鼻内窥镜下中鼻甲成形术

目的 :探讨内窥镜下中鼻甲成形和保留中鼻甲与预后的关系。方法 :双侧慢性鼻窦炎、鼻息肉 6 0例 ,在内窥镜鼻窦手术中 1侧行中鼻甲成形术 ,另 1侧保留中鼻甲 ,观察术后鼻腔黏连情况。结果 :中鼻甲保留侧术后发生鼻腔黏连 13例 ,中鼻甲成形侧仅 2例发生黏连。结论 :内窥镜下中鼻甲成形术能保持良好的中鼻甲形态 ,恢复鼻腔生理功能 ,防止术后黏连。     

中鼻甲成形术

中鼻甲具有重要的生理功能 ,但若存在肥厚、息肉样变、泡性中鼻甲及反向中鼻甲等病变时 ,则易导致窦口鼻道复合体阻塞、术后鼻腔粘连及术后疗效差等。我们对 32 8例慢性鼻窦炎和 /或鼻息肉患者行功能性鼻内窥镜手术 ,根据中鼻甲病变情况采取不同处理方法。旨在探讨中鼻甲成形术在鼻内窥镜手术治疗慢性鼻窦炎中的应用并对手术疗效进行统计分析。1　材料与方法1.1.　一般资料　 1995年 1月— 2 0 0 0年 6月 ,我院共行功能性鼻内窥镜手术 32 8例 ,单侧 5 8例 ,双侧 2 70例。其中男 193例 ,女 135例。年龄 :<12 (岁 ) 12例 ,12～ (岁 ) 5 1例 ,2…     

鼻内窥镜手术中病变中鼻甲的处理

目的 :探讨鼻内窥镜手术 ( ESS)对病变中鼻甲处理方法与慢性鼻窦炎 II型 2、3期手术疗效及鼻功能恢复之间的关系。方法 :2 1 4例慢性鼻窦炎 II型 2、3期患者行功能性鼻内窥镜手术。中鼻甲病变包括肥厚、泡性、反向弯曲等解剖变异及息肉样变。依中鼻甲病变程度行中鼻甲下缘激光烧灼 ,中鼻甲外侧部矢状切除及外侧部加下部部分切除术。结果 :术后 3～ 6个月中鼻甲形态基本恢复正常 ,无鼻腔粘连发生 ,慢性鼻窦炎 II型 2、3期的治愈好转率 86.4% ( 1 85 /2 1 4) ,无效率 1 3.6% ( 2 9/2 1 4)。结论 :对慢性鼻窦炎 II型 2、3期患者 ,在术中酌情处理病变中鼻甲 ,既防止鼻腔粘连的发生 ,形成一个开放的窦口 -鼻道通气引流系统 ,缩短换药时间 ,提高治愈好转率 ,又符合人体鼻腔生理、解剖功能     

鼻内窥镜手术的中鼻甲处理

鼻内窥镜手术中鼻甲处理一直存在争议,如何妥善的处理中鼻甲与术后疗效密切相关,现就30例鼻内窥镜手术对中鼻甲的处理进行探讨。1 资料与方法 鼻内窥镜手术30例,男21例,女9例。年龄18～76岁,平均年龄38岁。均为双侧慢性鼻窦炎、鼻息肉患者。在鼻内窥镜下行鼻息肉摘除,鼻道窦口复合体或筛窦手术后,1侧切除部分中鼻甲,1侧保留中鼻甲。统计术后住院鼻腔清理时间。术后2～5个月后复查鼻腔粘连情况和手术前后的嗅觉变化(检查粘连的方法,采用耳鼻咽喉科常规检查及内窥镜检查,嗅觉检查为直接嗅气味的主观测定法)。2 结果2.1 术后住院鼻腔清理时间:中鼻甲部分切除侧8～11d,平均9.2d;中鼻甲保留侧为7～9d,平均为7.9d。前者明显     

中鼻甲成形术在鼻内窥镜手术中的应用

目的探讨中鼻甲成形术在慢性鼻窦炎鼻息肉内镜治疗中的作用。方法222例慢性鼻窦炎鼻息肉病人中72例行中鼻甲成形,102例行部分切除未成形或中鼻甲全切,48例未处理中鼻甲。术后观察中鼻甲形态、粘连情况、术腔上皮化情况等。结果中鼻甲成形组中鼻甲与鼻腔外侧壁粘连发生率为20.8%(15/72),未成形组52.5%(21/40),保留中鼻甲组86.3%(19/22)(p<0.01)。术后鼻腔结痂干燥感发生率:成形组13.7%(10/72),未成形组30.0%(12/40),保留中鼻甲组9.1%(2/22)(p<0.01)。术后术腔上皮化时间:成形组6.5周,未成形组10周,保留中鼻甲组6周。结论中鼻甲成形术既保留了中鼻甲的形态和生理功能,又开放了窦口鼻道复合体,可以缩短术后鼻腔清理时间,促使术腔尽快上皮化,防止术后粘连,对提高鼻内镜的疗效有积极的作用。     

鼻内窥镜手术中肥厚中鼻甲的处理

中鼻甲存在畸形、肥厚及息肉样变等病变时 ,易导致窦口鼻道复合体阻塞、术后鼻腔粘连 ,术后疗效也差[1] 。我们对112例 (16 1侧 )慢性鼻窦炎和 /或鼻息肉并发中鼻甲肥厚患者行功能性鼻内窥镜手术 ,根据中鼻甲病变情况采取适当处理方法 ,探讨了自身异常的中鼻甲处理与否与手术疗效及鼻功能恢复之间的关系。1　资料与方法1.1.　一般资料　在我科 2 0 0 1— 2 0 0 3年行功能性内窥镜鼻窦手术的患者中选择有中鼻甲病变的患者共 112例 ,随机分成二组 :①A组为中鼻甲矫形组 5 0例 (76侧 ) ,男 2 8例 ,女 2 2例 ,年龄 17～ 6 9岁 ,Ⅱ型 2期 2 5侧 …     

鼻内镜下手术治疗慢性鼻窦炎临床疗效分析

目的:观察鼻内窥镜下手术治疗慢性鼻窦炎的临床效果。方法:回顾性分析126例慢性鼻窦炎患者的临床资料,所有患者均采用鼻内镜下手术治疗。结果:126例患者手术均获成功,成功率为100%,术后2年,治愈64例,好转42例,无效20例,总有效率为84.1%。术后并发症发生率为4.8%。术后随诊6～24个月,术后鼻腔黏连6例,黏连部位主要发生在中鼻甲与鼻中隔或鼻腔外侧壁,同时行下鼻甲部分切除术的患者主要为下鼻甲与鼻中隔黏连。结论:慢性鼻窦炎采用鼻内窥镜下手术治疗效果较为理想,加强术后护理管理对降低术后并发症的发生十分重要。     

鼻内镜术后鼻腔黏连的临床探讨

目的分析慢性鼻窦炎鼻息肉鼻内镜术后鼻腔黏连的原因,探讨防治的方法,以进一步提高鼻内镜鼻窦手术的疗效。方法对2005年3月至2005年12月在本科行鼻内镜鼻窦手术的患者136例238侧随访6个月,观察鼻腔黏连的情况,并回顾性分析病史资料。结果术后1个月发生30侧(12.6%)鼻腔粘连,25侧(10.5%)中鼻甲与鼻腔外侧壁粘连,16侧(6.7%)中鼻甲与鼻中隔粘连,1侧(0.42%)下鼻甲与鼻中隔粘连,予以鼻内镜下分离,部分使用微型电动切割器,解除鼻腔异常解剖结构,切除残余钩突。术后6个月观察鼻腔粘连下降到12侧(5.0%),其中中鼻甲与鼻腔外侧壁粘连7侧(2.94%),中鼻甲与鼻中隔粘连3侧(1.3%),筛窦腔闭塞2侧(0.84%)。结论围手术期皮质类固醇激素治疗,钩突的完整切除,中鼻甲的恰当处理,鼻腔异常解剖结构的解除,微型电动切割器的使用,合适的填塞材料选择及较长的中鼻道填塞的时间,术后定期术腔清理,粘连的及时处理可降低鼻内镜术后鼻腔的粘连率。     

功能性内窥镜鼻窦手术联合中鼻甲切除治疗难治性慢性鼻窦炎的效果

目的观察功能性内窥镜鼻窦手术联合中鼻甲切除治疗难治性慢性鼻窦炎的效果。方法选取2017年11月到2018年11月信阳市第四人民医院收治的100例难治性慢性鼻窦炎患者,按照随机数表法分为对照组和观察组,各50例。给予对照组功能性内窥镜鼻窦手术治疗,给予观察组功能性内窥镜鼻窦手术联合中鼻甲切除治疗。比较两组治疗效果和术后并发症发生率。结果观察组治疗总有效率为94.55%(52/55),高于对照组的82.22%(37/45),差异有统计学意义(P<0.05)。观察组术后并发症发生率为7.27%(4/55),低于对照组的20.00%(9/45),差异有统计学意义(P<0.05)。结论采用功能性内窥镜鼻窦手术联合中鼻甲切除治疗难治性慢性鼻窦炎,可明显提高治疗效果,降低术后并发症发生率,值得临床推广应用。     

鼻内镜手术病变中鼻甲不同处理方法与疗效的关系

目的探讨鼻内镜手术病变中鼻甲不同处理方法与慢性鼻窦炎、鼻息肉手术疗效及鼻功能恢复之间的关系。方法为60例慢性鼻窦炎和(或)鼻息肉患者行鼻内镜手术,对不同病变的中鼻甲进行适当的处理。分为中鼻甲成形术组和中鼻甲部分切除术组,术后对中鼻甲形态、术后清理时间、鼻腔粘连情况、手术前后嗅觉变化进行随访观察。结果术后6个月中鼻甲成形术组中鼻甲形态恢复正常27例(90.0%),水肿或息肉样变2例(6.7%),发生粘连1例(3.3%),术后嗅觉明显改善24例(80.0%),无变化6例(20.0%),术后清理时间为6～10天,平均(7.1±0.3)天。中鼻甲部分切除术组中鼻甲形态恢复正常20例(66.7%),水肿或息肉样变4例(13.3%),发生粘连6例(20.0%),术后嗅觉明显改善23例(76.7%),无变化7例(23.3%),术后清理时间为8～12天,平均(9.4±1.1)天。结论鼻内镜鼻窦手术中,对病变中鼻甲进行成形术比对中鼻甲进行部分切除术可以缩短术后鼻腔清理时间,促使鼻腔尽快上皮化,对防止术后粘连及提高临床治愈率有积极作用。     

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.