家兔急性鼻窦炎上颌窦黏膜病理改变

目的 观察家兔实验性鼻源性急性鼻窦炎上颌窦黏膜超微结构及黏液纤毛传输功能的改变.方法 健康成年雄性新西兰白兔15只,随机分为实验组(10只)和空白对照组(5只).将3 mm×5 mm×25 mm大小Merocel(R)高分子膨胀海绵置入实验组兔右侧鼻腔,并向高分子膨胀海绵中注射植入1 mlⅢ型肺炎链球菌悬液.2周后,用印度墨汁法测定上颌窦黏液纤毛传输速度.然后处死动物,取右上颌窦黏膜通过透射电镜观察其超微结构改变.结果 实验组家兔上颌窦黏液纤毛传输速度明显低于空白对照组,有极显著统计学差异(P＜0.01).实验组上颌窦黏膜在透射电镜下观察到纤毛变性、脱落,排列紊乱,可见复合纤毛、微管动力臂缺陷、胞质突起、内质网扩张、线粒体肿胀、胞浆水肿及黏膜下层淋巴细胞浸润等超微的结构改变.结论 急性鼻窦炎上颌窦黏膜超微结构明显改变,黏液纤毛传输速度减慢,结构改变导致功能下降.     

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。     

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。     

实验性急性鼻窦炎上颌窦黏膜超微结构观察

目的:观察家兔急性鼻窦炎上颌窦黏膜超微结构的动态改变。方法:25只家兔随机分为实验组(20只)和空白对照组(5只),先建立急性鼻窦炎鼻源性模型。建模后第1、2、3、4周每周随机选取实验组家兔5只处死,解剖并从右上颌窦腔取0.3 cm×0.3 cm大小新鲜黏膜组织用透射电镜观察其超微结构。对照组在第1周开始实验。结果:透射电镜观察,对照组家兔上颌窦黏膜纤毛排列整齐,无丢失,上皮细胞内线粒体无肿胀,内质网未见扩张;实验组家兔上颌窦黏膜纤毛变性,排列紊乱,部分纤毛丢失,出现复合纤毛、胞质突起、内质扩张、线粒体肿胀及黏膜下淋巴细胞浸润伴成纤维细胞增生等病理改变,与对照组比较,差异有统计学意义(P<0.05)。实验组家兔第1～4周,复合纤毛数量逐渐增多,第3、4周与第1周比较,差异均有统计学意义(均P<0.05)。内质网扩张和线粒体肿胀程度在第2周最明显,第4周后逐渐减轻,第2周与第4周比较差异有统计学意义(P<0.05)。结论:窦口阻塞及细菌感染导致上颌窦黏膜超微结构改变,是急性鼻窦炎病理演变过程的一个重要环节。     

兔慢性鼻窦炎模型建模方法的比较与优化改良

目的探讨改进慢性鼻窦炎动物模型的制备方法。方法将66只新西兰大白兔制成动物模型，随机分成空白对照组(6只)、假手术Ⅰ、Ⅱ组(各10只)、单纯细菌组(10只)、单纯窦口堵塞组(10只)、窦口堵塞 金黄色葡萄球菌组(10只)、窦口不完全堵塞 窦腔留置棉絮组(10只)，术后42d取上颌窦黏膜标本分别进行形态学观察及细菌学检查。结果各实验组建立慢性鼻窦炎模型成功率：窦口堵塞组为80％，窦口堵塞 金黄色葡萄球菌组为100％，窦口不完全堵寒 窦腔留置棉絮组为100％，单纯细菌组、空白对照组及假手术对照组均为0％。感染鼻窦均表现为中重度慢性炎症，培养的细菌以机会致病菌为主。采用窦口堵塞 金黄色葡萄球菌方法并发上颌窦积脓概率高。结论相对其他建模方法，窦口不完全堵塞 窦腔留置棉絮的建模方法是一种更理想的慢性鼻窦炎动物模型的制备方法。     

辛夷注射液窦腔灌注治疗家兔慢性上颌窦炎

目的建立家兔慢性上颌窦炎模型,观察自制辛夷注射液对慢性上颌窦炎的治疗效果.方法家兔28只,分为4组,其中实验组24只,再分为3组.在全麻下打开上颌窦前壁裂隙植入明胶海绵并注入金黄色葡萄球菌5周后制成慢性上颌窦炎模型.①空白组窦腔内灌注生理盐水2ml;②阳性对照组窦腔灌注庆大霉素2ml(8万U);③治疗组窦腔灌注辛夷注射液2ml.并于第3、5、7天分别以同样方法重复灌注.第10天处死动物做细菌培养和病理学检查.结果治疗组共有3个窦腔培养结果为阳性,对照组13个窦腔培养结果为阳性,空白组共14个窦腔分泌物有细菌生长.1、2、3组动物所有鼻窦黏膜均有炎症表现,但轻重程度不同.治疗组黏膜基本正常,对照组和空白组黏膜上皮排列不整齐,部分变性、坏死、脱落,有小溃疡形成,黏膜充血水肿明显并有炎细胞浸润.结论辛夷注射液窦腔内灌注对慢性上颌窦炎有很好的治疗作用.     

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。     

实验性鼻窦炎的病理及细菌学变化

目的 分析鼻窦炎由急性向慢性转变过程中的病理及细菌学变化.方法 用浸有金黄色葡萄球菌的膨胀海绵条阻塞鼻腔建立鼻源性鼻窦炎动物模型,分别于实验后1、2、4、6、8、10周时内镜下观察上颌窦,取出窦腔黏膜标本分别进行细菌学培养及组织病理学检查.结果 早期黏膜以单核细胞浸润为主;2周后可见淋巴细胞、中性粒细胞浸润,杯状细胞增加、腺体增生;4-6周后大量的杯状细胞生成;8周以后窦腔黏膜水肿严重,黏膜增厚.在整个过程中,杯状细胞增加最明显.早期窦内细菌学培养主要为金黄色葡萄球菌,以后逐渐被肺炎球菌、莫拉杆菌、大肠杆菌所代替.结论 通过鼻腔诱导引起的鼻源性鼻窦炎其黏膜所表现的病理变化经过了四个连续的病理阶段,客观反映了鼻窦炎由急性向慢性转变过程中的病理变化,随着病程的发展,机会致病菌的感染逐渐增多.     

儿童化脓性上颌窦炎采用高压氧和Димексида治疗

儿童鼻窦炎症发病率高,占耳鼻咽喉科疾病第三位,鉴于治疗困难,本文采用高压氧和10%(?)行局部治疗,共52例,年龄6～14岁。其中急性化脓性上颌窦炎10例,慢性上颌窦炎急性加重26例,慢性上颌窦炎16例。病程4月～3年。对32例进行了细菌学检查,15例为金黄色葡萄球菌,6例为变形杆菌。用500ml抗腐液先行上颌窦腔冲洗后,再行窦腔内局部给氧,压力为7～10kpa,持续10分钟,注入10%(?)5ml,每日2次,经治疗8～5日后,鼻腔流脓停止,阻塞感消失,鼻呼吸改善,所治疗52例随访2年有49例痊愈。指出,高压氧和10%(?)具有消除粘膜     

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…     

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。     

Comparison of Histopathological and CT Findings in Experimental Rabbit Sinusitis

The aim of this study was to investigate and compare histopathological and computerized tomographic (CT) findings of experimental acute sinusitis in an animal model. The noses of five healthy rabbits were inoculated with a gelatin sponge impregnated with a solution containing Staphylococcus aureus, and one healthy rabbit acted as the control. The animals were sacrificed on the tenth day, following the acquisition of paranasal CT scans. Specimens were obtained from the lateral nasal walls, and the ethmoid and maxillary sinuses of the animals for histopathological examination. Histopathological and CT findings were compared. Various degrees of epithelial disorganization, foci of ruptured epithelial cells, and inflammatory cell infiltration in the lamina propria were seen in the histopathological examinations of the five study rabbits, and mucosal thickening and soft tissue density were noted in their CTs. There was no correlation between the histopathological and CT findings. It was shown that CT did not reflect the acute changes in the sinus mucosa. Patients with chronic sinusitis must be evaluated for a chronic process. Computerized tomographic scans should not be obtained in acute sinusitis cases. In this way, both unnecessary radiation exposure and economic waste can be avoided.     

鼻用糖皮质激素治疗兔急性细菌性上颌窦炎的组织病理学及超微结构观察

目的探讨鼻用糖皮质激素喷雾剂布地奈德（budesonide）对兔急性细菌性上颌窦炎的黏膜组织病理学及超微结构的影响。方法健康成年新西兰白兔48只,采用鼻腔置入Merocel高分子膨胀海绵并注入肺炎链球菌建立急性细菌性上颌窦炎模型,10d后取出鼻腔膨胀海绵,随机分成抗生素治疗组（A组）、抗生素加鼻用激素治疗组（B组）、鼻用激素治疗组（C组）及对照组（D组）,每组各12只。分别于治疗2周及4周后每组各处死6只动物,行上颌窦黏膜组织病理学及超微结构观察。结果组织病理学观察结果示治疗2周及4周后A、B组上颌窦黏膜纤毛缺失及上皮层溃疡形成均轻于C、D组,尤其是B组上颌窦黏膜炎性细胞浸润明显轻于C、D组,差异均有统计学意义（P〈0.05）;A组上颌窦黏膜病理定性分析示炎性细胞浸润轻于C、D组,但差异无统计学意义（P〉0.05）。A、B两组之间上颌窦黏膜炎性细胞浸润在治疗2周后差异无统计学意义（P〉0.05）,治疗4周后,B组上颌窦黏膜炎性细胞浸润明显轻于A组（P〈0.05）。透射电镜观察示A、B两组兔上颌窦黏膜超微结构改变具有相似性。结论鼻用糖皮质激素治疗急性细菌性上颌窦炎,能减轻上颌窦黏膜的炎性细胞浸润,但尚不能作为取代抗生素的单一治疗。抗菌合并抗炎治疗会取得更好的疗效。     

鼻用糖皮质激素治疗兔急性细菌性上颌窦炎的细菌培养观察

目的探讨鼻用糖皮质激素喷雾剂布地奈德(budesonide)对兔急性细菌性上颌窦炎的细菌学的影响。方法健康成年新西兰白兔48只,采用鼻腔置入Merocel高分子膨胀海绵并注入肺炎链球菌的方法建立急性细菌性上颌窦炎模型,10 d后取出鼻腔膨胀海绵,随机分成抗生素治疗组(A组)、抗生素加鼻用激素治疗组(B组)、鼻用激素治疗组(C组)及对照组(D组),每组各12只。分别于治疗2周及4周后每组各处死6只动物,获取上颌窦腔分泌物作普通细菌培养。结果细菌培养结果显示治疗2周后,虽然A、B组上颌窦分泌物细菌培养阳性率低于C、D组,但组间差异无统计学意义(P>0.05)。治疗4周后,A、B组细菌培养阳性率明显低于C、D组,差异有统计学意义(P<0.05),A、B组间差异无统计学意义(P>0.05)。结论鼻用糖皮质激素合并抗生素治疗兔急性细菌性上颌窦炎时,未见影响抗生素的抗菌效果。     

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.     

五味消毒饮治疗大鼠实验性急性鼻咽炎的疗效观察

目的观察五味消毒饮对大鼠实验性急性鼻咽炎的治疗作用。方法SD大鼠30只，应用创伤后金黄色葡萄球菌接种法造成急性鼻咽炎模型，然后随机分成模型对照组、中药治疗组、西药对照组，并平行设置正常对照组分别进行治疗干预。治疗前后测量体温，观测大鼠的行为改变及白细胞变化，同时取鼻咽组织进行病理检查。结果大鼠感染后出现行为异常，白细胞增多。病理检查显示明显急性炎症改变。中药治疗组大鼠各项指标明显改善．与西药对照组相似。结论五味消毒饮对大鼠实验性急性鼻咽炎有良好的治疗作用。     

Effects of beta-toxin of Staphylococcus aureus on ciliary activity of nasal epithelial cells

OBJECTIVES: To investigate the in vitro effects of staphylococcal beta-toxin on ciliary activity and the in vivo effects on sinusitis induction. STUDY DESIGN: The in vitro effects of staphylococcal beta-toxin on ciliary activity were investigated at different concentrations and exposure times. Experimental sinusitis was induced in rabbits with application of beta-toxin and confirmed 7 days later. METHODS: Ciliated epithelial cells were taken from the maxillary sinus mucosa of 10 rabbits. Five culture dishes from each rabbit were used for the experimental group, and one culture dish from each rabbit was used for the control group. In the experimental group, ciliary beat frequency (CBF) was measured at concentrations of 0.1, 1, 2, 5 and 10 U/mL of beta-toxin using a video-computerized analysis technique, while in the control group, culture medium containing no toxin was used. CBF was measured 1, 2, 4, 6, 8, 12, 24, and 48 hours after administration of beta-toxin. To induce experimental sinusitis, 2 U/mL of beta-toxin was percutaneously applied to the maxillary sinus of 10 rabbits without occlusion of the natural ostium, while normal saline was percutaneously applied to the right-side maxillary sinus of 4 rabbits in the control group. At 7 days, mucosal membranes were taken from the inferomedial wall of the maxillary sinus for light microscopic study. RESULTS: CBF dropped significantly after an 8-hour incubation at 2, 5, and 10 U/mL of beta-toxin. No ciliary activity was observed after a 24-hour incubation at 2 and 5 U/mL and a 12-hour incubation at 10 U/mL of beta-toxin. Mucoid, purulent discharge was observed in the maxillary sinuses of the beta-toxin-applied group. Prominent epithelial disruption and infiltration of inflammatory cells into the epithelium and lamina propria were observed in the beta-toxin-applied group. CONCLUSIONS: Staphylococcal beta-toxin may reduce ciliary activity and induce sinusitis without occlusion of the natural ostium of the maxillary sinus in rabbits This study provides another animal model of sinusitis for understanding the pathogenesis of sinusitis induced by bacterial exotoxins.