咽喉反流症状或体征评分阳性的慢性鼻窦炎患者鼻内镜术后碱性等渗盐水冲洗的疗效观察

目的 探讨碱性等渗盐水鼻腔冲洗对于伴有咽喉反流症状或体征评分阳性的慢性鼻窦炎患者鼻内镜术后的临床疗效。 方法 80例咽喉反流症状或体征评分阳性的慢性鼻窦炎患者使用随机数字生成器分为2组,其中鼻内镜手术后接受碱性等渗盐水冲洗患者40例为研究组,鼻内镜术后接受生理盐水冲洗患者40例为对照组。根据外周血嗜酸粒细胞占白细胞百分比是否超过4.27%对研究组和对照组分层。在鼻内镜手术后2周、6周进行随访评估。评估包括反流症状指数评分量表、反流体征评分量表、鼻腔鼻窦结局20量表、视觉模拟量表、鼻阻塞症状评估量表、Lund-Kennedy评分以及不良反应记录。 结果 在2周时,研究组视觉模拟量表评分的变化量［3.0(2.0,4.0)分］>对照组［1.5(0.0,3.0)分］(P=0.016<0.05);在6周时,研究组鼻腔鼻窦结局20评分的变化量［(13.4±10.3)分］以及视觉模拟量表评分的变化量［3.0(2.0,4.0)分］>对照组［(8.7±6.1)、1.0(0.0,2.2分)］(P=0.001<0.05)。分层后,使用碱性等渗盐水冲洗的患者中外周血嗜酸粒细胞占白细胞百分比≤4.27%的亚组在鼻内镜手术后2周的鼻腔鼻窦结局20和视觉模拟量表评分变化量［13.0(8.0,19.0)、(3.2±1.9)分］更大(P=0.024<0.05,P=0.030<0.05)且在术后6周的鼻腔鼻窦结局20和视觉模拟量表评分变化量［(15.7±9.5)、2.0(2.0,4.0)分］更大(P=0.002<0.05,P=0.005<0.05)。2组患者均未出现严重不良反应。 结论 对于伴有咽喉反流症状或体征评分阳性的慢性鼻窦炎患者,在鼻内镜手术后早期护理阶段使用碱性等渗盐水进行鼻腔冲洗具有一定的临床疗效,尤其是在外周血嗜酸粒细胞占白细胞百分比低于4.27%的患者中。     

经腹腔镜置管冲洗治疗急性胆源性胰腺炎

目的 :探讨腹腔镜置管冲洗治疗急性胆源性胰腺炎的可行性和应用价值。方法 :在腹腔镜下用电刀切开胃结肠韧带 ,于网膜囊、小网膜孔处置管冲洗引流。结果 :4 8例中 4 3例治愈 ,3例死于多器官功能衰竭 ,1例死于ARDS ,1例死于感染性休克 ,死亡率 10 4 %。结论 :腹腔镜下置管冲洗治疗急性胆源性胰腺炎方法简单 ,安全可行 ,能减少并发症 ,降低死亡率     

神经内镜治疗12例分隔型慢性硬膜下血肿临床分析

目的探讨神经内镜治疗分隔型慢性硬膜下血肿的方法及疗效。方法采用神经内镜对12例分隔型慢性硬膜下血肿进行治疗。术中钻孔后稍作扩大呈直径2 cm骨窗,打开硬膜,导入神经内镜,内镜直视下清除血肿,冲洗至术野清晰,镜下充分探查血肿腔,清除增生的纤维束,打通所有分隔,将血肿腔所有死角残留的血肿彻底冲洗清除,内镜直视下放置引流管外接闭式引流。结果术后本组患者症状均很快明显改善,术后第2～6天拔除引流管,患者均如期出院,随访3～6个月,无1例复发。结论神经内镜治疗分隔型慢性硬膜下血肿效果良好、安全、直观、微创。     

宫颈癌根治术后泌尿系并发症的护理研究

目的:探讨改进妇科手术病人留置尿管拔除尿管的方法,预防泌尿系并发症发生。方法:将80例宫颈癌根治术病人随机分实验组40例,对照组40例。实验组术后第5 d开始行膀胱冲洗,在有尿意时拔出;对照组夹管2 h常规拔除导尿管。结果:实验组有3例发生尿潴留,对照组有10例发生尿潴留,两组比较有显著性差异(χ2=4.50,P<0.05);实验组1例发生泌尿系感染,对照组9例发生泌尿系感染,两组相比较有显著性差异(χ2=5.60P<0.05)。结论:对宫颈癌根治术病人先行膀胱冲洗后再拔尿管,可有效预防拔除尿管后泌尿系并发症的发生。     

不同膀胱病理状态下庆大霉素膀胱冲洗的安全性考察

目的:考察庆大霉素(GTM)膀胱冲洗在细菌性膀胱炎及出血性膀胱炎下的安全性.方法:收集接受GTM膀胱冲洗患者给药后30 min的血液(80 mg,2次/d),以荧光偏振免疫法(FPIA法)测定血药浓度;12只Wistar大鼠随机等分为对照组和模型组,模型组腹腔注射环磷酰胺140 mg/kg构建出血性膀胱炎模型,并以苏木精-伊红染色法(hematoxylin-eosin staining,HE染色法)观察造模结果.造模24 h后,两组大鼠分别给予GTM 8.4 mg/kg膀胱内注射,FPIA法测定给药30 min后血药浓度.结果:共有8例次患者进入实验,监测GTM平均血药浓度为0.234 μg/mL(0.14 ~ 0.40 μg/mL);模型组大鼠在接受GTM膀胱内注射后平均血药浓度为(7.53±1.32)μg/mL,与对照组(0.63±0.12) μg/mL相比有显著统计学差异(P < 0.01).结论:GTM膀胱冲洗对于细菌性膀胱炎是安全的,但应避免用于出血性膀胱炎患者.     

The potential of reuterin derived from Indonesian strain of Lactobacillus reuteri against endodontic pathogen biofilms in vitro and ex vivo

ObjectivesDespite the use of common irrigating solution with antimicrobial properties, failed root canal treatment remains a significant problem in endodontics. In the present study, we examined the efficacy of reuterin derived from probiotic bacteria, Lactobacillus reuteri on the biofilms of major endodontic pathogens using ex vivo model of root canal infections.MethodsBiofilms of major endodontic pathogens namely Enteoroccus faecalis, Fusobacterim nucleatum, Porphyromonas gingivalis, and Candida albicans were formed on root canals of 60 human premolar tooth samples accordingly a standard protocol. Thereafter, teeth were treated with either 2.5 % NaOCl (positive control), various concentrations of reuterin (test-group) or sterilized-distilled water (negative control) in a time-dependent assay. The efficacy of irrigation was evaluated by a time-dependent assay at 5 min and 30 min after irrigation by colony-forming units assay. The findings were further confirmed by species-specific real-time PCR. Data were statistically analysed using one way ANOVA with a significance level of P < 0.05.ResultsReuterin isolated from L. reuteri was effective against E. faecalis, C. albicans, F. nucleatum, and P. gingivalis biofilms, with a concentration of 100 µg/mL being the most effective compared to the negative control (P < 0.05) and also showed similar efficacy when compared with NaOCl.ConclusionReuterin isolated from L. reuteri has ability to inhibit in vitro and ex-vivo biofilms of endodontic pathogens, namely E. faecalis, F. nucleatum, P. gingivalis, and C. albicans. Reuterin has potential as a root canal irrigating solution due to its antibiofilm activity. Further research is warranted to determine the potential of probiotic bacteriotherapy in root canal systems.