鼻骨外伤X线摄影技术探讨

本文通过分析鼻骨外伤X线成像特点,重点探讨了常规X线与DR检查在鼻骨外伤中的应用价值,旨在提高对鼻骨骨折诊断的准确率。结果表明DR摄影是鼻骨常规检查的理想手段。     

亚低温治疗患者鼻饲营养并发症的观察及护理

报道48例亚低温治疗患者采用一次性投给、间歇滴注和连续输注营养膳的方式鼻饲营养，其并发症有：腹泻、腹胀、肠蠕动亢进，便秘，食物反流，吸入性肺炎，代谢紊乱，高血糖，水、电解质失衡，鼻胃管堵塞等。护理中体会到亚低温治疗患者鼻饲营养的时机最好在急性期1～2d后，应用鼻饲泵连续输注，适时使用胃肠动力药西沙比利．掌握营养膳的配制和正确的鼻饲方法，严密观察，发现异常及时处理，可大大降低并发症的发生。     

继发性唇裂鼻畸形硅胶植入整复术

本文介绍一种使继发性唇裂鼻畸形获得较好外形的新手术方法。术式包括切除偏曲的鼻中隔软骨,并将一片硅胶植入于中央作为鼻小柱支柱,从而矫正歪斜的鼻小柱和抬高鼻尖,使两侧鼻孔形态对称一致,用本法为11例单侧唇裂畸形较重者进行了整复,随访4个月至4年半。绝大多数(10/11)取得满意效果,未见有严重感染和变形等并发症。     

改良内侧上颌骨切除术治疗21例鼻息肉病

目的:探讨鼻息肉病的可行性手术方法,以提高治疗效果。方法:21例鼻息肉病患者一侧行唇龈沟径路,保留下鼻甲的改良内侧上颌骨切除术(modifiedmedialmaxillectomy,MMM);另侧行单纯鼻息肉摘除和鼻内筛窦切除术,并作为对照组。结果:术后随访12～34个月,平均20个月;改良内侧上颌骨切除术侧未见复发,另侧复发6例,两组复发率差异有显著性(P<0.05)。结论:改良内侧上颌骨切除术使鼻息肉病患者术后复发率显著降低,治疗效果显著,是一种可供选择的有效的治疗手段。     

伴有齿槽嵴裂的单侧唇裂术后继发鼻畸形的修复

目的探讨伴有齿槽嵴裂的单侧唇裂术后继发鼻畸形的修复方法。方法对34例伴有齿槽嵴裂的单侧唇裂术后继发畸形的患者,在行齿槽嵴植骨的同时,行彻底的鼻整形手术。结果术后随访1~3年,植骨区成活良好,鼻畸形较整形前明显改善,接近正常外形,效果满意。结论在行齿槽嵴植骨的同时,行彻底的鼻整形手术,能够取得满意的效果,并且节省了医疗费用,缩短了治疗时间。     

ATP下鼻甲注射治疗药物性鼻炎的价值

目的 探讨ATP下鼻甲注射治疗药物性鼻炎的价值,并对ATP治疗药物性鼻炎的机理进行分析。方法 对80例采用ATP下鼻甲注射治疗(ATP组)与40例采用激光治疗(激光组)作疗效比较。结果 ATP组有效率(95％),与激光组(100％),疗效相当,无显著性差异(P>0.05)。结论ATP下鼻甲注射治疗药物性鼻炎疗效佳,起效快,痛苦小,简便易行,费用低廉,且无毒、副作用,值得推广。     

Effects of topical anti-inflammatory drugs on eosinophil survival primed by epithelial cells. Additive effect of glucocorticoids and nedocromil sodium

Background Eosinophil infiltration is a hallmark of the inflammatory response in rhinitis and in nasal polypcsis. Objective We studied the effect of steroids and nedocromil sodium on eosinophil survival primed by epithelial cells from healthy (nasal mucosa) and inflamed (nasal polyp) respiratory tissue. Methods Blood eosinophils were incubated with increasing concentrations (10^-11 10^-5 M) of topical steroids (fiuticasone propionate, budesonide, triamcinolone acetonide and beclomethasone dipropionate) and/or nedocromil sodium prior to the addition of human epithelial cell conditioned media (HECM), eosinophil viability was measured and IC₅₀ for each drug was calculated. Results All four steroids and nedocromil sodium caused a dose-related inhibition of HECM-induced eosinophil survival. The IC₅₀ of steroids were lower in eosinophils primed by mucosa HECM than on those primed by polyp HECM (fluticasone, 4nM vs 114nM: budesonide, 21 nM vs 280 nM; triamcinolone, 7 nM vs 853 nM; and beclomethasone, 171 nM vs 181 nM). The combined inhibitory effect of 10^-7M budesonide plus 10^-5M nedocromil (43.8 ± 10.8%, P < 0.03) was significantly higher than budesonide (28.5 ± 9.2%) or nedocromil (16.7 ± 5.4%) alone and close to 10^-5M budesonide (52.3 ± 11%). No differences were found in cytokine (IL-8, IL-6, GM-CSF, TNFα, IL-lβ and RANTES) concentrations between HECM from mucosa and polyps. Conclusion These results suggest that topical anti-inflammatory drugs may diminish airway eosinophilic infiltration by decreasing eosinophil viability, that nasal polyp epithelial cell secretions may induce steroid resistance in eosinophils, and that nedocromil sodium has additive effects with steroids.     

Posture-induced nasal obstruction in patients with allergic rhinitis

Nasal resistance is affected by posture. In this study, the effects of supine and lateral recumbent positions were investigated in eight normal subjects and 31 patients with allergic rhinitis. Of the 31 patients with allergic rhinitis, five showed unilateral complete nasal obstruction and one patient showed bilateral complete obstruction during the change of posture. Total nasal resistance had a tendency to increase with repeating the change of posture (a paired t-test, P < 0.05). The supine and lateral recumbent positions did not induce variable changes in total nasal resistance in normal subjects. Posture induces complete nasal obstruction in the supine or lateral recumbent positions in some patients with allergic rhinitis.     

The desipramine-induced growth hormone response and the dexamethasone suppression test in obsessive-compulsive disorder.

Ten patients with DSM-III-R obsessive-compulsive disorder (OCD) underwent the desipramine (DMI) growth hormone (GH) stimulation test as well as the dexamethasone suppression test (DST). The results were compared with the responses in a group of matched healthy controls. The GH response to DMI did not differ between patients and controls and 9 of 10 patients showed cortisol suppression in response to dexamethasone. The data suggest that neither alpha 2 adrenergic dysfunction nor DST non-suppression are features of primary OCD.     

老年病人鼻饲方法的改进

目的探讨增加置管深度并抬高床头对预防老年鼻饲病人食物反流的效果。方法将 5 75例需鼻饲的卧床老年病人按鼻饲医嘱时间顺序及不平衡指数最小原则分成三组 ,分别给予教科书中的常规置管深度置管 (对照组 )、置管深度延长 10cm(观察 1组 )、置管深度延长 10cm并抬高床头 30～ 45°(观察 2组 )进行鼻饲。结果三组病人食物反流率比较 ,P <0 .0 1;观察 1、2组分别与对照组比较 ,P <0 .0 5、P <0 .0 1;观察 1组与观察 2组比较 ,P <0 .0 1。增加置管深度并抬高床头其食物反流率最低 ,仅增加置管深度次之 ,常规置管最高。结论增加置管深度并抬高床头可显著降低老年鼻饲病人食物反流发生率。