功能性鼻内镜鼻窦手术后术腔清理(附1080例临床分析)

目的：探讨功能性鼻内镜鼻窦手术后术腔清理对鼻窦结构及上皮功能恢复的影响。方法：1080例均为采取Messerklinger术式完成功能性鼻内镜鼻窦手术的病例。手术后2周进行第一次鼻腔鼻窦清理，以后每隔2周一次，共进行4或4次以上清理至术腔基本上皮化。结果：112例手术后1个月术腔基本上皮化，456例手术后2个月术腔基本上皮化，255例手术后3个月术腔基本上皮化；98例出现术后窦口闭锁，176例出现术腔粘连，在术腔清理过程中进行处理，这些并发症均消失；95例出现术后复发而需要进一步手术治疗。结论：术腔粘膜的再上皮化对功能性鼻内镜鼻窦手术后鼻窦功能的恢复至关重要，这一过程一般需要1～3个月甚至更长时间，手术后规范化的术腔清理能早期发现并处理粘膜病变、术腔狭窄及窦口阻塞，因而术后清理对提高功能性鼻内镜鼻窦手术的疗效有重要价值。     

经上颌窦前壁钻孔行鼻窦内窥镜术30例报告

报告经上颌窦前壁钻孔行鼻窦内窥镜手术３０例，疗效较好。与鼻腔、鼻窦内窥镜手术比较，该术式具有观察方便，出血少，反应轻，操作方便，并发症少，术后复发率低等优点。     

Current advances in rhinomanometry

Current advances in rhinomanometry were reviewed in this paper. Active posterior rhinomanometry with a “head-out” body plethysmograph may be the least invasive method currently available for measuring nasal patency. In general, active anterior rhinomanometry with a face mask or a nasal nozzle has been employed in various studies throughout the world. Nasal resistance as calculated from the equationR = 0.78 (ΔP/V)^1.33 at any points on a pressure/flow curve, or averaged nasal resistance may be the most suitable expression for nasal patency. Values for nasal resistance at ΔP 100 Pa in Japanese patients or ΔP 150 Pa in Caucasians have been widely employed as standard objective data for nasal obstruction, although rhinomanometric results sometimes do not agree with subjective evaluation of nasal obstruction. Nasal airflow acceleration or peak flow index during nasal breathing at rest can be applied as warranted to confirm an objective diagnosis of symptomatic nasal obstruction. Further, nationality and anthropological characteristics can be related to the severity and type of stuffiness.     

Variation of Nasal Respiratory Pattern With Age During Growth and Development

The purpose of this study was to determine changes in nasal respiratory pattern with growth and development, particularly to determine the age where upper airway growth ceases. The results on 361 healthy subjects, aged 7 to 24 years, based on aerodynamic measurements during rest breathing, showed clear differences between inspiratory and expiratory phases. Nasal airflow rate and cross-sectional area increased and oral-nasal pressure and nasal resistance decreased with age up to the age of 16, levelling by the age of 20 years. The body size and gender had effect only on nasal airflow rate. This study suggests that the measurements of the nasal respiratory pattern, determining impaired nasal airway, should be done during inspiration and using age-related assesment from a healthy population until the age of 16 years. From then on, guidelines for adults are applicable.     

P物质对变应性鼻炎动物模型鼻粘膜上皮短路电流的影响

目的观察Ｐ物质（ＳＰ）作用于变应性鼻炎动物模型鼻粘膜引起的离子分泌改变导致的上皮表面短路电流（Ｓｈｏｒｔ－ｃｉｒｃｕｉｔｃｕｒｒｅｎｔ，Ｉｓｃ）的变化。方法以鸡蛋清蛋白致敏大鼠后，用Ｕｓｓ－ｉｎｇ室技术测定鼻粘膜上皮表面短路电流。并观察神经激肽受体（ＮＫ１）拮抗剂ＣＰ９６３４５、组胺Ｈ１受体拮抗剂吡拉明、Ｈ２受体拮抗剂雷尼替丁和河豚毒素对ＳＰ的阻断作用。结果经ＳＰ刺激，致敏大鼠鼻粘膜表面Ｉｓｃ显著增高。经四种物质预处理均能显著阻断ＳＰ引起的Ｉｓｃ变化。结论ＳＰ经感觉神经末梢释放后，可引起上皮表面离子电位变化、上皮通透性增高等一系列鼻粘膜病理变化。     

鼻内翻性乳头状瘤及其癌变与p53蛋白异常表达

目的：探讨鼻内翻性乳头状瘤及其癌变与ｐ５３基因的关系。方法：采用免疫组化方法（ＡＢＣ法）对３６例鼻内翻性乳头状瘤（ＩＰ）组织和１６例鼻内翻性乳头状瘤癌变（ＩＰ＋ＳＣＣ）组织进行了ｐ５３蛋白检测。结果：３６例ＩＰ均为ｐ５３蛋白阴性，而在１６例ＩＰ＋ＳＣＣ组织中有５例为ｐ５３蛋白阳性，阳性率为３１．３％（５／１６），经统计学处理，二者差异显著（Ｐ〈０．００１）。结论：ｐ５３蛋白异常表达可能与ＩＰ的发生     

鼻内窥镜手术治疗鼻息肉65例临床观察

目的：观察鼻内窥镜手术治疗鼻息肉之效果。方法：65例（120侧）鼻息肉患者进行界内窥镜手术，术后随访6～15月。结果：参照FESS－95广州标准，痊愈78侧（65％）；好转32侧（26.7％）；无效10侧（8．3％）。结论：1）横行切除中鼻甲前五1／3～1／2，有助于减少中鼻甲与鼻腔外侧壁粘连，改善窦道复合体引流，减少息肉复发；2）术前细致研究鼻窦CT片，熟悉鼻窦解剖及术后加强换药，是防止手术并发症和提高疗效的关键。     

In vitro expression of inducible nitric oxide synthase in the nasal mucosa of guinea pigs after incubation with lipopolysaccharides or cytokines

In order to demonstrate the involvement of nitric oxide synthases (NOS) – in particular the inducible isoform (iNOS) – in inflammatory processes within the nasal airways, we used organ-bath incubation to study isolated inferior turbinates and mucosa of the maxillary sinus of guinea pigs. The pattern of the expression in various substructures of the nasal mucosa was of special interest. Mucosa was incubated for 6 h with lipopolysaccharides (LPS) produced by E. coli, interleukin II (IL-2) or tumor necrosis factor-alpha (TNF-α). Saline was used as the control solution. Following incubation the specimens were fixed in buffered 4% formaldehyde solution over a period of 4 h. Tissues were next exposed to nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase-reaction and immunostained with specific antibodies to iNOS. Results then showed a clearly increased or initiated expression of iNOS in epithelium, glands, leucocytes and blood vessels of treated tissues in comparison to the control specimens. The inflammatory mediator LPS and the cytokines Il-2 or TNF-α alone were found to be capable of increasing the expression of iNOS, although the effects of LPS clearly exceeded those of the cytokines. This finding implicates iNOS-generated nitric oxide as a key factor for causing nasal swelling, secretion and obstruction during nasal infections and allergic episodes. Received: 18 November 1997 / Accepted: 22 April 1998     

鼻塞持续气道正压通气治疗新生儿呼吸衰竭临床观察

目的观察经鼻塞持续气道正压通气(N-CPAP)治疗新生儿呼吸衰竭的效果。方法应用STEPHANN-CPAP小儿呼吸机对30例危重新生儿进行经鼻塞持续气道正压通气呼吸支持治疗,观察治疗前后临床症状和血气变化。结果治疗有效25例,无效5例。治疗有效患儿使用N-CPAP时间12~96h,平均(32±4)h。并发症为鼻黏膜损伤,共12例。全部病例均治愈出院。结论N-CPAP治疗新生儿肺炎并呼吸衰竭及早产儿原发性呼吸暂停效果显著,是新生儿科一种简便易行、无创安全、疗效显著的呼吸支持设备。