改良化学性迷路切除术治疗顽固性梅尼埃病初步观察

目的 初步观察鼓室内放置庆大霉素明胶海绵对顽固性梅尼埃病的疗效.方法 选取经正规保守治疗无效、严重眩晕伴中～重度听力损失的顽同性梅尼埃病患者6例,采用鼓室内放置庆大霉素(30 mg/ml)明胶海绵的方法 进行治疗.观察眩晕,听力及耳鸣的变化.结果 4例患者一次治疗后眩晕完全控制,随访1～3年无复发.2例治疗后仍有眩晕,其中1例重复治疗1次后随访2年眩晕控制;另1例给予鼓窜内地塞米松注射,眩晕发作较治疗前减轻.6例患者中,出现听力轻度恶化和一过性耳鸣加重各1例.结论 鼓室内放置庆大霉素明胶海绵可能是一种治疗顽固性梅尼埃病安全、有效的新方法.     

观察顽固性梅尼埃病患者经半规管阻塞联合内淋巴囊减压术治疗后的临床疗效

目的 探讨顽固性梅尼埃病患者经半规管阻塞联合内淋巴囊减压术治疗后的临床疗效。方法 选取2020年5月至2021年9月收治的80例顽固性梅尼埃病患者作为研究对象,用随机数字表法将其分对照组和观察组,各40例,对照组接受药物治疗,观察组接受经半规管阻塞联合内淋巴囊减压术治疗,比较两组患者治疗疗效、梅尼埃病四联症模拟视觉评分、听力评分、眩晕评分、影像学指标等。结果 观察组疗效95%高于对照组72.50%(χ²=7.4397,P <0.05);两组患者治疗前纯音测听评分(t=0.0317)、DHI评分(t=0.1833)、VAS评分(t=0.0680)比较(P> 0.05),治疗后,观察组纯音测听评分(t=17.3372)、DHI评分(t=21.4966)、VAS评分(t=10.3817)低于对照组(P <0.05);两组患者治疗前右椎动脉血流速度(t=0.2566)、基底动脉血流速度(t=0.0776)、左椎动脉血流速度(t=0.0425)比较(P> 0.05),治疗后,观察组右椎动脉血流速度(t=10.2261)、基底动脉血流速度(t=3.80...     

20%甘露醇联合地塞米松治疗梅尼埃病效果观察

梅尼埃病又称内耳眩晕症,主要病因为内淋巴积水,临床症状多表现为眼球震颤、耳鸣、听力失常、旋转性眩晕等。本院应用20%露醇联合地塞米松治疗梅尼埃病,并与单用20%甘露醇作比较,效果满意,现报道如下:1资料与方法1.1对象与分组我院2012年1月至2014年1月接受治疗的梅尼埃病患者72例,排除颈椎、心脏疾病导致眩晕,均伴随不同程度的恶心、呕吐、耳鸣、眼球震颤等症状。其     

内淋巴囊减压术治疗梅尼埃病的护理

目的探讨内淋巴囊减压术的观察护理要点。方法对24例实行内淋巴囊减压的患者实行针对性的专科护理，进行归纳并做回顾性分析。结果眩晕症状消失或明显改善者9例；耳呜症状消失或明显改善者14例；1例术后两年后复发，再行右内淋巴囊疤痕松解＋分流术，术后眩晕症状消失。结论内淋巴囊减压术的成功与针对性的专科护理密切相关。     

庆大霉素鼓室内注射治疗梅尼埃病19例分析

目的分析鼓室内注射庆大霉素治疗难治性梅尼埃病的方法及疗效。方法对19例难治性梅尼埃病患者鼓室内注射浓度为30mg/ml的庆大霉素0.5～0.8ml,每周一次,共3次。结果 19例患者治疗后随访18～24个月,眩晕控制为A级12例,B级4例,有效控制率为84.2%,听力损失者4例,约占有21.1%。结论鼓室内注射庆大霉素治疗难治性梅尼埃病疗效确切,对听力的损害轻微,且操作简单,费用低,易于临床推广。     

梅尼埃病的治疗

该文对梅尼埃病的治疗进行了系统综述.目前梅尼埃病不能治愈,所有的治疗都只是减轻相关的症状,大部分梅尼埃病患者依靠药物治疗,约1/3的人在药物治疗失败后需求助外科手术治疗.药物治疗分为急性发作期和间歇期的治疗,目前尚无国际统一的方案,多为经验治疗.近年来经鼓膜鼓室给药途径的药物治疗得到了广泛研究和发展.只有当系统内科治疗无效的顽固性梅尼埃病才考虑外科治疗,术式分两大类:保守性术式(内淋巴囊手术和耳蜗球囊切开术)和破坏性术式(迷路切除术和前庭神经切断术).总之,梅尼埃病的治疗还需进一步探讨.     

梅尼埃病的病因与治疗药物

梅尼埃病(Meniere’s Disease)是一种特发性内耳疾病.临床特征为:眩晕、耳鸣、耳胀满感和低频听觉丧失。本文讨论该疾病的发病机理和治疗药物。发病机理内淋巴积液 目前对梅尼埃病的发病机理尚未完全了解。病理组织学研究获知该病主要由内淋巴积液引起,内淋巴管连接内耳的耳蜗和前庭部。内淋巴管阻塞和(或)内淋巴囊功能障碍以及内淋巴分泌失调都会造成内淋巴积液。内淋巴囊的功能有:     

眩晕汤加减治疗梅尼埃病240例疗效观察

目的观察眩晕汤加减治疗梅尼埃病的临床疗效。方法将360例梅尼埃病患者随机分为治疗组240例和对照组120例。治疗组予眩晕汤加减治疗,对照组予山莨菪碱10mg加入5%葡萄糖溶液250ml中静脉滴注。治疗后比较2组疗效及眩晕整体评分。结果治疗组总有效率为89.5%高于对照组的71.67%,差异有统计学意义(P<0.05)。2组治疗后眩晕整体评分较治疗前均降低(P<0.05);且治疗组治疗后眩晕整体评分低于对照组,差异有统计学意义(P<0.05)。结论眩晕汤加减治疗梅尼埃病疗效确切,能明显改善患者症状,值得推广应用。     

倍他司汀治疗梅尼埃病所致眩晕的疗效观察及护理体会

目的：观察倍他司汀治疗梅尼埃病所致眩晕的疗效、安全性,总结护理体会。方法：将入选的76例梅尼埃病所致眩晕患者随机分成试验组（38例）和对照组（38例）,试验组在常规治疗基础上给予倍他司汀片每次1片,每日3次;对照组仅给予常规治疗。2组疗程均为1周。2组均给予系统护理。比较2组治疗1周后的临床疗效及不良反应。结果与结论：试验组总有效率（92.11%）显著高于对照组（73.68%）,差异有统计学意义（χ2=4.547,P=0.033）;试验组总不良反应发生率（18.42%）与对照组（15.79%）接近,差异无统计学意义（P〉0.05）。系统护理是梅尼埃病患者病情改善的必要条件,在系统护理的基础上给予倍他司汀治疗梅尼埃病所致眩晕具有较好疗效,且安全性较好。     

中西医结合治疗梅尼埃病57例

目的：观察中西医结合治疗梅尼埃病的临床疗效。方法：回顾性分析本院1997年5月～2009年6月以来收治的57例梅尼埃病患者,均用中西医结合治疗。结果：57例全部治愈,有效率为100%。结论：中西医结合治疗梅尼埃病疗效好、见效快、治愈率高、安全可靠。     

地奥心血康治疗梅尼埃病与氟桂利嗪的比较

梅尼埃病患者６２例，分为２组。３４例（年龄５８±ｓ１４ａ）口服地奥心血康２００ｍｇ，ｔｉｄ；２８例（年龄５３±１０ａ）服氟桂利嗪５ｍｇ，ｂｉｄ（加烟酸１００ｍｇｔｉｄ或长春西汀片５ｍｇｔｉｄ），疗程均为７ｄ。２组的有效率分别为９４％和８２％（Ｐ＞０．０５）。地奥心血康起效快，症状消失早，无不良反应，提示该药对梅尼埃病有良好疗效。     

实验性膜迷路积水对前庭碳酸酐酶的影响

目的 探讨实验性膜迷路积水前庭损害的机制。方法 用手术方法破坏豚鼠（n=20）内淋巴囊造成膜迷路积水模型,随机等分为实验组和对照组;用组织细胞化学染色法,观察膜迷路积水对前庭暗细胞、移行细胞、毛细胞碳酸酐酶的影响,并用计算机图像分析系统定量分析其阳性产物。结果 实验性膜迷路积水碳酸酐酶的分布与正常无显著变化（P>0.05）。结论 实验性膜迷路积水早期不影响前庭碳酸酐酶活性,提示实验性膜迷路积水早期对内淋巴液的产生无明显影响。     

Menierè's disease: is it a bilateral disease?

BACKGROUND: Bilateral Meniere's disease (MD) is still controversial due to different criteria used to assess the involvement of the primarily affected ear and the contralateral one. We evaluated the percentage of bilateral forms in 49 patients with MD. METHODS: 49 patients with (MD) were studied. All were selected according to the following requirements: history, tonal audiometry, glycerol test, Auditory Brainstem Response (ABR), vestibular examination. Magnetic Resonance (MR) was performed in 14 patients. RESULTS: A raised hearing threshold in the contralateral ear was found in 23 patients, but only 7 (14.3%) fulfilled the requirements to be considered affected by bilateral MD. The delay of occurrence in the contralateral ear was 7 years (from 5 to 12 years). Submillimeter Magnetic Resonance is determinant for differential diagnosis with Meniere-like syndromes. CONCLUSIONS: A conservative approach in surgical treatment of unilateral Meniere's disease is recommended because of the possibility of evolution in a bilateral form, that can occur even after 10 years from the onset of the disease.     

梅尼埃病合并甲状腺功能低下症的免疫相关分析

目的 评估梅尼埃病患者合并甲状腺机能减退症的免疫相关性.方法 回顾性病例对照研究,比较梅尼埃病(MD)与普通眩晕症之间同期应用甲状腺素补充替代疗法患者的分布情况.2005年2月-2010年5月间收治的以眩晕为主诉的患者1908例,其中50例梅尼埃病患者,符合1996年10月中华医学会耳鼻咽喉科学会全国会议(上海)制定的...     

Treatment of Budd-Chiari syndrome in a liver transplant unit, the role of transjugular intrahepatic porto-systemic shunt and liver transplantation

BACKGROUND: Budd-Chiari syndrome is an uncommon cause of liver failure usually associated with an underlying hypercoagulable state. AIM: To evaluate current trends in management of Budd-Chiari syndrome at our institution. METHODS: Twenty-two patients with Budd-Chiari syndrome underwent transjugular intrahepatic porto-systemic shunt, liver transplantation, or both in between 1992 and 2001. We analysed underlying diagnosis, medical therapy, complications, follow-up and overall outcomes. RESULTS: Five patients (17%) presented with fulminant liver failure and 17 patients (83%) with new-onset ascites or chronic liver disease. Seventeen patients (74%) underwent transjugular intrahepatic porto-systemic shunt: improvement or stabilization occurred initially in 14 (82%), whereas the other three patients died within a month. At a mean 3 years follow-up eight patients (47%) continued to do well clinically and four have died (23.5%); seven have required transjugular intrahepatic porto-systemic shunt revisions (mean 2.3 interventions), five have experienced transjugular intrahepatic porto-systemic shunt occlusion managed with new transjugular intrahepatic porto-systemic shunt placement and five patients underwent subsequent transplantation. Of the 10 patients who underwent liver transplantation, patient and graft survival are 80% at a mean 5.7 years of follow-up. No patient developed post-transplant Budd-Chiari syndrome. CONCLUSIONS: Transjugular intrahepatic porto-systemic shunt is usually feasible in patients with Budd-Chiari syndrome, and is best suited as a bridge to more timely liver transplantation. Long-term success of transjugular intrahepatic porto-systemic shunt is limited and usually requires revision, placement of a new shunt or liver transplantation. Liver transplantation with chronic anticoagulation offers excellent short- and medium-term patient and graft survival. In our series, there was no recurrence of Budd-Chiari syndrome after liver transplantation.     

Portal-systemic shunting in patients with fibrosis or cirrhosis due to chronic hepatitis C: the minimal model for measuring cholate clearances and shunt

BACKGROUND: Measurement of portal inflow and portal-systemic shunt using cholate clearances could be useful in monitoring patients with liver disease. AIM: To examine relationships of cholate clearances and shunt to cirrhosis and varices and to define minimal sampling requirements. METHODS: Five hundred forty-eight studies were performed in 282 patients enrolled in the Hepatitis C Antiviral Long-term Treatment to prevent Cirrhosis (HALT-C) trial. Stable, non-radioactive isotopes of cholate were administered intravenously and orally, clearances (Cl(iv) and Cl(oral)) were calculated from [dose/area under curve (AUC)] and cholate shunt from [(AUC(oral):AUC(iv)) x (Dose(iv):Dose(oral)) x 100%]. RESULTS: Cholate Cl(oral) and cholate shunt correlated with prevalences of both cirrhosis and varices (P < 0.0001 for all). Peripheral venous sampling at 5, 20, 45, 60 and 90 min defined the minimal model. Linear regression of cholate shunt determined from five points within 90 min vs. the standard method of 14 points over 3 h yielded slope of 1.0 and intercept 0.5% (r(2) = 0.98, P < 0.0001). Results were identical in the 189 validation studies (slope 1.0, intercept 0.5%, r(2) = 0.99, P < 0.0001). CONCLUSIONS: Cholate Cl(oral) and cholate shunt may be useful in monitoring patients with liver disease. The 5-point model enhances application of cholate Cl(oral) and cholate shunt in the non-invasive assessment of the portal circulation.     

Ménière's disease. A practical approach to management

The management of Ménière's disease continues to provide a formidable clinical challenge, mainly because its precise aetiology is unknown. The unpredictable natural history of the condition has consistently bedevilled attempts to evaluate therapeutic efficacy, and there have been no entirely satisfactory prospective controlled clinical trials of any specific medical or surgical treatment. Although no form of medication has been convincingly shown to influence the long term course of the disease, many drugs may be useful in the control of vertigo. In recent years conservation of hearing has assumed equal importance to the control of vertigo as the therapeutic goal. Indications for conservative endolymphatic sac surgery, which appears to offer the best prospect of preventing the progressive deafness which invariably accompanies the established condition, are discussed. The necessity for a flexible therapeutic approach to the management of Ménière's disease is underlined.     

先天性心脏病合并肺动脉高压患儿57例临床分析

目的分析先天性心脏病合并肺动脉高压患儿的临床资料,以提高对该病的临床诊治水平。方法 57例患儿均予以吸氧、抗感染以及强心、利尿、扩血管治疗。11例左向右分流型先天性心脏病以及5例复杂型先天性心脏病经内科治疗后肺部感染、心力衰竭难以控制,转我院心外科予以手术。术后8例患儿用前列地尔,6例患儿用西地那非降肺动脉压力。患儿于内科治疗前后、手术后药物治疗前后测肺动脉压力(PAP)、左室射血分数(LVEF)及血浆N端-脑钠肽前体(NT-proBNP)。结果 38例左向右分流型先天性心脏病患儿经内科治疗后PAP、血浆NT-proBNP水平均较治疗前下降(P<0.05),LVEF较治疗前升高(P<0.05)。11例左向右分流型先天性心脏病以及5例复杂型先天性心脏病患儿PAP、血浆NT-proBNP水平均高于前述38例患儿(P<0.05),LVEF低于前述38例患儿(P<0.05)。8例患儿术后予以前列地尔,6例予以西地那非治疗后,PAP、血浆NT-proBNP水平较用药前下降(P<0.05),LVEF较用药前升高(P<0.05)。结论先天性心脏病合并肺动脉高压需早治疗,可改善预后。前列地尔、西地那非在治疗肺动脉高压方面是有效的。     

Management of traumatic arterio-venous fistulas,experience in Armed Forces General Hospital,Addis Ababa

In Armed Forces General Hospital from March to December 1999, 53 patients were operated for Arterio-venous fistula. All were males, their age ranging from 19 to 46 years, average 27 years. The diagnosis of arterio-venous fistulas was established clinically. The pathological distribution of the lesions were: 23(43.4%) Arterio-Venous aneurysm; 11(20.75%) Arterio-Venous fistula, 19(35.85%) Arterial false aneurysms. The anatomical location was: 15 femoral, 10 Tibial, 6 poplitial, 6 brachial, 4 Axilláry, 1 ulnar, 7 external carotid and 1 occipital. The types of surgical procedures performed were: 29 (54.72%) excision of the arterio-venous fistula and aneurismal sac with arterial restoration by end to end anastomosis and/or saphenous vein graft, 16(30.19%) by excision of arteriovenous fistula and quadriple ligation of small vessels, 8(15.09%) excision of the false aneurismal sac and lateral repair of the artery (lateral arterioraphy). During the post operative period the patients were followed for three months, and we had the following results based on the clinical outcome criteria; 37(69.81%) excellent, 15(28.3%) good and 1(1.89%) fair.