inoculated into the maxillary sinus in the presence of a wound in the mucosa. In the third group (14 rabbits), A fumigatus was inoculated into the maxillary sinus in the presence of a blocked ostium. On days 15 and 30, endoscopic, histopathologic, bacterial, and mycological examinations of both maxillary cavities and mucous membrane were performed. The rabbits were painlessly sacrificed 30 days after inoculation; mucosal and bone biopsies of the maxillary sinus cavities were performed for histopathologic studies. We found that noninvasive fungal sinusitis had been induced in 2 rabbits of the second group and 8 rabbits of the third group. We conclude that introduction of fungi into a sinus with a blocked ostium induces fungal sinusitis. The present model of experimental fungal sinusitis seems to be reproducible and suitable for further studies of the development of fungal sinusitis.     

Effects of beta-toxin of Staphylococcus aureus on ciliary activity of nasal epithelial cells

OBJECTIVES: To investigate the in vitro effects of staphylococcal beta-toxin on ciliary activity and the in vivo effects on sinusitis induction. STUDY DESIGN: The in vitro effects of staphylococcal beta-toxin on ciliary activity were investigated at different concentrations and exposure times. Experimental sinusitis was induced in rabbits with application of beta-toxin and confirmed 7 days later. METHODS: Ciliated epithelial cells were taken from the maxillary sinus mucosa of 10 rabbits. Five culture dishes from each rabbit were used for the experimental group, and one culture dish from each rabbit was used for the control group. In the experimental group, ciliary beat frequency (CBF) was measured at concentrations of 0.1, 1, 2, 5 and 10 U/mL of beta-toxin using a video-computerized analysis technique, while in the control group, culture medium containing no toxin was used. CBF was measured 1, 2, 4, 6, 8, 12, 24, and 48 hours after administration of beta-toxin. To induce experimental sinusitis, 2 U/mL of beta-toxin was percutaneously applied to the maxillary sinus of 10 rabbits without occlusion of the natural ostium, while normal saline was percutaneously applied to the right-side maxillary sinus of 4 rabbits in the control group. At 7 days, mucosal membranes were taken from the inferomedial wall of the maxillary sinus for light microscopic study. RESULTS: CBF dropped significantly after an 8-hour incubation at 2, 5, and 10 U/mL of beta-toxin. No ciliary activity was observed after a 24-hour incubation at 2 and 5 U/mL and a 12-hour incubation at 10 U/mL of beta-toxin. Mucoid, purulent discharge was observed in the maxillary sinuses of the beta-toxin-applied group. Prominent epithelial disruption and infiltration of inflammatory cells into the epithelium and lamina propria were observed in the beta-toxin-applied group. CONCLUSIONS: Staphylococcal beta-toxin may reduce ciliary activity and induce sinusitis without occlusion of the natural ostium of the maxillary sinus in rabbits This study provides another animal model of sinusitis for understanding the pathogenesis of sinusitis induced by bacterial exotoxins.     

Xylitol enhances bacterial killing in the rabbit maxillary sinus

OBJECTIVES: Factors that alter airway surface liquid (ASL) ionic concentrations may influence the course of sinusitis. Xylitol has been shown to effect ASL ionic composition in vitro and to reduce nasal bacterial carriage, otitis media, and dental caries in vivo. We examined the effect of xylitol on experimental sinusitis in the rabbit model. STUDY DESIGN: Prospective randomized controlled study of xylitol, saline, and Pseudomonas aeruginosa administration to the rabbit maxillary sinus. METHODS: P. aeruginosa was administered to the sinuses of 26 New Zealand white rabbits. Saline was placed in the left maxillary sinus and xylitol in the right. The rabbits were randomly assigned to one of three groups: one, simultaneous administration of bacteria and solutions with bacterial analysis at 20 minutes, 11 rabbits; two, preadministration of solutions 1 hour before bacterial infection with analysis at 20 minutes, 11 rabbits; three, established sinusitis, 4 rabbits had daily injections of solutions for 5 days starting 7 days after P. aeruginosa administration. RESULTS: In group 1, 6.96% of injected bacteria were retrieved on the left (saline), whereas 0.095% were retrieved on the right (xylitol) (P = .034). In group 2, 5.64% of inoculum was recovered from the left and 2.89% from the right (P = .188). Group 3 demonstrated evidence of sinusitis with recovery of noninoculate bacteria. with no difference between right and left. CONCLUSIONS: Xylitol reduces experimental sinusitis when administered simultaneously with bacteria. Its effect in established sinusitis is less clear. A role may exist for xylitol in nasal irrigation fluid in human disease.     

实验性急性鼻窦炎上颌窦黏膜超微结构观察

目的:观察家兔急性鼻窦炎上颌窦黏膜超微结构的动态改变。方法:25只家兔随机分为实验组(20只)和空白对照组(5只),先建立急性鼻窦炎鼻源性模型。建模后第1、2、3、4周每周随机选取实验组家兔5只处死,解剖并从右上颌窦腔取0.3 cm×0.3 cm大小新鲜黏膜组织用透射电镜观察其超微结构。对照组在第1周开始实验。结果:透射电镜观察,对照组家兔上颌窦黏膜纤毛排列整齐,无丢失,上皮细胞内线粒体无肿胀,内质网未见扩张;实验组家兔上颌窦黏膜纤毛变性,排列紊乱,部分纤毛丢失,出现复合纤毛、胞质突起、内质扩张、线粒体肿胀及黏膜下淋巴细胞浸润伴成纤维细胞增生等病理改变,与对照组比较,差异有统计学意义(P<0.05)。实验组家兔第1～4周,复合纤毛数量逐渐增多,第3、4周与第1周比较,差异均有统计学意义(均P<0.05)。内质网扩张和线粒体肿胀程度在第2周最明显,第4周后逐渐减轻,第2周与第4周比较差异有统计学意义(P<0.05)。结论:窦口阻塞及细菌感染导致上颌窦黏膜超微结构改变,是急性鼻窦炎病理演变过程的一个重要环节。     

The effect of high single dose parenteral vitamin A in addition to antibiotic therapy on healing of maxillary sinusitis in experimental acute sinusitis

OBJECTIVE: The aim of this study is to investigate the therapeutic role of vitamin A in addition to standard antibiotic treatment on healing of experimental acute maxillary sinusitis. MATERIAL AND METHODS: Experimental maxillary sinusitis in rabbits was induced by blocking the left noses and direct inoculation of Staphylococcus aureus into the left maxillary sinuse cavities. Right maxillary sinuses were exposed to serum physiologic as the control group. Animals were divided into two groups. Forty-eight hours after the inoculation, Group A received only parenteral ampicilline-sulbactam (50 mg/kg), Group B were treated with same antibiotic regimen and parenteral a dose of 100.000 IU vitamin A in palmitate form. Animals were killed at 10th day and mucosas of each sinuses were examined histopathologically. Inflammation and sinus epithelium integrity were assessed. Groups were compared with using Mann-Whitney U test. RESULTS: All of the infected sinuses displayed various degrees of inflammation but there was no statistically significant difference between the study and control groups. Although epithelium integrity was slightly better in Group B but the difference was not meaningful. CONCLUSION: The adjuctive therapeutic role of vitamin A in acute sinusitis was found doubtful but this topic is worth to investigate more comprehensively.