家兔实验性上颌窦炎的细菌学变化

目的：探讨实验性上颌窦炎动物模型的制备方法，并在此基础上分析实验性上颌窦炎的细菌学变化。方法：将40只新西兰大白兔制成动物模型，分成6组：空白对照组、假手术对照组、窦口堵塞组、单纯细菌组、窦口堵塞加金黄色葡萄球菌组和窦口阻塞加肺炎链球菌组，检查术后不同时间窦腔脓性分泌物细菌学变化。结果：空白对照组细菌培养阳性率为0％(0／5)，假手术对照组为20％(2／10)，窦口阻塞组为84．6％(11／13)，单纯细菌组为10％(1／10)，窦口阻塞加细菌组100％(42／42)。术后2周内，培养的细菌以种植茵为主；3周以后，培养的细菌以机会致病菌为主。结论：窦口阻塞加注入细菌的方法可成功地制造实验性上颌窦炎动物模型，随着鼻窦炎时间的延长，培养出机会致病菌的阳性率升高。     

家兔实验性急性化脓性鼻窦炎模型的建立

目的探讨应用金黄色葡萄球菌建立家兔急性化脓性鼻窦炎模型的方法. 方法家兔40只,其中空白组10只,单纯手术组10只,余为模型组,在全麻下行上颌窦造口术,塞入棉绒,注入金黄色葡萄球菌0.3ml.造模后7天时观察其炎症反应和鼻黏液纤毛输送功能的变化. 结果实验性急性化脓性鼻窦炎家兔7天病程时白细胞(WBC)计数及中性粒细胞(N)百分比增加,血清C-反应蛋白浓度显著升高,窦腔分泌物细菌分离培养阳性,鼻黏液纤毛传输时间延长,光镜、电镜下窦腔及窦口黏膜充血、水肿、纤毛脱落等. 结论应用金黄色葡萄球菌,采取上颌窦造口术可以建立稳定的家兔急性化脓性鼻窦炎模型.     

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。     

手术对兔实验性鼻窦炎粘膜病理改变的作用

该文的目的是研究自然口扩大（ＭＭＡ）对正常鼻窦粘膜及由窦口堵塞诱发的合并与不合并细菌感染的鼻窦炎的作用以及改良鼻窦根治术（ＭＲＯ）后感染粘膜的恢复能力。取体重为２．７～４．０ｋｇ的兔３２只，分为３组。第１组为ＭＭＡ组，共１１只，堵塞一侧上颌窦口，其中４只窦腔注射金黄色葡萄球菌；另４只注射脆弱杆菌，余３只不注射细菌。４周后去除窦口堵塞物，向前向下扩大双侧窦口达５ｍｍ，术后４周处死动物。第２组为感染对照组，９只动物。堵塞一侧窦口，３只注射金黄色葡萄球菌，３只注射脆弱杆菌，３只不注射细菌，４周后各处死…     

家兔急性鼻窦炎鼻源性模型的建立

目的探讨在家兔鼻腔填塞膨胀海绵并植入细菌以制备急性鼻窦炎鼻源性动物模型的方法。方法健康成年雄性新西兰白兔30只,随机抽取5只处死,测量其右侧鼻腔前鼻孔上下径、内外径以及前鼻孔至上颌窦自然开口的距离,余25只分成模型组(10只)、单纯堵塞组(10只)和空白对照组(5只)。将2.5 mm×5 mm×28 mm大小Merocel高分子膨胀海绵置入模型组、单纯堵塞组兔右侧鼻腔,同时向模型组兔鼻腔内高分子膨胀海绵中注射植入1 mlⅢ型肺炎链球菌悬液,单纯堵塞组注射等量生理盐水。第10天行鼻窦CT扫描后将兔处死,分别取右上颌窦、筛窦窦腔分泌物行细菌培养,并将右上颌窦、筛窦完整取出,全组织包埋行组织病理学检查。结果除模型组1只于第4天死亡外,其余均存活。模型组家兔CT检查均示右上颌窦、筛窦腔不同程度浑浊化,鼻窦腔内分泌物细菌培养阳性率为100%,光镜观察可见窦腔大量中性粒细胞聚积,上皮变性,局部溃疡形成,黏膜内及黏膜下大量炎性细胞浸润。单纯堵塞组8只家兔可见类似的影像学改变,但病理学改变程度较轻,与模型组相比,差别有统计学意义。结论成功建立了家兔急性鼻窦炎的鼻源性动物模型,为进一步研究鼻源性鼻窦炎的发病机制及治疗干预奠定基础。     

鼻窦清合剂对兔鼻窦炎上颌窦黏膜形态影响的电镜观察

目的 观察鼻窦清合剂对兔鼻窦炎上颌窦黏膜炎症的影响。方法 行窦口不完全堵塞加用金黄色葡萄球菌建立急慢性鼻窦炎动物模型后,予以鼻窦清合剂高、低剂量灌胃治疗,并设立空白组、模型组、鼻渊舒（鼻渊舒口服液灌胃） 组作为对照;急性期用药1周,慢性期用药2周后,分别通过透射电子显微镜观察 ,比较各组兔上颌窦黏膜形态结构的变化。结果 鼻窦清合剂低剂量组黏膜形态最接近正常组,且急性各组优于慢性各组。结论 鼻窦清合剂可改善兔上颌窦炎症。     

家兔实验性慢性鼻窦炎窦腔粘膜血流测定

人类鼻窦炎窦腔粘膜血流量是否有改变尚无定论。本研究旨在建立慢性鼻窦炎的动物模型以测定窦腔粘膜血流量。作者用家兔作实验,麻醉后按下列三种方法建立实验性鼻窦炎:(1)皮下注射卵清蛋白,每周4次,共2周。窦腔内留置导管注射卵清蛋白,每周3次共2周,并接种肺炎链球菌(10~8个);(2)鼻背部皮肤作切口,鼻窦骨壁钻孔,切开窦腔粘膜放入一块带肺炎球菌的棉绒。(3)与第2种方法相同,但不接种细菌,用异丁稀酸封闭窦口。从实验性鼻窦炎产生到测鼻窦粘膜血流的时间为5周至9个月。部分家兔鼻窦粘膜进行光镜和扫描电镜组织学检查。结果:15只家兔中6只实验失败,其余家兔实验性鼻窦炎的表现是打喷嚏、流涕;鼻窦粘膜     

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.     

兔再生窦胶粘膜的纤毛活动性和超微结构的异常

粘液纤毛传输的恢复在慢性鼻窦炎的治疗中很重要。粘液纤毛传输对窦胶清除率的重要性已经包括内窥镜在内的各种方法证实，粘液纤毛传输机理是纤毛活动和鼻窦-鼻环境的复杂的相互作用，组织学上观察切除上颌窦粘膜对治疗亚急性或慢性上颌窦炎意义重大。研究目的是通过测量彻底切除上颌窦粘膜后，观察再生粘膜的纤毛传输速度及其组织学变化和纤毛活动性情况。新西兰白兔32只，体重1．8～2．6kg，盐酸氯胺酮（50mg／kg）肌注麻醉，两侧上颌窦前壁钻孔约5×10mm，一侧窦腔粘膜用锐剥离子和小剪完全剥离掉，另一侧作对照。白兔分3组：一组为窦口…     

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。     

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.     

Interferon gamma levels in the sinus, ear, and airway in a rabbit sinusitis model induced by Bacteroides inoculation

BACKGROUND: Previously, we found minimal bacterial dissemination and no evidence of systemic inflammation in a rabbit sinusitis model in which the left maxillary sinus was inflamed by Bacteroides inoculation with the ostium closed. However, we observed an increase in anti-Bacteroides IgG antibodies in the contralateral sinus, lower airway, and middle ear, with an apparent increase in interferon gamma (IFN-gamma) messenger RNA expression in the ear and sinus mucosa. OBJECTIVE: To evaluate how IFN-gamma production in the upper and lower airway is associated with localized bacterial sinusitis. DESIGN: Interferon gamma levels were measured in lavage solutions from the sinus, airway, and middle ear and in serum at 1, 2, 3, and 4 weeks following bacterial inoculation. SUBJECTS: The subjects were 6 rabbits at each time point. The controls were untreated (n = 5) and sham-operated (n = 4-5) rabbits at 2 and 4 weeks. INTERVENTION: Bacteroides fragilis (10(8) plaque-forming units) was inoculated into the left maxillary sinus. RESULTS: Interferon gamma levels in the ear and sinus were less than 0.2 microg/g protein in controls. Following bacterial inoculation into the left sinus, IFN-gamma levels increased up to 10-fold in both sinuses and even more in the middle ear at 3 weeks, independent of bacterial dissemination. Mean +/- SD IFN-gamma levels in the airway (0.3+/-0.28 microg/g protein in controls) were not altered by bacterial inoculation into the sinus. Serum IFN-gamma levels were very low (<0.05 microg/g protein) in most rabbits and were unchanged by bacterial inoculation. CONCLUSIONS: Interferon gamma levels increase in the ear and contralateral sinus in response to localized sinus inflammation, indicating concerted mucosal proinflammatory immune responses in the upper airway. Such responses may lead to the aseptic middle ear inflammation often observed in patients with chronic sinusitis.     

Experimentally induced sinusitis: the importance of vasomotor regulation

An acute pneumococcal maxillary sinusitis was induced in New Zealand white rabbits by unilateral obstruction of the sinus ostium and then injecting 10(8) Streptococcus pneumoniae into the sinus. After subjecting this bacterial strain to one animal passage, the bacteria were reisolated in nine of ten infected maxillary sinuses. All rabbits developed a unilateral purulent sinusitis, while a non-purulent sinusitis could be induced by occlusion only of the maxillary ostium. By using a non-diffusable tracer, microspheres labelled with Sn113, blood flow measurements were performed on these sinuses. These studies showed that the blood flow of the infected sinuses was significantly higher than on the control side. However, in chronic sinusitis (with a blocked ostium), the blood flow did not differ significantly from that on the control side. Biochemical studies in the animals with purulent sinusitis demonstrated that lactate concentration in the mucosa was significantly higher as compared to the control side. The glucose concentration was significantly lower in the mucosa of the infected side, as was the ATP content of the sinus mucosa in purulent sinusitis. These results indicate an increased glycolysis as well as a relative energy depletion in the sinus mucosa in purulent sinusitis, which could result in an impaired epithelial function.     

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。     

Experimentally induced sinusitis: the importance of vasomotor regulation

Summary An acute pneumococcal maxillary sinusitis was induced in New Zealand white rabbits by unilateral obstruction of the sinus ostium and then injecting 10⁸ Streptococcus pneumoniae into the sinus. After subjecting this bacterial strain to one animal passage, the bacteria were reisolated in nine of ten infected maxillary sinuses. All rabbits developed a unilateral purulent sinusitis, while a non-purulent sinusitis could be induced by occlusion only of the maxillary ostium. By using a non-diffusable tracer, microspheres labelled with Sn¹¹³, blood flow measurements were performed on these sinuses. These studies showed that the blood flow of the infected sinuses was significantly higher than on the control side. However, in chronic sinusitis (with a blocked ostium), the blood flow did not differ significantly from that on the control side. Biochemical studies in the animals with purulent sinusitis demonstrated that lactate concentration in the mucosa was significantly higher as compared to the control side. The glucose concentration was significantly lower in the mucosa of the infected side, as was the ATP content of the sinus mucosa in purulent sinusitis. These results indicate an increased glycolysis as well as a relative energy depletion in the sinus mucosa in purulent sinusitis, which could result in an impaired epithelial function.Presented at the First European Congress of Oto-Rhino-Laryngology and Cervico-Facial Surgery, Paris, 26–29 September 1988     

Middle ear pathologic changes associated with chronic anaerobic sinusitis in rabbits

OBJECTIVE/HYPOTHESIS: To study the histopathologic changes in association with the inflammatory/immune response present in the middle ears of a rabbit model of unilateral chronic anaerobic sinusitis. STUDY DESIGN: New Zealand white rabbits, two at each experimental time point. Normal rabbits and sham-operated animals served as controls. METHODS: Left maxillary sinusitis was induced by inoculating Bacteroides fragilis surgically after closure of the ostium. Cultures, lavages, and mucosa were harvested from bilateral middle ear and sinus cavities at 1, 2, 3, and 4 weeks following inoculation. Parameters analyzed include tissue for histopathologic study, immunoglobulin G antibody (IgG Ab) against B fragilis, and lactate dehydrogenase (LDH) levels in lavage samples, interferon gamma (IFN gamma) messenger RNA (mRNA) expression in mucosal tissue, and bacterial culture. RESULTS: Despite closure of the ostium of the left sinus, mild to moderate dissemination of B fragilis into the right sinus and left and right ears were observed in some but not all rabbits (2/8, 5/7, and 2/8, respectively). Histopathologic changes in the right sinus and middle ears were much less severe in contrast to the severe inflammatory changes in the left sinus. An immune response against B fragilis appeared to occur in the sinuses and ears bilaterally independent of bacterial dissemination, as evidenced by a rise of IgG Ab in lavage fluid and detection of IFNg mRNA. Neither control nor sham-operated animals had detectable levels of IFNg mRNA or IgG Ab. In B fragilis-inoculated rabbits, the magnitude of IgG Ab responses was equivalent in the right and left ear, independent of B fragilis dissemination; IgG Ab levels in the middle ear positively correlated to each other (P < .01) and to the levels in the sinuses (P < .01 and P < .01). LDH levels were closely associated with bacterial growth and degree of tissue inflammation. CONCLUSION: This reproducible model of chronic sinusitis provides an opportunity to study the middle ear infection and inflammatory/immune responses occurring with sinusitis. Our results indicate bilateral middle ear mucosal immune responses to an elicited sinus infection, independent of B fragilis dissemination.     

儿童鼻窦炎对咽鼓管与中耳传音功能的影响

目的：探讨儿童鼻窦炎对咽鼓管与中耳传音功能的影响及程度,观察治疗鼻窦炎后,中耳传音功能障碍的恢复情况。方法：对儿童鼻窦炎100例和正常儿童50例行耳科检查、咽鼓管咽口观察、声阻抗检查、纯音测听,对比结果;对鼻窦炎合并耳病变的68例患者（128耳）行有针对性的治疗。结果：鼻窦炎患者中鼓膜异常率为64%、咽鼓管咽口异常率为62%、咽鼓管功能异常率为63.5%、鼓室导抗图异常率为62.5%,听力减退47.5%,与正常儿童组相比,差异有统计学意义（P＜0.01）。急性鼻窦炎、亚急性鼻窦炎与慢性鼻窦炎中耳病变的发生率和程度相比,差异有统计学意义（P＜0.05）。治疗鼻窦炎后,中耳传音功能障碍有明显改善。结论：儿童鼻窦炎引起咽鼓管功能的改变,中耳病变发生率较正常儿童显著增高;随病程的延长,发病率增高且程度加重。     

Development of maxillary accessory ostium following sinusitis in rabbits

OBJECTIVES/HYPOTHESIS: Maxillary accessory ostium is one of the anatomical variations that may play a role in the development of chronic maxillary sinusitis. Although some authors claim that accessory ostia develop following acute maxillary sinusitis, it is not clear whether they are congenital or acquired. STUDY DESIGN: Animal experimental study. METHODS: Ten New Zealand type rabbits were used in the study. In phase 1, lateral nasal walls of five New Zealand type rabbits were examined for the presence of natural and accessory ostia of the maxillary sinus and any area resembling fontanelles in humans. In phase 2, experimental sinusitis was induced in the right sides of the other five rabbits. Following sacrifice, lateral nasal walls were examined for the development of accessory ostia. RESULTS: Six of the ten sides of phase 1 animals contained a membranous part in the medial wall of the maxillary sinus resembling the fontanelles in humans (60%). None of them had an accessory maxillary ostium. Accessory ostia developed in two of the five sides with sinusitis (40%). CONCLUSIONS: We have shown for the first time that accessory maxillary ostia develop following experimental sinusitis in rabbits. Further studies in humans are indicated.