【摘要】 目的 观察鼻内镜下激光治疗变应性鼻炎的疗效。 方法 2005年6月－2008年7月采用鼻内镜下Nd:YAG激光治疗变应性鼻炎患者384例，其中男206例，女178例；年龄13~74岁，平均31岁。病程1~33年，平均7.7年。按照2004年制定的《变应性鼻炎诊治原则及推荐方案》评分均gt;6分。术前及术后1、6、24个月时分别对患者症状和体征进行评分和分析。 结果 所有患者均获随访，随访时间1~24个月，平均22.7个月。其中术后1、6、24个月分别有384、380和358例患者获随访。统计术前及术后1、6、24个月时症状以及体征评分总分分别为（11.32±1.03）、（3.06±1.17）、（3.32±1.37）、（4.09±2.03）分，术后各时间点评分均较术前显著改善，差异有统计学意义（Plt;0.05）；术后各时间点间差异均有统计学意义（Plt;0.05），其中以术后1个月效果最好。 结论 鼻内镜下激光治疗变应性鼻炎疗效确切，但远期有一定复发率。【Abstract】 Objective To explore the clinical efficacy of operation by laser under nasal endoscope for the treatment of allergic rhinitis. Methods A total of 384 patients with allergic rhinitis undergoing operation by Nd : YAG laser under nasal endoscope from June 2005 to July 2008 were enrolled in the study, including 208 males and 178 females with their age ranged from 13 to 74 years old averaging at 31.2 years. The course of the disease ranged from 1 to 33 years averaging at 7.7 years. According to The Treatment Principle and Recommending Program for Allergic Rhinitis regulated in 2004, the scores of these cases were all higher than 6. Scoring and analysis of patients’ symptoms and body signs were performed before operation and 1, 6, and 24 months after operation. Results All the patients were followed up with the time period ranged from 1 to 24 months averaging at 22.7 months. A total of 384, 380 and 358 patients were followed up respectively 1, 6, and 24 months after operation. The general score of symptoms and body signs before operation, 1, 6, 24 months after operation were respectively 11.32±1.03, 3.06±1.17, 3.32±1.37, and 4.09±2.03. The scores after operation were significantly better than that before operation (Plt;0.05). The curative effect at the first month was the best. Conclusion Operation by laser under nasal endoscope is one of the valid, feasible methods for the treatment of allergic rhinitis, but during the long-term period, recurrence in some cases is possible.
【摘要】 目的 比较3种方法治疗鼻前庭囊肿的优缺点，探讨鼻前庭囊肿的最佳治疗方法。 方法 2002年1月-2008年6月收治鼻前庭囊肿患者84例，随机分为3组，分别采用微波、鼻前庭揭盖术和唇龈沟切口径路鼻前庭囊肿切除术治疗。 结果 84例患者均治愈。3组治疗时间和出血量比较均有统计学意义（Plt;0.05）。术后4例发生感染，分别为鼻前庭揭盖术组1例（3.57%），唇龈沟切口径路鼻前庭囊肿切除术组3例（10.71%）。随访1年，仅微波治疗组3例患者（10.71%）因囊肿壁残留复发，行鼻内镜下鼻前庭囊肿揭盖术后治愈。 结论 鼻内镜下鼻前庭囊肿；揭盖术具有精确、微创、手术时间短、并发症少、复发率低等优点。【Abstract】 Objective To identify the best treatment method for nasal vestibular cyst by comparing three kinds of operative methods. Methods Eighty-four patients with nasal vestibular cyst in this department were divided into three groups from January 2002 to June 2008. They were operated by microwave, uncover method under nasal endoscope and cyst cxcision by crevicular lip approach, respectively. Results All of the 84 patients were cured with 4 infected: one patient (3.57%) was operated by uncover method under nasal endoscope and three patients (10.71%) were operated by cyst excisionby crevicular lip approach. On the contrast of quality of blooding and operating time, there was significant difference among the three operative methods (Plt;0.05). Only three patients (10.71%) operated by microwave recurred after one year of follow-up caused by remained cyst, which were cured after reoperated by uncover method under nasal endoscope. Conclusion Uncover method under nasal endoscope is an effective operation for treating nasal vestibular cyst with such advantages as less trauma, precise operation, short operative time, and less recurrence.
目的通过漂浮导管（Swan-Ganz导管）监测外周血管阻力指数（SVRI）作为优化的心功能不全状态下感染性休克早期目标导向治疗（EGDT）的临床意义。 方法2012年1月至2014年1月第四军医大学附属西京医院心血管外科ICU收治体外循环心脏术后感染性休克患者8例，其中男7例、女1例，年龄（50.9±11.1）岁。以中心静脉压（CVP）为复苏目标行经验性容量复苏治疗，循环未见改善，则实施漂浮（Swan-Ganz）导管监测血流动力学指标，以外周血管阻力指数（SVRI）为优化目标复苏，观察Swan-Ganz导管复苏前及复苏6 h、24 h后的血流动力学及氧代谢指标，分析复苏达标所需时间。 结果8例患者平均住ICU时间（16.87±3.35）d，发生肺部并发症8例，急性肾功能衰竭5例，急性肝功能衰竭1例，消化道出血1例。6例28 d后病情好转存活，死亡2例。8例感染性休克患者经Swan-Ganz导管目标导向治疗6 h和24 h后平均动脉压（MAP）分别为（65.8±2.76）mm Hg、（67.8±3.79）mm Hg，中心静脉压（CVP）分别为（12.75±3.37）cm H2O、（9.75±2.86）cm H2O，心排血量指数（CI）分别为（2.36±0.12）L·min-1·m-2、（2.41±0.39）L·min-1·m-2，外周血管阻力指数（SVRI）分别为（1 892.60±2 294.62）dyn·s·m2·cm-5、（2 053.90±205.54）dyn·s·m2·cm-5，各项指标均较治疗前升高；治疗6 h和24 h后动脉血乳酸分别为（11.83±1.16）mmol/L、（6.47±2.59）mmol/L，较治疗前[（14.98±0.45）mmol/L]下降。 结论采用Swan-Ganz导管监测SVRI作为优化目标导向治疗心功能不全状态下感染性休克可以提高6 h复苏成功率，改善患者预后。
ObjectiveTo examine the differences between totally thoracoscopic surgery and median sternotomy in scope of trauma, postoperative recovery and postoperative complications. MethodsWe retrospectively analyzed the clinical data of 331 patients with cardiac myxoma in our hospital between January 2001 and November 2015. The patients were devided into 2 groups by the different methods of operation:a totally thoracoscopic surgery group including 196 patients with 71 males and 125 females at a mean age of 50 (42.00-57.50) years, and a median sternotomy group including 135 patients, with 53 males and 82 females at a mean age of 52 (38.00-61.00) years. The clinical records of the two groups were compared in scope of trauma, postoperative recovery, and postoperative complications. ResultsThere was shorter time in breathing machine and ICU time (P<0.001), and fewer volume in blood transfusion, blood loss (P<0.001) in the totally thoracoscopic surgery group. There was less pain and postoperative complications (P<0.001) in the totally thoracoscopic surgery group. The aortic clamp time in the totally thoracoscopic surgery group was not significantly different compared with that in the median sternotomy group (P=0.15) While cardiopulmonary bypass time was shorter in the median sternotomy group (P<0.001). ConclusionTotally thoracoscopic surgery is a safe and reliable method in treating cardiac myxoma. Our results suggest that totally thoracoscopic surgery has the advantage of fewer blood loss, blood transfusion, and postoperative complications compared with median sternotomy surgery. Totally thoracoscopic surgery leads to earlier recovery and less pain.
Objective To investigate the effects of exogenous pulmonary surfactant （PS） on ventilation weaning and respiratory mechanics in infants with acute lung injury（ALI） after cardiopulmonary bypass （CPB）.Methods Twelve infants underwent cardiopulmonary bypass cardiac surgery committed with ALI and difficulty in weaning from ventilation were included in this study.Exogenous PS was used in the treatment via intra-tracheal administration.The changes of blood gas，respiratory mechanics and the conditions of ventilation weaning were observed.Results After intra-tracheal PS administration，spontaneous breath remained steady；spontaneous respiratory rate significantly decreased from，tidal volume of spontaneous breath increased significantly.Three concave sign disappeared and koilosternia was alleviated.PaCO2 value decreased significantly and peak inspiratory pressure（PIP） decreased from （36.18±10.25）cm H2O to （25.11±5.14）cm H2O （Plt;0.01）.Static lung compliance （Cstat） increased from （1.49±0.65）mL·cm H2O-1·kg-1 before treatment to （1.95±0.50） mL·cm H2O-1·kg-1 6 h after treatment （Plt;0.01）；and airway resistance （Rstat）decreased from （128.17±26.34） cm H2O·L-1·s-1 before treatment to （78.56±18.22） cm H2O·L-1·s-1 6 h after treatment （Plt;0.01）.All 12 infants weaned from ventilator successfully.Conclusion Combined with PS intra-tracheal treatment，lung protective ventilation strategy can significantly improve parameters of respiratory mechanics，increase dynamic lung compliance，decrease airway resistance，which can decrease the breathing effort of the infants and make it easy to wean from ventilator.
Abstract: Objective To observe the influence of various methods of cerebral protection during deep hypothermic circulatory arrest (DHCA ) on S-100 protein. Methods Eighteen dogs were randomly and equally divided into three groups: the deep hypothermic circulatory arrest (DHCA group ) , the DHCA with retrograde cerebral perfusion (DHCA + RCP group ) , and the DHCA with intermittent antegrade cerebral perfusion (DHCA + IACP group ). Upon interruption of cardiopulmonary bypass (CPB) , the nasopharyngeal temperature was slowly lowered to 18℃, before CPB was discontinued for 90 minutes, after 90 minutes, CPB was re-established and the body temperature was gradually restored to 36℃, then CPB was terminated. Before the circulatory arrest, 45min, 90min after the circulatory arrest and 15min, 30min after re-established of CPB, blood samples were drawn from the jugular veins fo r assay of S-100 protein. Upon completion of surgery, the dogs was sacrificed and the hippocampus was removed from the brain, properly processed for examination by transmission electron microscope for changes in the ultrastructure of the brain and nerve cells. Results There was no significant difference in the content of S-100 protein before circulatory arrest among all three groups (P gt; 0.05). After circulatory arrest, DHCA and DHCA +RCP group showed an significant increase in the content of S-100 protein (P lt; 0.01). There was no significant difference in the content of S-100 protein after circulatory arrest in DHCA + IACP group. Conclusion Cerebral ischemic injuries would occur if the period of DHCA is prolonged. RCP during DHCA would provide protection for the brain to some extent, but it is more likely to cause dropsy in the brain and nerve cells. On the other hand IACP during DHCA appears to provide better brain protection.