多通道微创经皮肾镜结合钬激光治疗复杂性肾结石的临床研究

目的 探讨多通道微创经皮肾镜结合钬激光治疗复杂性肾结石的临床疗效.方法 将86例复杂性肾结石患者分为两组,研究组(46例)采用多通道微创经皮肾镜结合钬激光碎石术,对照组(40例)行单通道微创经皮肾镜结合体外冲击波碎石术治疗.比较两组碎石取出时间、结石清除率、术后血红蛋白下降率、术中输血率、术后住院时间及并发症发生率.结果 研究组的碎石取出时间为(102±23)min,对照组为(121±28)min,两组比较差异无统计学意义(P＞0.05).研究组术后血红蛋白下降率为6.5%(3/46)、术中输血率为17.4%(8/46)、结石清除率为82.6%(38/46)、术后住院时间为(5.6±1.7)d,对照组分别为12.5%(5/40)、22.5%(9/40)、72.5%(29/40)、(7.4±1.8)d,两组比较差异均有统计学意义(P＜0.05).结论 多通道微创经皮肾镜结合钬激光治疗复杂性肾结石手术时间短、术中出血少、结石清除率高,且并发症相对较少,值得临床推广应用.

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Objective To investigate the effect of multi-channel minimally invasive percutaneous nephrolithotomy in combination with Yag laser in complex renal calculi operation. Methods Eighty six complex renal calculi patients were divided into two groups, study group (46 cases) was treated with multi-channel minimally invasive percutaneous nephrolithotomy combined with Yag laser, control group was treated with single-channel minimally invasive percutaneous nephrolithotomy combinated with extracorporeal shock wave treatment. Comparison of gravel removed time, stone clearance rate,postoperative hemoglobin decreasing rate, blood transfusion rate of surgery,length of stay time and operative complications were done between the two groups, the results were analysed statistically. Result The gravel removed time was (102±23) min in study group, and ( 121 ± 28) min in control group, there was no significant difference between the two groups(P ＞ 0.05 ). In study group, postoperative hemoglobin decreasing rate was 6.5%(3/46), blood transfusion rate of surgery was 17.4% (8/46), stone clearance rate was 82.6%( 38/46 ), length of stay time was (5.6 ± 1.7) d,while those in control group was 12.5%(5/40),22.5%(9/40),72.5%(29/40), (7.4 ± 1.8) d,respectively. There was statistical significance between the two groups(P＜ 0.05 ). Conclusion Multi-channel minimally invasive percutaneous nephrolithotomy in combination with Yag laser in the treatment of complex renal calculi has the shorter operation time, less blood loss,less complications and higher stone clearance rate, and is worthy of promotion.     

无创间歇正压通气治疗尘肺并发呼吸衰竭的疗效观察

目的 探讨无创间歇正压通气(NIPPV)治疗尘肺并发呼吸衰竭的疗效.方法 将46例尘肺并发呼吸衰竭患者随机分为治疗组26例和对照组20例.对照组采用常规治疗方法,治疗组在常规治疗的基础上,联合NIPPV治疗,比较两组患者治疗后心率、呼吸频率和PH、二氧化碳分压(PaCO2)、氧分压(PaO2)的变化.结果 治疗组治疗有效率为88.5%(23/26),对照组为60%(12/20),两组治疗有效率的差异有统计学意义(P＜0.05);治疗后治疗组患者心率为(95.38±10.75)次/min,较对照组[(103.00±12.56)次/min]下降;治疗组呼吸频率[(21.69±1.37):次/min]较对照组[(22.60±1.57)次/min]减慢;治疗组PaCO2[(52.88±10.75)mmHg]比对照组[(59.66±11.49)mm Hg]降低;治疗组PaO2[(100.77±25.3)mm Hg]较对照组[(71.82±17.94 mm Hg]明显升高;两组比较,差异均有统计学意义(P＜0.05).结论 NIPPV对治疗尘肺并发呼吸衰竭患者有效,可提高治疗有效率,改善动脉血PaO2和PaCO2.

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Objective To evaluate the value of noninvasive intermittent positive-pressure ventilation (NIPPV) in treatment of patients with pneumonoconiosis combined with respiratory failure. Method There were 46 inpatients with pneumonoconiosis combined with respiratory failure. Tetwenty-six inpatients treated with conventional therapy and NIPPV were categorized as treatment group; Tetwenty inpatients just treated by conventional therapy served as control group. Compared with the changes of HR、RR and arterial blood gas index (PH、PaCO2、PaO2) in two groups after treatment. Results The effective ratio of treatment group was 88.5%, control group was 60%, which had significant difference (P＜0.05); The HR in treatment group after treatment was(95.38±10.75)beats per minute, control group was [(103.00±12.56)beats per minute; The RR in treatment group was (21.69±1.37) breaths per minute, control group was [(22.60± 1.57)breaths per minute];The PaCO2 in treatment group was (52.88±10.75)mm Hg, control group was [(59.66± 11.49)mm Hg];All of those were significantly decreased than those in control group (P＜0.05). The PaO2 in treatment group was (100.77±25.3)mm Hg, control group was [(71.82±17.94) mmHg];Compared with the control group, PaO2 in the treatment group increased significantly (P＜0.05). Conclusion NIPPV is beneficial to pneumonoconiosis combined with respiratory failure in different degrees.     

胸腔阻抗无创血流动力学监测在非心脏手术老年患者全麻术后的临床应用

目的 评价胸腔阻抗(TEB)无创血流动力学监测在非心脏手术老年患者全麻术后的应用价值.方法 选取收治于ICU的非心脏手术全麻术后老年患者56例,按照随机数字表法分为对照组和TEB组,每组28例,所有患者均给予常规监护并监测中心静脉压,TEB组在上述基础上行TEB无创血流动力学监测,根据监测结果给予利尿药、正性肌力药、血管扩张剂或补液治疗;比较两组患者心率、平均动脉压、中心静脉压、尿量以及机械通气时间、住ICU时间.结果 两组患者同一时间相应的心率、平均动脉压、中心静脉压、尿量比较差异均无统计学意义(P＞0.05).机械通气时间TEB组患者为(19.5±15.9)h,较对照组的(25.5±16.5)h缩短,但差异无统计学意义(P=0.173);住ICU时间TEB组患者为(2.8±1.0)d,较对照组的(3.6±1.6)d缩短,且差异有统计学意义(P=0.032).结论 TEB无创血流动力学监测对非心脏手术老年患者全麻术后的治疗具有指导作用,有利于患者的术后恢复.

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Objective To evaluate the application value of non-invasive hemodynamic monitoring by thoracic electrical bioimpedance (TEB) in elderly non-cardiac surgery patients after general anaesthesia.Methods Fifty-six elderly non-cardiac surgery patients after general anaesthesia were divided into control group and TEB group with 28 patients in each group by random digits table. All patients received standardized care including central venous pressure (VAP). Besides these monitoring, hemodynamic monitoring by TEB was used to evaluate the hemodynamic state of patients in TEB group. Diuretics, inotropic agents, vasoactive drugs or intravenous fluid therapy were used according to monitoring guidance. The heart rate (HR), mean arterial pressure (MAP), VAP, urine output (UO) were recorded in different time. The length of mechanical ventilation and ICU stay were also recorded. The difference in HR, MAP, VAP, UO, the length of mechanical ventilation and ICU stay between two groups were analyzed. Results The differences between two groups had no significance in HR, MAP, VAP, UO at the same time (P ＞ 0.05 ). The length of mechanical ventilation of TEB group [ (19.5±15.9)h] was shorter as compared to that of control group [ (25.5 ± 16.5) h ], but the difference was not significant (P =0.173). The ICU stay of TEB group [(2.8 ± 1.0) d ] was shorter as compared to that of control group[(3.6±1.6)d] and the difference was significant (P=0.032). Conclusion Non-invasive hemodynamic monitoring by TEB can monitor the changes of hemodynamics and direct treatment in elderly non-cardiac surgery patients after general anaesthesia.     

无创血流动力学监测仪在重症急性胰腺炎合并肺水肿患者中的临床应用

目的 研究无创血流动力学监测仪在重症急性胰腺炎(SAP)合并肺水肿患者鉴别诊断中的意义.方法 回顾性分析29例SAP早期液体复苏过程中出现肺水肿患者的临床资料.根据患者出院诊断等分为观察组(非心源性肺水肿)18例和对照组(心源性肺水肿)11例.将两组无创血流动力学监测数据进行比较.结果 对照组心排出量[(3.34±1.09)L/min]、心脏指数[(2.06±0.46)L/(min·m2)]、心脏搏出量[(41.89±13.72)ml]、心搏指数[(25.59±7.32)ml/m2]、加速指数[(59.24±28.41)L/100 s2]、左心室工作指数[(2.09±0.67)(kg·m)/m2]、左心室射血时间[(254.32±27.34)ms]、射血分数(0.37±0.03)和速度指数[(27.11±11.32)L/100 s]较观察组[分别为(4.12±1.06)L/min、(2.64±0.48)L/(min·m2)、(46.21±11.81)ml、(28.87±5.32)ml/m2、(79.43±29.01)L/100 s2、(3.21±0.84)(kg·m)/m2、(281.29±29.11)ms、0.54±0.04、(39.34±12.11)L/100 s]显著降低(P<0.01);射血前期[(116.54±22.37)ms]和收缩时间比(0.48±0.04)较观察组[分别为(95.24±21.41)ms、0.36±0.02]显著增高(P<0.01或<0.05).结论 无创血流动力学监测仪为SAP合并肺水肿患者鉴别诊断提供了较好的依据.

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Objective To study the significance of the non-invasive hemodynamic monitor system in the differential diagnosis of severe acute pancreatitis (SAP) combined with pulmonary edema. Methods Twenty-nine cases of SAP during fluid resuscitation treatment combined with pulmonary edema were reviewed and the data of the non-invasive hemodynamic monitor system was analysed and summarized.According to the diagnosis on discharge, 18 patients were enrolled in test group (noncardiogenic pulmonary edema group) and 11 patients were enrolled in control group (cardiogenic pulmonary edema group). The data of two groups were determined and compared. Results In control group, cardiac output [(3.34±1.09) L/min], cardiac index [(2.06 ± 0.46) L/ (min·m2)], stroke volume [(41.89 ± 13.72) ml], stroke index[(25.59 ± 7.32) ml/m2], accelerate cardiac index [(59.24 ± 28.41) L/100 s2], left cardiac work index [(2.09 ± 0.67) (kg·m)/m2], left ventricular ejection time[(254.32 ± 27.34) ms], ejection fraction (0.37 ±0.03) and velocity index [(27.11 ± 11.32) L/100 s] were all significantly lower than those in test group [(4.12 ± 1.06) L/min, (2.64 ± 0.48) L/ (min·m2), (46.21 ± 11.81) ml, (28.87 ± 5.32) ml/m2, (79.43 ±29.01) L/100 s2, (3.21 ± 0.84)(kg·m)/m2, (281.29 ± 29.11) ms,0.54 ±0.04, (39.34 ± 12.11) L/100 s,respectively] (P < 0.01); pre-ejectionphase [(116.54 ± 22.37) ms] and systolic time ratio (0.48 ± 0.04) were significantly higher than those in test group[(95.24 ± 21.41) ms,0.36 ± 0.02,respectively] (P < 0.01 or <0.05). Conclusion Non-invasive hemodynamic monitor system is helpful in the early differential diagnosis of SAP combined with pulmonary edema.     

无创间歇正压通气治疗尘肺并发呼吸衰竭的疗效观察

Objective To evaluate the value of noninvasive intermittent positive-pressure ventilation (NIPPV) in treatment of patients with pneumonoconiosis combined with respiratory failure. Method There were 46 inpatients with pneumonoconiosis combined with respiratory failure. Tetwenty-six inpatients treated with conventional therapy and NIPPV were categorized as treatment group; Tetwenty inpatients just treated by conventional therapy served as control group. Compared with the changes of HR、RR and arterial blood gas index (PH、PaCO2、PaO2) in two groups after treatment. Results The effective ratio of treatment group was 88.5%, control group was 60%, which had significant difference (P＜0.05); The HR in treatment group after treatment was(95.38±10.75)beats per minute, control group was [(103.00±12.56)beats per minute; The RR in treatment group was (21.69±1.37) breaths per minute, control group was [(22.60± 1.57)breaths per minute];The PaCO2 in treatment group was (52.88±10.75)mm Hg, control group was [(59.66± 11.49)mm Hg];All of those were significantly decreased than those in control group (P＜0.05). The PaO2 in treatment group was (100.77±25.3)mm Hg, control group was [(71.82±17.94) mmHg];Compared with the control group, PaO2 in the treatment group increased significantly (P＜0.05). Conclusion NIPPV is beneficial to pneumonoconiosis combined with respiratory failure in different degrees.     

大环内酯类抗生素对生物被膜菌产β-内酰胺酶的作用

目的 探讨不同浓度阿奇霉素、红霉素、罗红霉素对生物被膜肺炎克雷伯杆菌产β-内酰胺酶的影响.方法 应用改进的平板培养法建立肺炎克雷伯杆菌生物被膜模型,用扫描电镜观察鉴定.取肺炎克雷伯杆菌30株,经37 ℃ 24h孵育,比浊法配制0.5麦氏比浊标准(MCF)菌悬液,分为A组(生物被膜组)、B.组[1最低抑菌浓度(MIC)阿奇霉素生物被膜组]、B2组(1/8 MIC阿奇霉素生物被膜组)、C,组(1 MIC红霉素生物被膜组)、C2组(1/8 MIC红霉素生物被膜组)、D1组(1 MIC罗红霉素生物被膜组)、D2组(1/8 MIC 罗红霉素生物被膜组)七组,每组200μ1.分别检测各组产β-内酰胺酶的活性.结果 A组、B1组、B2组、C1组、C2组、D1组、D2组β-内酰胺酶的活性分别为0.6534、0.3196、0,4260、0.5028、0.5108、0.6524、0.6470 U/mg,B1组、B2组、C1组、C2组β-内酰胺酶活性均明显低于A组,差异有统计学意义(P＜0.05);D1组、D2组β-内酰胺酶活性与A组比较差异无统计学意义(P＞0.05).B1组β-内酰胺酶活性明显低于B2组,差异有统计学意义(P＜0.05);C1组与C2组比较差异无统计学意义(P＞0.05).结论 高浓度的阿奇霉素对生物被膜有较强的破坏作用.

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Objective To investigate the effect of azithromycin,erythromycin and roxithromyein at varying concentration on the β-lactamase produced in the biofilm of Klebsiella pneumoniae.Methods Models of Klebsiella pneumoniae were built up with the modified flat-board method and identified with the confocal scanning laser microscopy.Thirty Klebsiella pneumoniae were incubated at 37 ℃for 24 h,and allocated into 7 groups:biofilm (group A),by 1 MIC azithromycin (group B1),by 1/8 MIC azithromycin (group B2),by 1 MIC erythromycin (group C1),by 1/8 MIC erythromycin (group C2),by 1 MIC roxithromycin (group D1),and biofilm induced by 1/8 MIC roxithromycin (group D2),with 200 μ1 each.The β-lactamase activity in each group was quantitated.Results The β-lactamase activity in group A,group B1,group B2,group C1,group C2,group D1 and group D2 was 0.6534,0.3196,0.4260,0.5028,0.5108,0.6524 and 0.6470 U/mg respectively.The β-lactamase activity in group B1,group B2,group C1 and group C2 was lower than that in group A,and statistically significant difference was observed (P＜0.05).The B-lactamase activity in group D1 and group D2 was similar to that in group A,and no statistically significant differences was observed between them (P＞0.05).The β-lactamase activity in group B1 was lower than that in group B2,and statistically significant difference was observed (P <0.05).No statistically significant difference was observed between group C1 and group C2 (P＞0.05).Conclusion Azithromycin at higher concentration exerts better effects on biofilm formation than other macrolides.     

兔颈动脉损伤后再狭窄与p53蛋白关系的研究

Objective To observe the effect of p53 protein on smooth muscle cell(VSMC)in rabbit artery balloon injury.Methods Restenosis model of carotid artery after balloon injury was established in rabbits.30 rabbits were divided into 2 groups,the sham group(n = 6)and the vascular injury group(n = 24).With H.E.staining and automatic image analysis system,we investigated artery morphology alteration and measured the area of arterial intima and media.The expressions of p53 protein were detected by immunohistochemical analysis.Results With H.E.staining and automatic image analysis and immunohistochemistry,the results showed that the expression of p53 was significantly reduced and the intima area was increased in model group compared with the sham group(P ＜0.01).But the expression of p53 in media was remarkably reduced compared with intima(P ＜ 0.01).Conclusions The possible mechanism of preventing arterial restenosis in the balloon injury might be related with p53,which may be through inhibiting neointimal proliferation in arterial restenosis .     

不同血浆靶浓度的普鲁泊福对鼻内镜手术应激反应的影响

Objective To observe the effect of propofol target controlled infusion with different blood plasma target concentration on stress reaction during the nasal endoscope operation. Methods Sixty patients with ASA Ⅰ - Ⅱ scheduled for the nasal endoscope operation were divided into three groups by random digits table: each group was 20 patients, group A, B, C was given propofol target controlled infusion with blood plasma target concentration 3,4,5 μ g/mi respectively. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2), blood glucose, serum cortisol, bispectral index ( BIS ), extubation time were recorded before anesthesia,at 30 min after the operation starting and 60 min after the extubation.Results The descent degree of HR and MAP at 30 min after the operation starting were group C ＞ group B ＞ group A (P = 0.024,0.010 );the descent degree of MAP at 60 min after the extubation were group C ＞group B ＞ group A (P = 0.011 ). BIS and extubation time were 65 ± 8 and (25 ± 7) min in group A, 53 ± 11 and( 36 ± 13 ) min in group B, 45 ± 12 and(45 ± 9 ) min in group C, there were significant differences among three groups(t = 2.476,P= 0.023;t = 2.657,P= 0.012). The blood glucose was increased at 30 min after the operation starting and 60 min after the extubation, the ascensus degree were group A ＞ group B ＞ group C (P= 0.000、0.000);the serum cortisol was decreased at 30 min after the operation starting, the descent degree was group C ＞ group B ＞ group A (P= 0.000), increased at 60 min after the extubation, the ascensus degree was group A ＞ group B ＞ group C (P= 0.001 ). Conclusions Propofol target controlled infusion with blood plasma target concentration 4-5 μ g/ml can ensure eligible depth of anesthesia, decrease pain stimulus, remain stable vital sign,depress the stress reaction caused by nasal endoscope operation efficiently,with short extubation time. It is an eligible blood plasma target concentration.     

超声在女性压力性尿失禁诊治中的应用价值

目的 探讨超声参数在评估女性压力性尿失禁(SUI)中的作用及意义.方法 应用超声测量46例女性SUI患者(研究组)行经闭孔无张力悬吊带术(TVT-O)前后膀胱颈活动度、膀胱尿道后角、尿道角及残余尿量的变化,并与43例体检正常妇女(对照组)进行比较.结果 研究组术前膀胱颈活动度及膀胱尿道后角[(14.46±1.28)mm、(124.87±2.95)°]大于对照组[(7.47±0.55)mm、(107.83±3.24)°](P＜0.01),尿道角[(23.61±2.28)°]小于对照组[(36.24±2.23)°](P＜0.01);研究组术后各参数与对照组比较,差异均无统计学意义(P＞0.05).研究组术后膀胱颈活动度及膀胱尿道后角[(7.84±0.76)mm、(108.74±3.63).]小于术前(P＜0.01),尿道角[(34.39±3.46).]大于术前(P＜0.01),而残余尿量组内、组间比较差异均无统计学意义(P＞0.05).结论 女性SUI患者经手术治疗后膀胱颈活动度、膀胱尿道后角、尿道角都有不同程度的改变,可以基本恢复到正常状态,且疗效相对稳定;手术不增加患者的残余尿量;超声在排除精神心理因素之后,对客观评估病情轻重和治疗后的恢复状态有着其他检查手段不可代替的优势.

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Objective To evaluate the significance and role of ultrasound parameters in the female stress urinary incontinence (SUI). Methods The changes of the distance of bladder neck mobility,posterior urethra-vesical angle,urethral angle and residual urine volume before and after the operation of transobturator tension-free vaginal tape surgery (TVT-O) for 46 cases of female SUI (experimental group ) by ultrasound were studied,and compared with 43 normal women (control group). Results The experimental group before the operation had the greater distance of bladder neck mobility and posterior urethra-vesical angle [(14.46 ± 1.28) mm, (124.87 ±2.95)°] than the control group [(7.47 ±0.55) mm, (107.83 ±3.24)°] (P ＜ 0.01 ), but the urethral angle [( 23.61 ± 2.28 )°] was smaller than the control group [(36.24 ±2.23 )°] (P ＜ 0.01 ). There was no significant difference in the distance of bladder neck mobility, posterior urethra-vesical angle, urethral angle and residual urine volume between the experimental group after the operation and the control group (P ＞ 0.05 ). The experimental group before the operation had the greater distance of bladder neck mobility and posterior urethra-vesieal angle than those after the operation [(7.84±0.76) mm, (108.74±3.63)°] (P ＜0.01), the urethral angle was smaller than that after the operation [(34.39 ± 3.46)°] (P ＜ 0.01 ), but the residual urine volume had no significant difference (P ＞ 0.05 ).Conclusions After the operation, there are some changes in the distance of bladder neck mobility, posterior urethra-vesical angle and urethral angle for the patients with female SUI,and these parameters can be restored the normal state,and have the relatively stable effect. The residual urine volume dosen't increase after the operation. Ultrasound has the advantage in objectively assessing the severity and recovery status after the operation exclusion of mental and psychological factors.     

脓毒症休克患者血管外肺水的监测及其对预后的预测价值

目的 分析脓毒症休克患者血管外肺水(EVLW)的变化特点,探讨其与脓毒症休克预后的关系.方法 采用回顾性分析的方法,将21例脓毒症休克患者根据最终临床转归分为存活组(10例)与死亡组(11例),观察两组患者的临床特征,利用脉波指示剂连续心排血量(PiCCO)监护仪进行血流动力学监测,测定EVLW,分析其与患者预后的关系.结果 存活组入院第1、2、3天EVLW分别为(12.7±1.8)、(11 3±1.3)、(10.1±1.3)ml/kg,死亡组分别为(14.4±1.0)、(14.6±1.4)、(14.6±1.3)ml/kg,两组比较差异有统计学意义(P＜0.05);存活组随入院时间延长EVLW均明显下降(P＜0.05),死亡组无明显变化(P＞0.05).结论 脓毒症休克患者EVLW均有明显增加;EVLW的动态变化可预测患者的预后.

Abstract：

Objective To analyze the alterative characteristics of the extravascular lung water (EVLW ) in the patients with septic shock and clarify its value on the prognosis of these patients.Methods By the methods of retrospective analysis,according to the ultimate survival,21 patients with septic shock were divided into survivor group (10 cases) and non-survivor group (11 cases).The clinical features of the patients were observed and hemodynamic monitoring was made with PiCCO monitor.The EVLW was measured and the relationship between the EVLW and the prognosis of patients was analyzed.Results On the first,second and third day,EVLW was (12.7 ±1.8),(11.3 ±1.3),(10.1 ±1.3) ml/kg in survivor group,and (14.4 ± 1.0),(14.6 ± 1.4),(14.6 ±1.3) ml/kg in non-survivor group respectively,and there were statistical differences between two groups (P <0.05).However,on the second day after the intensive therapy,EVLW in survivor group dropped significantly(P＜0.05),but the non-survivor group only declined slightly,and compared with the result of the first day,there was no obvious difference (P >0.05).Conclusions The EVLW in the patients with septic shock increases significantly.The dynamic changes of the EVLW may be one of the factors for predicting the prognosis of patients with septic shock.     

长期小剂量克拉霉素治疗儿童慢性分泌性中耳炎的临床观察

目的：观察长期小剂量克拉霉素治疗儿童慢性分泌性中耳炎的疗效。方法：选取本院耳鼻喉门诊2011年3月-2013年9月诊断的28例COME患儿（44耳）,按照随机数字表法将其分为克拉霉素组（24耳）和对照组（20耳）各14例,两组患儿均给予0.5%麻黄素滴鼻液滴鼻、口服黏液促排剂口服1周,克拉霉素组同时口服克拉霉素,疗程为12周;对照组口服阿莫西林,疗程为1周。观察比较两组患儿12周后的治疗效果。结果：治疗12周后,克拉霉素组的有效率75.0%（18/24）明显高于对照组的45.0%（9/20）,差异有统计学意义（P〈0.05）。两组治疗前的平均听阈比较差异无统计学意义（P〉0.05）,而治疗后克拉霉素组的平均听阈（15.6±4.3）dB明显低于对照组的（29.2±7.1）dB,差异有统计学意义（P〈0.01）。结论：长期小剂量口服克拉霉素治疗儿童慢性分泌性中耳炎效果良好,值得临床推广应用。     

嵌入法蝶形软骨鼓膜成形术的临床应用

目的 探讨嵌入法蝶形软骨鼓膜成形术的临床应用.方法 选择中央型鼓膜穿孔患者38例38耳,应用嵌入法蝶形软骨鼓膜成形术,同期内植法颞肌筋膜鼓膜成形术46例46耳作为对照组.结果 术后6个月随访,鼓膜愈合率软骨组为92.1%,对照组为91.3%,两组比较差异无统计学意义(P>0.05);纯音测听复查示平均气导提高>10 dB及平均气骨导差<10 dB的发生率差异同样无统计学意义(P>0.05).已愈合患者随访12～38个月,软骨组无鼓膜再穿孔;对照组再穿孔4耳,粘连2耳.结论 嵌入法蝶形软骨鼓膜成形术是一种简单、成功率高的技术,其远期愈合及听力恢复效果稳定,具有临床实用价值.     

鼓室内注射地塞米松治疗突发性耳聋的临床观察

目的 分析鼓室内注射地塞米松对经常规治疗无效突发性耳聋的治疗效果.方法 选择44例经常规治疗无效的突发性耳聋患者,按机械抽样法随机分为鼓室内注射组24例和对照组20例,对照组给予常规治疗,鼓室内注射组在耳显微镜下往鼓膜内缓慢注入地塞米松2.5 mg.结果 鼓室内注射组总有效率(37.5%,9/24)明显高于对照组(10.0%,2/20),差异有统计学意义(P<0.05).鼓室内注射组纯音听阈治疗后[(52.75±20.14)dB]较治疗前[(70.26±20.76)dB]明显改善(P<0.05),同时也优于对照组治疗后[(63.55±19.36)dB](P<0.05).结论 鼓室内注射地塞米松可作为常规治疗无效的突发性耳聋患者的挽救治疗手段,亦可作为避免全身大剂量使用激素不良反应的常规治疗手段之一.     

腺样体切除联合置管术在小儿难治性分泌性中耳炎治疗中的应用研究

目的 探讨腺样体切除联合置管术应用于小儿难治性分泌性中耳炎的治疗效果.方法 选取上海交通大学医学院附属上海儿童医学中心2012年4月至2014年2月间入院治疗的小儿难治性分泌性中耳炎患者90例,应用随机数表法随机分为观察组45人和对照组45人.对照组使用低温等离子腺样体切除术;观察组则应用腺样体切除联合置管术治疗.统计两组患者治疗效果、炎性积液及并发症情况,按显效、有效和无效来评价患儿临床疗效,记录并统计参与试验患儿中耳炎性积液时间和听力损失、鼓膜穿孔等并发症情况.结果 临床疗效方面,观察组和对照组的治疗总有效率分别为91.11%和73.33%,两组差异具有统计学意义(χ2=8.631,P<0.05).观察组患儿中耳积液时间为7.63±1.27天短于对照组的11.78±1.75天,差异具有统计学意义(t=3.481,P<0.05).观察组治疗后中耳炎复发的比例(2.22%)比对照组(42.22%)低,差异具有统计学意义(χ2=9.165,P<0.05).两组并发症发生率分别为8.88%和40.00%,患儿鼓膜穿孔、化脓性中耳炎和听力损失等方面较对照组发生数明显更少,差异具有统计学意义(χ2=8.186,P<0.05).结论 腺样体切除联合置管术能够有效治疗小儿难治性分泌性中耳炎,改善临床症状,提高治疗有效率,应用效果良好,值得临床推广.     

嵌入法蝶形软骨鼓膜成形术的临床应用

目的探讨嵌入法蝶形软骨鼓膜成形术的临床应用。方法选择中央型鼓膜穿孔患者38例38耳，应用嵌入法蝶形软骨鼓膜成形术，同期内植法颞肌筋膜鼓膜成形术46例46耳作为对照组。结果术后6个月随访，鼓膜愈合率软骨组为92．1％，对照组为91．3％，两组比较差异无统计学意义（P〉0．05）；纯音测听复查示平均气导提高〉10dB及平均气骨导差〈10dB的发生率差异同样无统计学意义（P〉0．05）。已愈合患者随访12～38个月，软骨组无鼓膜再穿孔；对照组再穿孔4耳，粘连2耳。结论嵌入法蝶形软骨鼓膜成形术是一种简单、成功率高的技术，其远期愈合及听力恢复效果稳定，具有临床实用价值。     

新生儿先天性食管闭锁术后早期营养途径比较

目的 比较新生儿先天性食管闭锁术后早期三种营养途径的临床应用效果.方法 将81例新生儿先天性食管闭锁术后早期按不同的营养支持方式分为肠内营养组(27例)、肠外营养组(30例)及肠内外营养组(24例),根据术后一般情况及生化指标进行分析.结果 肠内营养组、肠外营养组、肠内外营养组除了禁食时间[分别为(7.2±9.8)、(7.1±9.3)、(7.4±9.6)d]外,热量摄入、体重变化、体重、不耐受例数、住院天数比较差异均有统计学意义(P＜0.01),优劣为肠内外营养组＞肠内营养组＞肠外营养组,差异有统计学意义(P＜0.05).肠内营养组、肠外营养组、肠内外营养组除了C反应蛋白[分别为(7.0±2.4)、(6.4±1.8)、(6.2±1.3) mg/L]外,总蛋白、白蛋白、血红蛋白等其他各项检验指标比较差异均有统计学意义(P＜0.01),优劣为肠内外营养组＞肠内营养组＞肠外营养组,差异有统计学意义(P＜0.05).结论 新生儿先天性食管闭锁术后早期肠内外营养更符合食物消化、吸收的生理过程,值得在临床中推广.     

鼻内镜手术后并发分泌性中耳炎的临床探讨

目的探讨鼻内镜手术后分泌性中耳炎发生的原因。方法为50例78侧慢性鼻窦炎患者行鼻内镜鼻窦手术,手术前后检查咽鼓管功能,术后随访检查咽鼓管咽口,分析分泌性中耳炎的发生率及原因。结果50例78侧手术中,术前咽鼓管功能正常70耳,异常8耳,术后咽鼓管功能正常56耳,异常22耳,差异有统计学意义（P〈0．05）：术后咽鼓管功能正常组中咽鼓管咽口肿胀8耳,咽鼓管功能异常组中咽鼓管咽口黏膜肿胀16耳,差异有统计学意义（P〈0．05）;术后6例10耳发生分泌性中耳炎中,9耳咽鼓管咽口肿胀,1耳咽鼓管咽口正常,差异有统计学意义（P〈0．05）。结论鼻内镜手术后可能会出现咽鼓管咽口炎性肿胀,导致咽鼓管功能障碍至分泌性中耳炎。     

脑电双频指数值监控镇静深度对妇科腹腔镜术后认知功能的影响

目的观察不同脑电双频指数(Bispectral index,BIS)值监测下对妇科腹腔镜术后认知功能的影响。方法选择2012年4月至2014年12月儋州市第一人民医院妇科择期行腹腔镜手术的患者80例,根据患者BIS值分为2组:A组(40BIS值≤50)42例和B组(50BIS值≤60)38例。简易精神状态量表(mini-mental state examination,MMSE)评价认知功能,患者疼痛程度评价使用视觉模拟评分法(visual analogue scale,VAS)。结果 A组麻醉后自主呼吸恢复时间[(3.4±0.9)min]明显短于B组[(5.2±1.6)min](P0.05)。A组麻醉后苏醒时间和拔管时间[(7.7±2.4)min、(8.6±2.3)min]与B组[(7.9±2.5)min、(8.4±2.7)min]比较差异无统计学意义(P0.05)。A组和B组麻醉前MMSE评分差异无统计学意义(P0.05),麻醉结束拔管1、3 h后MMSE评分两组均明显降低(P0.05),拔管24 h后两组MMSE评分恢复到麻醉前水平(P0.05)。其中麻醉结束拔管1 h后A组MMSE评分显著高于B组(P0.05),拔管3、24 h后两组的MMSE比较差异无统计学意义(P0.05)。A组七氟烷用量为(14.3±3.5)m L,显著低于B组的(18.5±4.8)m L(P0.05)。A组24 h后VAS评分为1.8±0.6,B组为1.7±0.5,两组比较差异无统计学意义(P0.05)。结论 40BIS值≤50组术后患者认知功能障碍较50BIS值≤60组轻,具有一定的临床应用价值。     

胆石症合并肝硬化患者应用腹腔镜胆囊切除术的疗效分析

目的 探讨胆石症合并肝硬化患者行腹腔镜胆囊切除术(LC)的疗效.方法 回顾性分析50例胆石症合并肝硬化患者的临床资料,分别进行LC(LC组,23例)或开腹胆囊切除术(OC组,27例),比较两组患者的手术时间、术中出血量、住院时间和并发症发生情况.结果 LC组手术时间[(43.2±15.6)min]、术中出血量[(78.3±22.5)ml]和住院时间[(5.7±2.5)d]均明显优于对照组[分别为(77.4±21.2)min、(195.7±32.4)ml、(93±3.2)d],差异有统计学意义(P＜0.05);两组术后并发症主要为脱水和尿路感染,但发生率组间比较差异无统计学意义(P＞0.05).两组术后均无其他严重并发症和死亡病例出现.结论 对于Child-Pugh A、B级的胆石症合并肝硬化患者而言,LC是一种安全可行的微创手术,值得临床推广应用.