舌下神经与面神经吻合术修复面瘫

舌下神经与面神经吻合术作为一种有效的修复手段，已被基础研究和临床实践所证实，目前除传统的舌下-面神经端端吻合术外，还有保护舌功能的几种改进术式，但对其手术时机、预后影响因素及不同术式的优劣等问题尚无共识。     

Study on Remodeling of Astrocytes in Facial Neuclus after Peripheral Injury

To observe the glial reactions surrounding facial motor neurons following facial nerve anastomosis. At 1,7,21 and 60 d following facial nerve anastomosis, the recovery process of facial movement was observed, the glial fibrillary acidic protein （GFAP） immunoreactivity was analyzed by a combined method of fluorescent retrograde tracing and immunofluorescent histochemical staining, and the uhrastructure of astrocytes were observed under a transmission electron microscope （TEM）, respectively. Postoperatively the function of facial muscles could not return to normal, often accompanied with hyperkinetic syndromes such as synkinesis at the late stage. Motor neurons in every facial subnucleus could be retrogradely labeled by fluoro-gold （FG）, and displayed an evident somatotopic organization. Normally there was a considerable number of GFAP-positive cells in nonnucleus regions but few inside the facial nucleus region. Postoperatively the GFAP immunoreactivity in the anastomotic side increased significantly, but gradually decreased at the late stage. The ultrastructure of astrocytes in our experiment showed that the sheet-like process of astrocytes invested and protected the injured facial motor neurons. The present study shows that reactive astrocytes undergo some characteristic changes during the process of facial nerve injury and regeneration. The plastic change at the late stage may be involved in the mechanism of synkinesis.     

扩大的前鼓室切开术取出咽鼓管异物一例

患者男，19岁，因右耳溅入电焊渣后流脓，听力下降1个月为主诉于2005年6月29日入院，患者1个月前被电焊渣溅入右耳内，即感耳内疼痛，无流血及眩晕等不适，因稍后缓解而未检查治疗，1周后始右耳流脓停止，但数日后再次发作，颞骨CT检查发现右咽鼓管内有金属异物而转诊我院。     

Plastic Changes of Synapses and Excitatory Neurotransmitter Receptors in Facial Nucleus Following Facial-facial Anastomosis

The remodeling process of synapses and neurotransmitter receptors of facial nucleus were observed. Models were set up by facial-facial anastomosis in rat. At post-surgery day （PSD） 0,7,21and 60, synaptophysin （p38）, NMDA receptor subunit 2A and AMPA receptor subunit 2 （GluR2） were observed by immunohistochemical method and semi-quantitative RT-PCR, respectively. Mean-while, the synaptic structure of the facial motorneurons was observed under a transmission electron microscope （TEM）. The intensity of p38 immunoreactivity was decreased, reaching the lowest value at PSD day 7, and then increased slightly at PSD 21. Ultrastructurally, the number of synapses in nucleus of the operational side decreased, which was consistent with the change in P38 immunoreactivity. NMDAR2A mRNA was down-regulated significantly in facial nucleus after the operation （P〈0.05）, whereas AMPAR2 mRNA levels remained unchanged （P〉0.05）. The synapses innervation and the expression of NMDAR2A and AMPAR2 mRNA in facial nucleus might be modified to suit for the new motor tasks following facial-facial anastomosis, and influenced facial nerve regeneration and recovery.     

针药复合麻醉胃大部切除20例临床分析

阿片受体激动剂芬太尼等药物与针刺的镇痛效应有协同作用,已在动物实验中得到证实。我院自1983年起,在针麻胃切除手术中,以小剂量芬太尼、氟哌啶为辅助用药进行临床观察。现报道如下: 一、方法分组:针麻加小剂量芬太尼、氟哌啶组(简称针药组)20例。硬膜外麻醉组(即对照组,简称硬膜组)20例。二组性别、年龄、病种、手术时间等基本相同(见表1、2)。     

针麻胃切除术的临床观察

<正> 我院与上海针灸所协作自1983年起在辨证施针提高针麻效果的同时,选用神经安定镇痛药芬太尼、氟哌啶作为针麻胃切除术中的辅助用药,进行临床观察,现将结果分析如下:方法分组:针麻加辅助用药组(简称针麻     

尘肺合并支气管结核1例诊疗报告

粉尘职业危害严重,尘肺患者易合并结核感染。支气管结核（bronchial tuberculosis,BTB）是指发生在气管、支气管黏膜、黏膜下层及外膜（软骨和纤维组织）的结核病。多数支气管结核患者缺乏典型结核中毒症状,X线表现不典型,痰找抗酸杆菌阳性率低,     

接种百白破疫苗不良反应的预防及护理对策

目的 分析接种百白破联合疫苗不良反应发生的原因并提出预防措施及护理对策.方法 回顾我院从2011年1 ～12月中,共接种吸附无细胞百白破疫苗9682人次,其中基础免疫7938人次,加强免疫1743人次.对接种过百白破疫苗者进行预防不良反应采取护理观察.结果 接种9682人次中,共发生不良反应218例,主要以局部反应和低热为主,未见潜在生命威胁的其他不良反应.结论 预防接种不良反应与受种者的个体差异、接种人员操作技术等有密切关系.规范操作流程,安全接种技术,加强接种后的护理可减少和避免不良反应.     

维生素C片溶液的颜色检查方法的探讨

目的维生素C片溶液的颜色检查方法的探讨。方法通过滤纸过滤法、滤膜过滤法、精密称定滤纸过滤法、精密称定滤膜过滤法等4种测定方法比较吸光度。结果精密称定所得测定结果较平行。微孔滤膜过滤所得测定液澄清,所测定吸光度值比较低。结论边缘产品建议适用精密称定微孔滤膜滤过法测定。     

单侧声带囊肿与声带息肉患者手术前后嗓音声学的对比研究

目的 探讨单侧声带囊肿与声带息肉患者手术前后的嗓音声学分析指标变化特点。方法 单侧声带囊肿和声带息肉患者各25例,嗓音显微外科手术前1天、术后1周、术后1个月行嗓音主观评分及客观声学检测,比较结果。结果 手术前,声带囊肿组的最长发声时间(MPT)较声带息肉组小(P<0.05),两组患者嗓音障碍指数(VHI-10评分)、嗓音嘶哑度评分(GRBAS)及基频(F0)、基频微扰(jitter)、振幅微扰(shimmer)、噪谐比(NHR)差异无统计学意义(P>0.05);术后1周,声带囊肿组GRBAS评分及jitter、shimmer和NHR比声带息肉组高(P<0.05),两组患者VHI-10分级、MPT和F0差异无统计学意义(P>0.05);术后1个月,两组患者VHI-10评分、GRBAS分级、MPT、F0、jitter、shimmer及NHR等差异均无统计学意义(P>0.05)。结论 单侧声带囊肿对患者声门闭合功能的影响较单侧声带息肉大,手术后声带息肉患者的嗓音嘶哑度及粗糙度较声带囊肿患者恢复快。