脸形冷袋的研制与临床应用

目的为了减轻上颌窦根治术后病人出血、肿胀、疼痛程度及缩短其持续时间.方法选用合理材料制作成脸形冷袋.随机将128例上颌窦根治术后病人分为观察组和对照组各64例,观察组于术后连续3 d应用脸形冷袋外敷,对照组术后连续3d外敷盐袋.结果与对照组比较,观察组渗血时间明显缩短,面部肿胀、疼痛明显减轻(均P＜0.01.结论上颌窦根治术后病人应用脸形冷袋,能有效减轻局部症状,减轻病人经济负担.     

上颌窦囊肿鼻内镜下的手术分析

目的探讨鼻内镜下行上颌窦囊肿摘除术的疗效。方法将104例上颌窦囊肿患者随机分为治疗组56例和对照组48例。治疗组在鼻内镜下进行手术,对照组行传统柯-陆氏上颌窦囊肿摘除术。观察比较2组手术时间、手术出血量、术后住院时间、住院期间费用及术后不良反应发生情况。结果治疗组的手术时间、手术出血量、术后住院时间、住院期间费用均较对照组显著减少(P<0.05)。治疗组的面部肿胀、疼痛、麻木,牙齿酸胀,切口感染等发生率显著低于对照组(P<0.05)。结论上颌窦囊肿经鼻内镜摘除手术效果良好,应作为首选术式。     

早期持续冰敷对上颌截骨正颌术后患者的影响

目的 探讨基于温度控制的持续冰敷对上颌Le FortⅠ型截骨正颌手术后患者早期上颌肿胀、出血、疼痛、舒适度及非冻结性损伤发生率的影响。 方法 将63例上颌Le FortⅠ型截骨正颌手术患者随机分为观察组（33例）和对照组（30例）,术后6 h内分别进行基于温度控制的持续冰敷（观察组）和间断冰敷（对照组）。 结果 观察组冰敷前后肿胀进展程度显著小于对照组,冰敷期间的舒适度得分显著高于对照组（均P＜0.05）;两组冰敷期间使用止血药量、镇痛药量和非冻结性损伤发生率差异无统计学意义（均P＞0.05）。 结论 基于温度控制的持续冰敷能有效缓解上颌Le FortⅠ型截骨正颌手术后患者早期上颌肿胀,增加患者舒适度,不会导致患者皮肤损伤。     

10%盐水冰袋联合弹力绷带持续加压冷敷用于全膝关节置换术后关节肿痛

目的 探讨安全经济有效的减轻全膝关节置换术后关节肿胀及疼痛的方法.方法 将60例膝关节骨性关节炎实施全膝关节置换术患者按住院号单双数分为观察组和对照组各30例.术后对照组采用绷带包扎,10％盐水冰袋冷敷;观察组用弹力绷带包裹患肢后用10％盐水冰袋冷敷,再用弹力绷带加压包扎,均持续3d.结果 观察组下肢肿胀、疼痛程度显著轻于对照组,肿胀及疼痛消退时间显著短于对照组(均P＜0.01).结论 10％盐水冰袋联合弹力绷带持续加压冷敷可有效减轻全膝关节置换术后膝关节肿胀和疼痛,加快肿胀、疼痛消退.     

腹部手术病人实施舒适护理探讨

将135例腹部手术病人随机分为观察组(68例)和对照组(67例),对照组按常规护理,观察组实施舒适护理.观察两组病人术后消化道反应、肠功能恢复以及术后疼痛等情况.结果观察组上述指标均显著优于对照组(P＜0.05、P＜0.01).提示舒适护理能缩短腹部手术病人胃肠功能恢复时间,减轻疼痛,促进病人早日康复.     

经牙槽嵴顶提升术在上颌后牙种植修复中的应用效果

目的 探讨经牙槽嵴顶提升术在上颌后牙种植修复中的应用效果。方法 选取我院2019年1月-2021年 1月收治的100例上颌后牙种植修复患者为研究对象,按照随机数字表法分为对照组和观察组,各50例。对 照组采用侧壁开窗上颌窦底提升术联合同期种植,观察组采用经牙槽嵴顶提升术联合同期种植,比较两组手 术指标、近远期疗效及疼痛程度。结果 两组上颌窦提升高度、种植体直径和种植体长度比较,差异无统计 学意义（P＞0.05）;观察组手术时间短于对照组,差异有统计学意义（P＜0.05）;两组术后12、24个月周围 骨吸收比较,差异无统计学意义（P＞0.05）;观察组术后12、24个月种植体稳定性系数、剩余牙槽骨高度 和平均获得骨高度均高于对照组,差异有统计学意义（P＜0.05）;观察组术后12、24 h VAS评分均低于对 照组,差异有统计学意义（P ＜0.05）。结论 采用经牙槽嵴顶提升术进行上颌后牙种植修复可有效缩短手 术时间,降低术后疼痛程度,改善植体稳定性系数、剩余牙槽骨高度和平均获得骨高度。     

手指康复操训练对经桡动脉行冠脉造影患者肢体并发症的影响

目的减轻经桡动脉行冠脉造影患者术后术侧肢体的肿胀、疼痛程度。方法将196例择期经桡动脉行冠脉造影的住院患者分为对照组99例与干预组97例。对照组术后予常规护理,干预组在对照组基础上进行手指康复操锻炼。观察两组手掌周径、疼痛程度、出血情况。结果干预组手掌周径(术后4、12 h)显著小于对照组,疼痛程度显著轻于对照组(P0.05,P0.01);两组出血程度比较,差异无统计学意义(P0.05)。结论手指康复操锻炼可缓解经桡动脉行冠状动脉介入术患者术后术侧手部肿胀程度及疼痛感,不会增加穿刺点出血发生率。     

上颌磨牙采用不同拔牙术对减轻患者疼痛的效果

目的探讨上颌磨牙患者采用微创拔牙术治疗效果及减轻患者疼痛的作用。方法回顾本院2015年2月至2016年2月上颌磨牙患者临床资料300例,按照随机数字表法将此次研究对象分为对照组(传统拔牙)与治疗组(微创法拔除),分别为150例。通过问卷调查形式调查两组患者畏惧程度,由医院牙科医生负责检查两组患者拔牙窝完整性情况,采用视觉模拟法(VAS)评价两组患者术后疼痛程度,测量两组患者术后肿胀程度。结果治疗组畏惧程度明显轻于对照组,P0.05;治疗组术后肿胀程度为(8.124±1.140)mm明显低于对照组(11.263±2.411)mm,u=11.434,P=0.000;治疗组拔牙窝完整性为(1.339±0.561)明显优于对照组(3.142±0.868),u=15.259,P=0.000;治疗组术后VAS评分为(2.142±0.361)分明显低于对照组(3.361±0.475)分,u=16.878,P=0.000。结论采用微创拔牙术治疗上颌磨牙可有利于减轻患者术后肿胀程度及疼痛程度,保持患者牙窝完整性,从而减轻患者畏惧感,易被患者接受,因此值得推广。     

经肱动脉路径冠状动脉介入治疗患者组合式压迫止血器应用效果观察

目的 探讨组合式压迫止血器在经肱动脉路径行冠脉动脉介入治疗压迫止血的效果。方法 将经肱动脉路径行冠状动脉介入治疗患者60例分成两组各30例。对照组采用3M弹力绷带加压包扎的常规止血方法,观察组采用组合式压迫止血器压迫止血。比较两组压迫止血即刻,术后2 h、4 h、6 h出血发生率、局部肿胀程度及疼痛评分;压迫24 h局部压力性损伤发生率。结果 观察组不同时段局部肿胀程度及疼痛评分显著低于对照组,总出血发生率和压力性损伤发生率显著低于对照组(均P<0.05)。结论 组合式肱动脉止血器应用于经肱动脉路径行冠状动脉介入治疗压迫止血效果良好,操作安全且能减轻患者疼痛,预防压力性损伤发生。     

鼻内镜辅助下上颌窦根治术治疗真菌性上颌窦炎的临床研究

目的探讨鼻内镜辅助下上颌窦根治术治疗真菌性上颌窦炎的临床价值。方法选择40例患者在鼻内镜辅助下上颌窦根治术治疗真菌性上颌窦炎，并与常规开放上颌窦根治术的患者比较，观察两组手术时间、术中出血以及总住院时间，并统计两组术后发生的并发症。结果观察组术中出血显著少于对照组（P〈0．05），总住院时间显著短于对照组（P〈0．05），观察组术后出现引流不畅、上唇麻木以及术后出血的比率均显著低于对照组（P〈0．05）。结论鼻内镜辅助下上颌窦根治术治疗真菌性上颌窦炎其手术创伤小，术后恢复快，并发症少，值得临床推广。     

上颌窦内提升技术在上颌后牙缺损患者中的应用效果

目的 探讨上颌窦内提升技术应用于上颌后牙缺损患者的效果。方法 选取咸阳市口腔医院2021年 2月-2022年12月收治的行口腔种植修复的上颌后牙缺损患者104例为研究对象，采用随机数字表法分为对照 组和观察组，各52例。对照组实施传统种植修复术治疗，观察组实施上颌窦内提升技术治疗，比较两组 临床疗效、并发症发生情况、手术指标、治疗满意度、生活质量、口腔出血指数、患牙菌斑指数及种植 体周围骨吸收量情况。结果 观察组治疗总有效率为98.08%，高于对照组的76.92%（P＜0.05）；观察组并 发症发生率为3.85%，低于对照组的23.08%（P＜0.05）；观察组治疗时间以及患者咀嚼功能恢复时间均 短于对照组（P＜0.05）；观察组满意度高于对照组（P＜0.05）；观察组干预后生活质量评分高于对照组 （P＜0.05）；两组种植体周围骨吸收量比较，差异无统计学意义（P＞0.05）；观察组口腔出血指数、患牙 菌斑指数优于对照组（P＜0.05）。结论 上颌窦内提升技术应用于上颌后牙缺损患者，可获得较为满意的 治疗结果，降低并发症发生率，缩减手术治疗时间，改善患者口腔出血指数。     

Nobel clinician软件引导上颌窦内提升术在磨牙缺失修复中的应用研究

目的:研究Nobelclinician软件引导上颌窦内提升术在磨牙缺失的应用效果,为临床应用提供指导。方法:选择2016年10月-2018年10月在笔者医院进行手术的86例上颌磨牙缺失患者为研究对象,按照随机数表法分为观察组和对照组,每组43例。对照组:采用常规上颔窦内提升术;观察组:在Nobelclinician软件引导下进行上颌窦内提升术,两组均使用nobelreplace种植体种植。比较两组患者的种植体存留率及种植体周围组织情况[包括术前上颌窦底距牙槽嵴骨高度(Bone height of the maxillary sinus floor from the alveolar ridge,RBH)、术后6个月新骨获得量、术后1年垂直骨丧失、牙周探诊深度(Periodontal probing depth,PPD)];比较两组患者治疗后的X片检查结果及治疗满意度。结果:观察组的RBH、PPD及术后1年垂直骨丧失均显著小于对照组,术后6个月新骨获得量显著大于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后随访6个月,观察组的种植体存留率(100.00%)与对照组(94.55%)相比,差异不具有统计学意义(P>0.05),X片检查结果显示,两组患者的种植体及周围骨组织均结合良好,术后1年均已生成新的上颌窦底壁。观察组患者的满意度(100.00%)显著高于对照组(90.70%),差异具有统计学意义(P<0.05)。结论:Nobelclinician软件引导上颌窦内提升术能够降低垂直骨丧失量,增加新骨获得量,有助于提高磨牙缺失修复的美学效果,提高患者满意度。     

Sinusitis in long-term intubated, intensive care patients: nasal versus oral intubation

Discussion of paranasal sinusitis as a nosocomial infection in the mechanically ventilated intensive care (ICU) patient has recently been intensified. Some authors have emphasized nasotracheal intubation as a possible pathogenetic pathway. The aim of this study was to investigate the impact of nasotracheal or orotracheal intubation on the development of sinusitis in ICU patients. METHODS. In a prospective study, we followed 44 patients who required mechanical ventilation (greater than 24 h) in the ICU because of prolonged recovery from abdominal, thoracic, or posttraumatic surgery. Twenty patients were intubated nasotracheally and 24 orotracheally. Assignment to the groups was random. All were provided with a nasogastric tube and initially treated with systemic antibiotics. They received local antimicrobial prophylaxis of the nose, oropharynx, and stomach. Daily a-scan examinations of the maxillary sinuses were performed from the day of admission to the ICU until extubation, tracheotomy, death, or transfer. The average observation period was 6.9 days in the oral group and 7.1 days in the nasal group. In the case of a pathologic finding, aspiration of the antral sinus was carried out. In this study sinusitis indicated a sonographic finding; it did not necessarily imply a bacterial infection. RESULTS. At the beginning of the observation period, 6 patients in the oral group and 4 in the nasal group already had a pathologic maxillary sinus finding. At the end, in 15 of 24 in the oral group and 19 of 20 in the nasal group unilateral or bilateral sinusitis could be demonstrated. Development of bilateral sinusitis (13/20 in the nasotracheal group, 8/24 in the orotracheal group) was mainly observed after the appearance of unilateral sinusitis. The site corresponded to the site of the nasal tube in 65%. Unilateral paranasal infection was observed in nasotracheally and orotracheally intubated patients after an average of 2.8 and 2.6 days, respectively, whereas bilateral sinusitis had an average time delay of 4.5 and 5.7 days. Aspiration of the maxillary sinus was performed in 22 of 34 cases with sinusitis. Pathogenic organisms could be demonstrated in 7 of 13 nasotracheally intubated patients but only 2 of 9 with orotracheal tubes. CONCLUSION. We found that patients intubated orotracheally developed significantly less sinusitis than those intubated nasotracheally. Edema, local infection of the nasal mucosa, or mechanical obstruction of sinus drainage pathways by the tube are possible explanations. The fact that 63% of orally intubated patients had a pathologic maxillary sinus finding as well suggests that in addition to other reasons, an increased central venous pressure, positive pressure ventilation, and the supine position must be regarded as predisposing factors that increase the incidence of sinusitis. We conclude that the conditions of critically ill patients predispose to the development of sinusitis. Nasotracheal intubation is to be regarded as an additional risk, and therefore oral intubation should be preferred.     

COMPLICATIONS OF THE CALDWELL-LUC OPERATION AND HOW TO AVOID THEM

The complications of the Caldwell-Luc operation were retrospectively studied in 1990. The case records were analysed and updated information from telephone interviews and posted questionnaires were available for most patients. One hundred and eighty-five patients with 216 procedures with a mean postoperative follow-up period of 33.5 months were studied. The commonest indication for the operation was for chronic sinusitis. There were three common complications found: facial swelling (61.9%), pain and/or numbness of the face (46.0%) and pain and/or numbness of the teeth/gums (30.9%). Rare complications are postoperative epistaxis (0.4%), oroantral fistulae (0.4%), epiphora (0.4%) and dental discoloration (0.4%). This paper discusses the pathophysiology of these complications and surgical techniques on how to avoid them. Although the use of the Caldwell-Luc operation has declined in recent years with the development of endoscopic sinus surgery, it still has occasional indications and a set of practical guidelines on how to prevent complications would be useful. The basis for treating chronic sinusitis with functional endoscopic sinus surgery at the expense of the more traditional form of treatment is also discussed.     

Bacteriology of chronic sinusitis after amoxicillin-clavulanate potassium therapy

The bacteriology of chronic sinusitis was studied after amoxicillin-clavulanate potassium therapy. Patients with chronic sinusitis were randomly divided into 2 groups. In the study group, 90 patients were given a 2-week course of amoxicillin-clavulanate potassium before functional endoscopic sinus surgery. In the control group, 113 patients did not take any antibiotics within 2 weeks before the surgery. Swab specimens were taken from the maxillary and ethmoid sinuses during surgery and sent for aerobic and anaerobic culture. In the study group, the culture rates of maxillary and ethmoid sinuses were 45.6% and 28.9%, respectively. In the control group, the culture rates of maxillary and ethmoid sinuses were 53.1% and 34.5%, respectively. The culture rates between the control group and the study group were not significantly different, either for the maxillary sinus or the ethmoid sinus. This showed that treatment with amoxicillin-clavulanate potassium did not change the bacteriology of chronic sinusitis.     

Endosinusal treatment impact and prognostic value of IL-5 in chronic maxillary sinusitis

Objectives: The aim of the study was to evaluate subjective outcomes in patients with chronic maxillary sinusitis after steroid/antibiotic endosinusal treatment. Furthermore, the aim was to test the hypothesis that pretreatment levels of interleukin-5 (IL-5) in sinus fluid could predict response to endosinusal steroid/antibiotic treatment.Methods: Thirty patients with chronic maxillary sinusitis were recruited for the study. Patients were treated endosinusally with 2 mg dexamethasone and 40 mg gentamycine per maxillary sinus for 5 days. Patients rated nasal/CRS disease-specific symptoms and completed a self-administered questionnaire concerning sinusitis symptoms at inclusion and after 30 days. Sinus lavage, collected at inclusion, was analyzed for IL-5 concentration.Results: 56.6% of patients had improvement after endonasal treatment with decrease in symptoms (responders), and 43.4% were unchanged or worsened after treatment (nonresponders). Significant improvement was noted for overall sinusitis symptoms score (P = 0.02) and for obstruction, postnasal drip, headache, sneezing, and cough (P < 0.05). There is positive correlation between baseline IL-5 level in sinus lavage and improvement rate of overall sinusitis symptoms score (P < 0.01) and improvement rate of nasal secretion score (P < 0.01).Conclusions: Steroid-antibiotic endosinusal treatment in patients with chronic maxillary sinusitis was proven effective in reducing subjective sinusitis symptoms. Improvement rate to endosinusal treatment is expected be higher in patients with increased level of IL-5 in maxillary sinus lavage. Increased concentrations of IL-5 in sinus fluid might be used as a predictor of a good response to endosinusal treatment of maxillary chronic sinusitis.     

超声刀经胸乳入路腔镜下行甲状腺癌根治术疗效及安全性分析

目的探讨超声刀经胸乳入路腔镜下行甲状腺癌根治术的临床疗效及安全性。方法按就诊顺序编号将我院2012年2月-2014年2月收治的48例甲状腺癌患者分为对照组（24例）和观察组（24例）,其中对照组行传统开放手术治疗,观察组采用超声刀经胸乳入路腔镜下行甲状腺癌根治术治疗,比较两组患者的临床治疗效果。结果两种术式的手术时间比较差异无统计学意义（P〉0.05）;对照组的术中出血量多于观察组,术后引流时间和住院时间长于观察组,并发症发生率也高于观察组,比较差异均具有统计学意义（P〈0.05）;术后疼痛评分显示,观察组术后第1天和第3天的疼痛评分均低于对照组,差异具有统计学意义（P〈0.05）,两组患者第5天的疼痛评分差异无统计学意义（P〉0.05）。结论采用超声刀经胸乳入路腔镜下行甲状腺癌根治术可缩短术后引流及住院时间,降低并发症发生率,同时对患者的创伤较小,术后疼痛较轻,值得临床借鉴和推广。