鼻修复及再造术11例

鼻修复及再造术１１例隋军＊后群＊王文慧＊张秀华全鼻或大面积鼻缺损的手术修复方法很多，主要有前额带蒂组织瓣，前臂带血管蒂组织瓣，游离组织瓣、颞浅血管蒂筋膜复合岛状瓣及鼻唇沟外有蒂对称双翼皮瓣等。各种方法都具有其优缺点，我科自１９８５年以来采用前三种方...     

32例鼻硬结病临床分析

目的：总结鼻硬结临床诊治经验。方法：回顾分析1998年11月～2009年7月收治的32例鼻硬结患者的临床资料。结果：32例鼻硬结中良性肿瘤27例,炎性肿块4例,恶性肿瘤1例,均行手术治疗,术后无并发症。27例良性肿瘤和4例炎性疾病患者中,18例随访3个月～10年（平均70个月）,无复发和恶变;4例复发再次手术治疗;3例死于其他疾病;6例失访。1例恶性黑色素瘤术后6个月死于肝转移。结论：前庭解剖区域范围虽小,但可发生各种性质的肿块,手术为治疗本病的首选方法。     

固态硅橡胶隆鼻成形术（附90例报告）

我科近年应用固态硅橡胶行隆鼻成形术90例,取得较为满意的效果.本文拟讨论术前设计、术中操作及术后处理方面的有关问题. 一、材料全部采用上海硅橡胶制品研究所生产的医用级弹性硅橡胶块,根据不同患者的要求雕制成形     

鼻内镜治疗脑脊液鼻漏58例临床分析

脑脊液鼻漏（CSFR）是鼻颅底外科的常见病症,传统的修补方法有经颅内修补和经颅外修补2种进路。文献报道可知,颅内修补法损伤大,并发症多,且成功率低,颅外法修补成功率高,特别是应用鼻内镜技术以来,修补成功率显著提高^[1]。我科应用鼻内镜技术行脑脊液鼻漏修补,取得满意疗效,报告如下。     

鼻内镜下手术治疗慢性鼻-鼻窦炎的效果及生存质量调查

目的调查鼻内镜下手术治疗慢性鼻-鼻窦炎患者的效果及生存质量的影响。方法慢性鼻一鼻窦炎患者60例根据治疗方法不同分为对照组与观察组,每组各30例,对照组给予药物治疗,观察组给予鼻内镜下手术治疗,对比两组预后疗效与生存质量情况。结果观察组的治愈率与总有效率分别为66．7％和96．7％,对照组的治愈率与总有效率分别为50．0％和80．0％,差异有统计学意义（P〈0．05）。两组治疗前敌对、焦虑、精神病性、恐怖和偏执评分比较差异无统计学意义（P〉0．05）,治疗后均明显下降,且观察组下降明显明显优于对照组,差异有统计学意义（P〈O．05）。结论采用鼻内镜下手术治疗慢性鼻一鼻窦炎患者能提高治疗效果,明显改善患者的生存质量,值得推广应用。     

经鼻前庭内镜下切除鼻前庭囊肿

鼻前庭囊肿主要位于鼻前庭底部皮肤下，上颌骨牙槽突浅面的软组织内。多采用经唇龈沟进路手术切除。2001年6月至2007年1月，我们采用鼻内镜经鼻前庭进路切除鼻前庭囊肿31例，效果良好。现报告如下。     

长期口服小剂量罗红霉素治疗鼻内镜鼻窦手术后迁延不愈的临床观察

目的 探讨长期口服小剂量罗红霉素治疗鼻内镜鼻窦手术后迁延不愈患者的疗效.方法 对符合入选条件的53例鼻内镜鼻窦术后患者口服罗红霉素(150mg/d)3个月,停药后顺延随访3个月观察其疗效.结果 按鼻内镜检查结果 ,术腔完全上皮化,无异常分泌物,窦口周边上皮化,窦口开放良好者15例(28.3%);术腔部分上皮化,有少量粘性分泌物,窦口呈开放状态22例(41.5%);术腔仍有明显水肿,无明显上皮化倾向,有息肉形成,水肿粘膜阻塞鼻窦开口或鼻窦口闭锁,窦腔粘连16例(30.2%).结论 罗红霉素作为十四元环大环内酯类药物有其很好的抗炎作用,对鼻内镜鼻窦术后迁延不愈的患者有很好的疗效.     

鼻颌筛复合体骨折内镜引导的手术治疗

<正>当面部受到直接打击时,眶内侧壁、上颌骨、鼻骨和筛骨可同时发生骨折,称为鼻颌筛(naso-maxilla-ethmoid,NME)复合体骨折。NME复合体骨折属于复合性眼眶骨折的一个类型,在治疗上如处理不当,会引起严重的面部畸形和视功能障碍。对NME复合体骨折笔者在鼻内镜引导下采用美容整复治疗,现总结报告如下。1资料与方法1.1一般资料2000年至今,共收治NME复合体骨折患者60例,其中男50例50眼,女10例10眼;左眼21眼,右眼39眼;年龄17～24岁,平均21.25岁。病程为伤后0.5～15 d。外伤原因分别为军事训练伤43例,执行军事任务枪击伤10     

鼻内镜下手术治疗上颌窦鼻内翻乳头状瘤的临床疗效观察

目的探讨鼻内镜下手术治疗上颌窦鼻内翻乳头状瘤的治疗效果。方法选取我院2008年1月~2013年12月收治的上颌窦鼻内翻乳头状瘤患者做为研究对象,按照入院顺序随机分为治疗组与对照组,治疗组应用鼻内镜下手术治疗,对照组患者应用传统鼻侧切开术。结果治疗组患者的临床数据优于对照组,差异有统计学意义(P0.05)。跟踪随访2~3年,治疗组患者的恶变与复发率低于对照组,差异有统计学意义(P0.05)。结论应用鼻内镜下手术治疗上颌窦鼻内翻乳头状瘤的效果显著,术中微创治疗,术后无并发症发生,值得临床推广应用。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

基层医院护士在临床合理用药中的作用

目的充分利用护士在医师和患者间的特殊地位和作用,促进基层临床合理用药。方法从护士的工作性质出发,论述护士参与促进合理用药的方便和优势。结果通过实践,护士在促进合理用药中的作用得到有效发挥,基层合理用药环境得到极大改善。结论充分利用护士与医师和患者间的特殊桥梁作用,在基层医院促进合理用药,规范医师用药行为,防止药物滥用,引导患者安全用药,降低药源性疾病。