布地奈德体位滴鼻治疗伴腺样体肥大的小儿分泌性中耳炎31例

目的 探讨布地奈德体位滴鼻治疗伴有腺样体肥大的小儿分泌性中耳炎的疗效。 方法 选取伴腺样体肥大的分泌性中耳炎患儿62例作为研究对象,按治疗方法不同分为治疗组和对照组,每组各31例,治疗组予布地奈德体位滴鼻,对照组行等待观察,对两组临床效果进行分析比较。 结果 治疗组有效率为83.87%,对照组有效率为61.29%,差异有统计学意义(P<0.05)。 结论 布地奈德体位滴鼻在治疗伴有腺样体肥大的小儿分泌性中耳炎中疗效显著,局部应用不良反应小。     

儿童阻塞性睡眠呼吸暂停低通气综合征危险因素的

目的 研究儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的潜在危险因素及其因素之间的协同作用。 方法 因打鼾、呼吸音粗、张口呼吸等就诊福建省福州儿童医院耳鼻咽喉科行多导睡眠(PSG)监测的患儿纳入研究对象。经过PSG监测确诊为OSAHS的321例临床病例资料完整的患儿为病例组(OSAHS组)。采用年龄和性别匹配的方法,纳入经过PSG监测排除OSAHS的321例临床资料完整的儿童作为对照组。收集这两组患儿口咽部检查和电子鼻咽喉镜等检查结果的临床病例资料进行回顾性分析。 结果 多因素回归分析显示,伴有鼻窦炎的患儿OSAHS发生率较无鼻窦炎时高3.229 78倍(P<0.001);与Ⅰ度扁桃体比较,Ⅱ度扁桃体发生儿童OSAHS的OR为1.596 58(P=0.032 2),Ⅲ度和Ⅳ度扁桃体发生儿童OSAHS的OR分别为2.306 52(P=0.000 8)和4.430 85(P<0.001)。与Ⅰ度腺样体比较,Ⅱ度腺样体发生儿童OSAHS的OR为1.804 33(P=0.005 1),Ⅲ度和Ⅳ度腺样体发生儿童OSAHS的OR分别为2.883 38(P<0.001)和3.220 91(P=0.000 2)。分层分析显示,伴有鼻窦炎的患者中随着腺样体肥大程度的递增,OSAHS的发病危险增加的趋势高于不伴有鼻窦炎的患者(P=0.004 1)。 结论 儿童阻塞性睡眠呼吸暂停低通气综合征是多因素共同作用的结果,其中腺样体肥大、扁桃体肥大、鼻窦炎是儿童OSAHS的独立危险因素。鼻窦炎可以与肥大的腺样体产生协同作用,共同增加OSAHS的发病风险。     

鼻内镜下等离子射频消融术对合并鼻窦炎的小儿腺样体肥大患者疗效及鼻腔黏膜纤毛清除功能的影响

目的 探讨鼻内镜下等离子射频消融术治疗小儿腺样体肥大并鼻窦炎的临床疗效及对鼻腔黏膜纤毛清除功能的影响。 方法 选取腺样体肥大并鼻窦炎患儿96例,随机平均分为两组,对照组采用普通手术切除法,观察组采用低温等离子射频消融法,对比两组患者的手术时间、术中出血量、鼻内镜下评分下降幅值,采用糖精试验测定手术前后鼻腔黏膜纤毛传输速率(MTR)。 结果 两组患者的临床疗效比较差异无统计学意义(P>0.05)。两组患者的手术时间、术中出血量及鼻内镜下评分下降幅值比较,差异有统计学意义(P<0.05)。与手术前比较,对照组患者手术后MTR差异无统计学意义(P>0.05),观察组患者手术后MTR差异有统计学意义(P<0.05);与治疗组比较,观察组患者手术后MTR差异有统计学意义(P<0.05)。 结论 鼻内镜下等离子射频消融术治疗小儿腺体肥大并鼻窦炎的术中出血量少、手术时间短且对患者鼻腔黏膜纤毛清除功能影响不明显,临床疗效显著。     

腺样体与咽鼓管圆枕的毗邻关系及其与分泌性中耳炎的相关性

目的　观察腺样体肥大儿童的腺样体与咽鼓管圆枕的毗邻关系,探讨其与分泌性中耳炎的相关性。方法 144例腺样体肥大（或同时扁桃体肥大）70°鼻内镜下行等离子消融术患儿,术中观察并记录腺样体与咽鼓管圆枕的毗邻关系,并将其分为Ⅰ、Ⅱ、Ⅲ共3型;比较3组患儿分泌性中耳炎发病率、腺样体重度肥大（A/N比值是否大于0.7） 的发生率并计算有无统计学差异。结果　本组患儿分泌性中耳炎发病率23.6%;腺样体与咽鼓管圆枕的毗邻关系及合并分泌性中耳炎,Ⅰ型3例（9.1%,3/33）、Ⅱ型10例（16.9%,10/59）、Ⅲ型21例（40.4%,21/52）,Ⅰ型与Ⅱ型分泌性中耳炎发生率无显著性差异（χ 2=1.077,P =0.299）,Ⅰ型与Ⅲ型有显著性差异（χ 2=9.757,P =0.002）,Ⅱ型与Ⅲ型有显著性差异（χ 2 =7.542,P =0.006）;Ⅰ型和Ⅱ型组腺样体A/N＞0.7之和为34.9%,三型组A/N＞0.7为82.2%,Ⅰ型及Ⅱ型腺样体重度肥大率之和与Ⅲ型有显著性差异（χ 2=30.556,P =0.000）。结论　腺样体与咽鼓管圆枕毗邻关系及腺样体的肥大程度与分泌性中耳炎有显著相关性。     

鼻内镜手术联合鼻用糖皮质激素治疗腺样体肥大性

目的 探讨鼻用糖皮质激素辅助鼻内镜下腺样体切除术治疗腺样体肥大性小儿鼾症的临床效果及安全性。 方法 选取腺样体肥大性小儿鼾症患者98例为研究对象,采用随机平行对照法将其分为2个组各49例。对照组给予鼻内镜下腺样体切除术,以及口服头孢克洛颗粒、雾化吸入地塞米松等常规治疗。观察组在对照组基础上给予鼻用糖皮质激素喷鼻。比较两组治疗有效率、不良反应发生率、治疗前后鼻咽侧位片A/N值、呼吸暂停低通气指数、睡眠质量、免疫与炎症因子水平的差异。 结果 观察组总有效率为89.80%(44/49),对照组为73.47%(36/49),观察组显著高于对照组(χ2=4.356, P=0.037)。观察组出现鼻出血1例,鼻前庭干燥感1例,发生率为4.08%,对照组未见鼻出血及鼻前庭干燥感发生,两组不良反应发生率比较差异无统计学意义(P>0.05)。治疗前,两组鼻咽侧位片A/N值、呼吸暂停低通气指数及睡眠质量比较差异无统计学意义(P>0.05),治疗后两组鼻咽侧位片A/N值、呼吸暂停低通气指数及睡眠质量均改善,且组间比较差异有统计学意义(P<0.05)。治疗前,两组IgE、LTE4、TNF-α、IL-6、IL-8比较差异无统计学意义(P>0.05),治疗后,两组IgE、LTE4、TNF-α、IL-6、IL-8均降低,且组间比较差异有统计学意义(P<0.05)。 结论 对腺样体肥大性小儿鼾症患者,给予鼻用糖皮质激素辅助鼻内镜腺样体切除术治疗能够通过抑制炎症因子释放,改善打鼾、鼻塞等临床症状,且风险较小,患儿睡眠质量较高,值得推广应用。     

鼻呼出一氧化氮对慢性鼻窦炎诊断的临床应用价值

目的 探讨鼻呼出一氧化氮(nNO)在慢性鼻窦炎(CRS)临床诊断中的应用价值。 方法 回顾性分析135例CRS患者及40例非CRS患者的临床资料,包括患者nNO水平的差异,nNO水平与年龄、BMI、外周血嗜酸性粒细胞计数及百分比、CT Lund-Mackay评分及E/M比值的相关性,通过Logistic回归及ROC曲线分析nNO在CRS中的诊断应用价值。 结果 CRS组、CRSsNP组及CRSwNP组的nNO水平显著低于非CRS组(P<0.001),CRSwNP组的nNO水平显著低于CRSsNP组(P<0.001);eCRSwNP组及non-eCRSwNP组患者的nNO水平显著低于非CRS组患者(P<0.001),eCRSwNP组的nNO水平显著低于non-eCRSwNP组患者(P<0.05)。CRS组和CRSwNP组nNO水平均与E/M比值及Lund-Mackay评分呈显著负相关性(r=-0.423, P<0.001;r=-0.650, P<0.001;r=-0.434, P<0.001;r=-0.608, P<0.001)。Logistic回归分析发现nNO水平与CRS分型显著相关(P<0.01)。nNO对鉴别非CRS与CRS、CRSsNP及CRSwNP具有中度预测价值(AUC=0.849,P<0.001;AUC=0.771,P<0.001;AUC=0.894,P<0.001),对鉴别CRSsNP与CRSwNP具有中度预测价值(AUC=0.776,P<0.01)。对鉴别非CRS与non-eCRSwNP具有中度预测价值(AUC=0.861,P<0.001),eCRSwNP具有高度预测价值(AUC=0.910,P<0.001)。 结论 nNO水平对CRS、CRSsNP和CRSwNP、eCRSwNP和non-eCRSwNP的初步诊断以及鼻息肉病变范围的预测具有一定的临床应用价值。     

糠酸莫米松鼻喷剂联合玉屏风颗粒可提高儿童腺样体肥大疗效

目的 探讨糠酸莫米松鼻喷剂联合玉屏风颗粒治疗儿童腺样体肥大的疗效。 方法 采用前瞻性随机对照研究,对90例4~10岁腺样体肥大儿童单用糠酸莫米松鼻喷剂或联合玉屏风颗粒口服治疗8周,对比治疗前后患儿临床症状积分,内镜下观察腺样体变化,记录上呼吸道感染次数。 结果 对照组(鼻喷激素)临床症状总积分减少19.5%,鼻咽阻塞程度从82.2%下降到73.6%(P<0.01),上呼吸道感染次数大于1次者占44.19%;试验组(联合用药)临床症状总积分减少31.7%,鼻咽阻塞程度从85.4%下降到71.4%(P<0.01),上呼吸道感染次数>1次者占16.67%。 结论 糠酸莫米松鼻喷剂治疗儿童腺样体肥大有效,联合玉屏风颗粒可进一步提高疗效,并可减少儿童上呼吸道感染的发生率。     

新生儿动脉血血气分析与听力筛查结果相关性

目的 探讨新生儿动脉血血气分析指标与听力筛查结果的关系。 方法 回顾性分析医学中心新生儿科496例患儿听力筛查结果和入院时动脉血血气分析指标。 结果 自动听觉脑干反应(AABR)、畸变产物耳声发射(DPOAE)和声导抗和总听力筛查通过率分别为61.9%(307/496)、61.3%(304/496)、90.1%(447/496)和56.7%(281/496)。三种听力筛查方法通过率差异有统计学意义(χ2=131.00,P<0.001)。AABR与DPOAE测试结果一致性极强(Kappa=0.817,P<0.001),两者与声导抗测试一致性较弱(Kappa值分别为0.262、0.256,P均<0.001)。单因素Logisitic分析显示乳酸升高(OR=0.544,P=0.001)、二氧化碳分压升高(OR=1.917,P=0.009)、pH降低(OR=1.692,P=0.021)与听力筛查不通过显著相关。多因素Logisitic分析显示,乳酸(OR=0.627,P=0.018)、氧分压(OR=1.493,P=0.047)与听力筛查结果不通过显著相关。二氧化碳分压、pH和血氧饱和度和听力筛查结果无明显相关性(P>0.05)。 结论 新生儿缺氧及其伴随的血气变化可能会影响听力筛查结果。     

25+微创玻璃体视网膜手术联合玻璃体腔注射雷珠单抗治疗增生型糖尿病视网膜病变的临床观察

目的 研究25+微创玻璃体视网膜手术(VRS)联合玻璃体腔注射雷珠单抗(IVR)治疗增生型糖尿病视网膜病变(PDR)的效果。 方法 选取行25+微创VRS患者88例(88眼),分为治疗组(n=44)和对照组(n=44)。治疗组术前3~5 d予以IVR治疗后行25+微创VRS;对照组仅行25+微创VRS。比较两组患者术中情况、最佳矫正视力(BCVA)、眼压及术后并发症情况。 结果 治疗组患者的手术时间、电凝次数、医源性裂孔发生率、玻璃体腔硅油填充率均低于对照组(P<0.05);术后两组患者BCVA均高于术前(P<0.05),术后两组患者眼压均低于术前(P<0.05);术后3个月,治疗组患者玻璃体积血发生率、牵拉性视网膜脱离发生率均低于对照组(P<0.05)。 结论 行25+微创VRS联合IVR可有效缩短手术时间,降低医源性裂孔和玻璃体出血发生率,降低硅油填充率,有助于PDR患者术后视力的恢复。     

加速康复外科理念在功能性内镜鼻窦手术围手术期护理的初步应用

目的 初步探讨加速康复外科理念(ERAS)在功能性内镜鼻窦手术(FESS)围手术期护理中的作用。 方法 将在2017年10月1日~2017年12月31日行全麻功能性鼻内镜鼻窦手术的48例患者按入院日期的单、双分配到ERAS组(n=17)及常规手术组(n=31)。将住院费用、术后疼痛程度、术后睡眠情况、术后活动意愿及术后进食质量进行组间对比。 结果 两组的住院费用差异无统计学意义(P=0.16)。ERAS组在术后当天即摆脱了疼痛的困扰,活动意愿及进食质量也显著高于常规手术组(P<0.001)。常规手术组的疼痛程度需在术后第2天方能达到ERAS组相似的水平(P=0.14),活动意愿及进食质量也需在术后第1天才能达到ERAS组相似的水平(P=0.23,P=0.15)。睡眠质量在术后当天虽然未见显著的组间差异(P=0.25),但ERAS组的睡眠时间显著长于常规手术组(P=0.002)。 结论 在住院费用无显著增加的前提下,ERAS有望帮助FESS患者获得更大的术后舒适度。     

腺样体消融联合鼓膜打孔术治疗儿童腺样体肥大合并分泌性中耳炎55例

目的 探讨同时运用低温等离子技术开展腺样体消融术联合耳内镜下鼓膜打孔术的前提下,治疗腺样体肥大合并分泌性中耳炎患儿的临床疗效.方法 将确诊为腺样体肥大合并分泌性中耳炎的患儿111例(183耳)随机分为实验组55例(89耳)和对照组56例(94耳),两组均接受鼻内窥镜下腺样体低温等离子消融术,对照组实施鼓膜切开术,实验组...     

腺样体肥大程度与分泌性中耳炎的相关性研究

目的：探讨腺样体大小与分泌性中耳炎(SOM)的相关性。方法：根据腺样体肥大的程度．将140例患儿分为腺样体中度肥大组和病理性肥大组。分析腺样体肥大程度对中耳功能的影响及两组间SOM发病率的差异。结果：两组之间SOM发生率差异有统计学意义；两组之间声导抗图的类型分布差异具有统计学意义。结论：腺样体肥大程度与SOM发病率呈正相关。     

Relation between adenoid size and otitis media with effusion

AimsThis study compares the efficacy of adenoidectomy on otitis media with effusion (OME) in patients with different size of adenoids and the connection between differently sized adenoids and middle ear effusion.Material and methodsChildren with a history of at least 3 months’ OME underwent adenoidectomy and myringotomy without the insertion of a tympanostomy tube. Treatment assignment was stratified by adenoids’ size causing choanal obstruction (grade I-III) and according to Eustachian tube ostium obstruction (grade A–C). The subjects were followed for 12 months.ResultsAdenoidectomy was significantly more effective in children with adenoids in contact with torus tubarius (grade B, C) compared to those with small adenoids without contact (P < 0.001). The volume of the adenoids was irrelevant (P = 0.146). The size of adenoids did not affect the viscosity of the middle ear secretion. The distribution of mucous and serous secretion was not dependent on the size of adenoids; the efficacy of adenoidectomy was 82% in mucous as well as serous secretion.ConclusionThe relation between adenoids and torus tubarius is more important than the volume of the adenoids. The viscosity of middle ear fluids (serous or mucous) did not influence the rate of treatment efficacy.     

儿童腺样体切除术对相关疾病转归的影响

目的探讨腺样体切除术在治疗儿童分泌性中耳炎、鼻窦炎及鼾症的临床作用。方法对住院行腺样体切除术的68例分泌性中耳炎、鼻窦炎及鼾症患儿的临床表现、治疗方法和预后进行回顾性分析。结果68例患儿经切除肥大的腺样体,辅以相应的药物治疗,临床症状均明显好转。结论腺样体肥大较易成为儿童分泌性中耳炎、鼻窦炎及鼾症发病的基础因素。切除肥大的腺样体是治疗儿童分泌性中耳炎、鼻窦炎及鼾症有效、安全的方法。     

鼾症儿童腺样体肥大的声导抗分析

目的　观察分析鼾症儿童的声导抗。方法　选取75例3～8岁不同程度腺样体肥大鼾症儿童,进行声导抗测试,并记录结果和参数。结果　鼾症儿童腺样体肥大III 度中,出现A型曲线的几率低,明显低于50%,反之出现B和C型鼓室图的几率高,声反射引出率低,平均峰压低,与I度和II度差别明显,差异有统计学意义。结论　不同等级腺样体肥大对儿童的中耳影响不同,腺样体越大,引起儿童分泌性中耳炎的几率越大,程度越严重。     

不同术式治疗伴腺样体肥大的儿童分泌性中耳炎的疗效及安全性

目的：探讨不同手术方式治疗伴腺样体肥大的儿童分泌性中耳炎的疗效及安全性。方法回顾性分析2011年4月至2014年7月收治的81例（149耳）腺样体肥大伴分泌性中耳炎患儿的临床资料,其中Ⅰ组22例（41耳）行单纯鼓膜切开置管术、Ⅱ组33例（59耳）行单纯腺样体切除术、Ⅲ组26例（49耳）行鼓膜置管加腺样体切除术;比较三组术前、术后3个月平均听阈,分析各组术后疗效及并发症。结果Ⅰ、Ⅱ、Ⅲ三组患儿术前平均听阈分别为53．54±6．68、53．61±6．98、52．92±7．28 dB H L ,组间两两比较差异无统计学意义（ P＞0．05）;Ⅰ、Ⅱ、Ⅲ三组患儿术后平均听阈分别为17．63±5．09、14．47±3．62、14．88±3．92 dB H L ,Ⅰ组听力恢复较Ⅱ组、Ⅲ组差（ P＜0．05）,而Ⅱ组与Ⅲ组之间差异无统计学意义（P＞0．05）。Ⅰ、Ⅱ、Ⅲ组术后分别有6、2、8例出现脱管、感染、创面出血等并发症。结论单纯腺样体切除术治疗伴腺样体肥大的儿童分泌性中耳炎疗效确切,并发症少。     

Antibody production directed against pneumococci by immunocytes in the adenoid surface secretion

OBJECTIVE: In previous studies of the adenoid surface secretion we revealed the presence of activated T cells, granulocytes engaged in phagocytosis and immunocytes that produce IgG, IgA and IgM. In the present study the objective was to assess the ability of these immunocytes to produce antibodies directed at S. pneumoniae. METHOD: Nine children subjected to adenoidectomy due to adenoid hypertrophy, secretory otitis media or recurrent otitis media were enrolled in the study. Samples of adenoid surface secretion were obtained by an imprint method and for comparison samples of adenoid tissue and peripheral blood were also obtained as well as a nasopharyngeal culture. Double-colour enzyme-linked immunospot (ELISPOT) assays were performed to detect total and pneumococci-specific IgG- and IgA-antibody secreting cells (ASC). In the adenoid tissue, the presence of H. influenzae type b specific ASC was also examined. RESULTS: ASC were present in all nine samples of adenoid surface secretion with a dominance of IgG-ASC as compared to IgA-ASC. The proportion of ASC relative to the total number of lymphocytes was always greater in the secretion than in the corresponding adenoid tissue. The adenoid surface secretion samples from three of nine children contained IgG-ASC directed against S. pneumoniae. IgG-ASC directed against S. pneumoniae were detected in six of eight adenoids and IgA-ASC directed against S. pneumoniae were detected in two of eight adenoids. IgA-ASC directed against H. influenzae type b (Hib) were detected in one of seven adenoids. CONCLUSION: The immunocytes in the adenoid surface secretion and the adenoid tissue itself hold the property to produce antibodies specific for known pathogens of the upper airways. These ASC are probably engaged in the immunologic defence of the nasopharyngeal mucosa and further studies are therefore called upon.     

Middle ear effusion and allergy in childhood

Besides mechanical or infectious factors in the genesis of secretory otitis media IgE-mediated hypersensitivity has often been discussed. In order to estimate the importance of an allergic reaction in the development of middle ear disease, we examined 27 children having adenoids and a secretory otitis media. We documented the patients' history of allergy and determined the IgE-levels in the serum, the middle ear effusions and the adenoid tissue. 5 out of 27 children suffered from an allergy of the upper respiratory tract, but only in one child we found an elevated level of IgE in middle ear effusion. On the basis of our investigations and recent literature, we suggest that an allergic rhinitis might cause an Eustachian tube dysfunction in a few patients. There is no evidence of a local allergic reaction of the middle ear mucosa.     

Cellular immune response of adenoidal and tonsillar lymphocytes to the P6 outer membrane protein of non-typeable Haemophilus influenzae and its relation to otitis media.

Cellular immune responses to the P6 outer membrane protein of non-typeable Haemophilus influenzae (NTHi) were determined in vitro by measuring immunoglobulin (Ig) secreting cells and lymphocyte proliferation in adenoidal and tonsillar lymphocytes from 19 children. Preliminary tests showed that P6 did not stimulate naive cells such as cord blood lymphocytes, but did stimulate sensitized cells in adenoids and tonsils. Cellular proliferation was significantly higher in adenoidal lymphocytes than in tonsillar lymphocytes (median: quadratile of stimulation index = 3.7:2.3-5.5 vs. 1.2:1.0-2.1, p < 0.02). A comparison between children with or without otitis media revealed that proliferative responses to P6 of adenoidal lymphocytes from children with otitis media were significantly decreased (2.0:1.8-3.6 vs. 3.7:2.3-5.5, p < 0.04). P6-specific antibody secreting cells were identified in a total of 14 adenoids and the number of cells secreting IgA was decreased in the otitis media group compared to controls (median: quadratile/10(6) cells = 435:359-499 vs. 755:593-1870, p < 0.05). Cultivation with P6 stimulated IgA secretion in children without otitis media, while no response was seen in children with otitis media (median: quadratile/10(6) cells = 1323:915-2410 vs. 2240:1900-2830, p < 0.02). These preliminary data demonstrate that lymphocytes from adenoids and tonsils recognize P6 as a specific antigen and that the adenoid is the more reactive of the two organs. Impaired P6-specific cellular immune responses of adenoids in children with otitis media may explain the recurrent nature of otitis media due to NTHi in the otitis prone population.