345例腺样体肥大患儿细菌学相关性分析

目的　研究腺样体肥大儿童的鼻咽部细菌学特点。方法　选取住院手术的345例腺样体肥大患儿,术中留取腺样体表面分泌物及腺样体实体组织标本,行细菌培养及药敏试验,根据细菌培养条件致病菌检出情况,比较患儿在性别、年龄、孕周、喂养方式等多个相关因素间的差异,并分析其药敏特点。结果　腺样体肥大患儿中条件致病菌检出率为29.86%（103/345）,以流感嗜血杆菌为主,其 次为金黄色葡萄球菌和肺炎链球菌。伴鼻窦炎患儿条件致病菌检出率高于不伴鼻窦炎患儿（χ2=5.729,P =0.022）;伴扁桃体肥大患儿条件致病菌检出率高于不伴扁桃体肥大患儿（χ2=6.231,P =0.013）;腺样体Ⅲ度患儿条件致病菌检出率高于腺样体Ⅳ度患儿（χ2=6.518,P =0.011）。在性别、年龄、孕周、喂养方式、家庭宠物、生活环境、病史长短等方面各组无显着性差异（P >0.05）。以上常见细菌对β-内酰胺酶抑制剂复合药物、喹诺酮类抗生素较敏感,对非β-内酰胺酶抑制剂和磺胺类药物耐药明显。结论　流感嗜血杆菌、金黄色葡萄球菌和肺炎链球菌是儿童腺样体肥大的菌群分布中3种主要的条件致病菌。鼻窦炎、扁桃体肥大及腺 样体分度是影响儿童腺样体肥大菌群的重要因素。腺样体相关疾病诊治中,头孢类抗生素仍是用药首选,但二代头孢中的头孢呋辛耐药明显,为不推荐用药。     

孟鲁司特钠与鼻用激素治疗儿童腺样体肥大的Meta分析[论著]

目的　系统评价孟鲁司特钠与鼻用激素治疗儿童腺样体肥大的疗效。方法　计算机检索PubMed、EMbase、The Cochrane Library、OVID数据库，纳入孟鲁司特钠与鼻用激素治疗儿童腺样体肥大的研究。采用RevMan5.3软件包对纳入文献进行Meta分析。结果　最后纳入5篇随机对照研究。口服孟鲁司特钠治疗腺样体肥大治疗后的A/N比值明显低于治疗前的A/N比值[MD=-0.24，95%CI（-0.31，-0.17），P <0.0001]。口服孟鲁司特钠联合鼻用激素治疗腺样体肥大治疗后的A/N比值明显低于治疗前的A/N比值[MD=-0.25，95%CI（-0.28，-0.21），P <0.0001]。口服孟鲁司特钠组与鼻用激素组治疗后的A/N比值减小度差异不大[MD=-0.00，95%CI（-0.02，0.01），P =0.59]。联合治疗组治疗腺样体肥大后的A/N比值减小度较口服孟鲁司特钠组更明显，差异有统计学意义 [MD=-0.04，95%CI（-0.06，-0.02），P <0.0001］。单一用药或联合用药，打鼾、睡眠障碍、张口呼吸等症状均有改善。结论　口服孟鲁司特钠及鼻用激素均能有效治疗腺样体肥大儿童患者，二者联合治疗明显优于单纯一种药物治疗。短期内使用药物有效，长期研究尚未报道，需进一步研究。     

细菌感染与儿童腺样体肥大及其相关疾病

腺样体肥大是儿童最常见的疾病之一,可引起慢性扁桃体炎、分泌性中耳炎、儿童慢性鼻-鼻窦炎等并发症。针对腺样体肥大及其相关疾病的病因学研究,多从腺样体作为“储菌池”、腺样体肥大造成的机械性阻塞和腺样体免疫异常等方面进行研究。本文就腺样体肥大的微生物学与慢性扁桃体炎、分泌性中耳炎和慢性鼻窦炎的相关性进行综述。     

治疗儿童腺样体肥大相关性分泌性中耳炎的网状Meta分析

目的　采用网状Meta分析的方法比较7种干预措施治疗儿童腺样体肥大相关性分泌性中耳炎的疗效和安全性。方法　计算机检索PubMed、Embase、Web of Science、Cochrane Library、CNKI、中国生物医学文献数据库（CBM）、维普（VIP）和万方数据库,检索时间为以上各数据库建库至2019-12-31止,纳入不同干预措施治疗儿童腺样体肥大相关性分泌性中耳炎的随机对照试验及半随机对照试验,由两名研究者根据纳入与排除标准及Cochrane手册要求,单独进行文献筛查及数据提取,并完成交叉核对。使用Cochrane偏倚风险评估工具,对纳入文献进行质量评价,采用Stata14.0、Review Manager 5.3和GeMTC0.14.3软件对纳入文献进行Meta分析。结果　最终纳入28个研究,2994例分泌性中耳炎伴腺样体肥大儿童。结果显示：①网状Meta分析对治疗后总有效率进行比较,等级概率图显示腺样体切除联合鼓膜置管术最佳,其次为腺样体切除联合鼓膜激光打孔术;纯音听阈测定（pure tone audiometry,PTA）显示腺样体切除联合鼓膜置管术改善最佳。②并发症发生率比较,等级概率图显示腺样体切除联合鼓膜激光打孔术优于腺样体切除联合鼓膜置管术,但二者差异无统计学意义（OR 1.32,95%CI 0.26～5.36）。③复发率方面,等级概率图显示复发率最少是腺样体切除联合鼓膜置管术。④直接Meta分析将腺样体切除联合鼓膜置管术与单纯鼓膜置管术比较,鼓膜愈合时间比较两者差异无统计学意义（P =0.16）,鼓室积液消失时间比较差异有统计学意义（WMD -2.10,95%CI -2.4～-1.8,P＜0.00001）。结论　治疗儿童分泌性中耳炎伴腺样体肥大的7种干预措施中,腺样体切除联合鼓膜置管术疗效最佳,复发率最低,受纳入文献数量及质量影响,上述结论需在今后研究中进一步验证。     

2016～2020年石家庄地区儿童急性化脓性中耳炎主要病原菌耐药性变迁及流感嗜血杆菌的血清型分布#br#

目的　了解2016～2020年石家庄地区儿童急性化脓性中耳炎主要病原菌耐药性变迁及流感嗜血杆菌的分型，为临床合理用药提供依据。方法　收集河北省儿童医院2016年1月～2020年12月门诊和住院的544例急性化脓性中耳炎患儿的耳脓性分泌物，培养鉴定及检测药物敏感性。应用血清荚膜分型法对流感嗜血杆菌进行血清分型。结果　544例耳脓性分泌物标本中细菌培养阳性392例，阳性率为72.1%，各年间病原菌阳性检出率差异无统计学意义（χ2=1.862，P =0.761）。儿童急性化脓性中耳炎常见致病菌是金黄色葡萄球菌，检出率为37.7%（148/392），其次是肺炎链球菌，检出率为26.3%（103/392）和流感嗜血杆菌，检出率为15.1%（59/392）。急性化脓性中耳炎患儿分为0～1岁、1～3岁、3～6岁、>6岁４个年龄段，各年龄段病原菌阳性检出率差异有统计学意义（χ2=21.737，P =0.001），其中0～1岁患儿病原菌阳性检出率最高。5年间肺炎链球菌对红霉素、四环素和复方新诺明的耐药率较高均>75%。除2016年外，金黄色葡萄球菌对青霉素、红霉素、克林霉素的耐药率均>80%。流感嗜血杆菌对氨苄西林的耐药率为20.0%～57.1%，对复方新诺明的耐药率较高为45%～80%。59株流感嗜血杆菌中49株为不可分型流感嗜血杆菌。结论  2016～2020年5年内石家庄地区引起儿童急性化脓性中耳炎的病原菌主要是金黄色葡萄球菌、肺炎链球菌和流感嗜血杆菌，这些病原菌对多种抗菌药物存在不同程度耐药，应定期监测本地区耐药情况，为临床医师合理选用抗菌药物提供依据。     

睡眠呼吸障碍儿童扁桃体及腺样体组织细菌学分析

目的　探讨睡眠呼吸障碍（sleep disordered breathing,SDB）儿童扁桃体及腺样体组织的细菌学特点。方法　经多导睡眠图监测确诊的163例SDB患儿纳入研究,其中120例同时接受扁桃体及腺样体切除术,4例接受单纯扁桃体切除术,39例接受单纯腺样体切除术,124例接受扁桃体切除术的患儿按照有无扁桃体炎反复发作的病史分为两组,扁桃体炎组71例和无扁桃体炎组53例。术中取部分扁桃体和（或）腺样体组织进行细菌学检查。结果　120例患儿中的114例（95.00%）两个部位分离出的细菌种类相同,120例中有17例（14.17%）两个部位均感染了两种细菌,混合感染的细菌种类均相同。在各个季节两个部位中金黄色葡萄球菌和流感嗜血杆菌的检出率无显著性差异（扁桃体：χ2=8.538,P =0.201;腺样体：χ2=5.427,P =0.490）。有无慢性扁桃体炎病史的扁桃体组织内的各种细菌检出率无显著性差异（χ2=3.028,P =0.387）。结论　同一个SDB患儿的扁桃体和腺样体组织检出的细菌种类几乎相同,有无慢性扁桃体炎病史的扁桃体组织内的不同细菌检出率无显著性差异。     

内舒拿联合孟鲁司特钠治疗腺样体肥大的Meta分析

目的 评价内舒拿联合孟鲁司特钠治疗儿童腺样体肥大的疗效.方法 系统检索PubMed、万方、中国知网、维普网数据库2010～2020年内舒拿联合孟鲁司特钠治疗小儿腺样体肥大的相关文献.按照纳入和排除标准进行筛选文献,使用"Cochrane偏倚风险评估"工具进行文献质量评价,对纳入文献采用RevMan 5.3软件进行MET...     

腺样体肥大所致鼻气道阻塞对儿童颅面发育的影响

目的探讨腺样体肥大所致鼻呼吸阻塞对儿童颅面发育的影响。方法对30例腺样体肥大儿童（腺样体肥大组）和27例正常儿童（正常儿童组）分别进行声反射鼻测量和X线头颅测量。结果腺样体肥大组鼻咽腔容积为（15.49±6.59）cm3,较正常儿童组（20.78±4.91）cm减小,差异有统计学意义（P〈0.01）;腺样体肥大组鼻气道阻力为（5.58±3.28）cmH2O/Lmin,较正常儿童组（2.28±1.30）cmH2O/Lmin增大,差异有统计学意义（P〈0.01）。X线头颅测量显示腺样体肥大组儿童面部形态呈明显的垂直向生长,下颌后缩,下颌角变大,其中前下面高为（68.32±6.66）mm,较正常儿童组（62.09±6.30）mm增大,差异有统计学意义（P〈0.01）;面高比例为0.7±0.08,较正常儿童组0.77±0.11减小,差异有统计学意义（P〈0.05）。结论腺样体肥大可致鼻阻力增大和鼻咽腔容积减小;鼻气道阻塞可明显影响儿童颅面发育。     

鼻内窥镜在腺样体切除术中的应用

应用鼻内窥镜结合鼻腔切割吸引器行腺样体切除术５３例,其中单纯腺样体肥大（Ａ）１３例,腺样体肥大十扁桃体肥大（Ａ＋Ｔ） １２例,腺样体肥大十分泌性中耳炎（Ａ＋Ｓ） １０例,腺样体肥大十扁桃体肥大十分泌性中耳炎（Ａ＋Ｔ＋Ｓ）１８例,手术不仅适用于儿童,也适用于成人。本文对鼻内窥镜下腺样体切除术的优缺点进行了讨论。     

儿童与成人慢性分泌性中耳炎细菌学特点的分析

目的对比研究中耳炎差异球菌、肺炎链球菌、流感嗜血杆菌、卡他莫拉菌、金黄色葡萄球菌、草绿色链球菌在慢性分泌性中耳炎(secretory otitis media,SOM)儿童及成人患者的中耳积液(middle ear fluid,MEF)及鼻咽部分泌物(nasopharynx,Nph)中的检出率。方法运用PCR技术，观察并比较6种细菌在慢性分泌物中耳炎儿童组与成人组患者的MEF及Nph中的阳性率。结果①本研究中SOM儿童组与成人组患者MEF的主要细菌分布相似。PCR检测阳性率分别为91.30%（63/69）和 88.25%（30/34），差异无统计学意义（χ2=0.244，P>0.05）；②儿童组及成人组患者的MEF中，常可检测出2种或2种以上的细菌，但儿童组较成人组更为常见，差异具有统计学意义（P<0.05）；③儿童组患者MEF中阳性率最高的细菌为肺炎链球菌及金黄色葡萄球菌，成人组患者MEF中阳性率最高的细菌为金黄色葡萄球菌；④儿童组患者的MEF中，肺炎链球菌的阳性率高于成人组，差异具有统计学意义（χ2=5.526，P<0.05），其余5种细菌差异无统计学意义（P>0.05）；⑤儿童组MEF与Nph细菌阳性率比较，NPh中草绿色链球菌、流感嗜血杆菌、卡他莫拉菌的阳性率均高于MEF（χ2=21.852，P<0.05；χ2=21.369，P<0.05；χ2=4.309，P<0.05），差异具有统计学意义（P<0.05）；而金黄色葡萄球菌、肺炎链球菌及耳炎差异球菌在MEF与Nph中阳性率相似，差异均无统计学意义（P>0.05）；⑥成人组MEF与Nph细菌检出率比较，除草绿色链球菌在Nph中阳性率高于MEF（χ2=15.281，P<0.05）外，其余5种细菌差异均无统计学意义（P>0.05）。结论SOM儿童患者较成人更易发生中耳腔多种细菌混合性感染。     

儿童慢性鼻窦炎合并腺样体肥大菌谱及预后相关因素分析

目的 分析慢性鼻窦炎(CRS)合并腺样体肥大患儿腺样体表面及鼻腔内细菌谱,比较腺样体手术对CRS的临床疗效及相关因素分析.方法 收集2017年10月—2019年10月就诊于北京儿童医院耳鼻咽喉科的30例CRS合并腺样体肥大患儿的相关临床资料,其中男22例,女8例.所有患儿均行腺样体和/或扁桃体切除术,术中采集腺样体表面...     

儿童鼻窦炎与腺样体肥大的关系

儿童鼻窦炎发病率高,腺样体肥大是导致儿童鼻窦炎发病的重要原因之一。腺样体肥大可通过影响鼻腔发育、阻碍鼻腔引流和不断释放致病菌而持续影响鼻窦炎的发生发展,鼻窦炎则可通过炎症刺激导致腺样体肥大增生。变态反应因素可同时影响到鼻窦炎和腺样体炎症,是治疗儿童鼻窦炎和腺样体肥大时需要考虑的重要治疗靶点。腺样体与儿童鼻窦炎关系密切互为因果,而腺样体切除术可作为儿童鼻窦炎保守治疗效果不好时的首选外科治疗方案。     

儿童腺样体肥大和变应性鼻炎关系的临床研究

目的探讨儿童腺样体肥大与合并变应性鼻炎的相关性。方法抽选2017年10月至2018年10月间收治的60例儿童腺样体肥大患者,均对患儿进行鼻咽侧位像DR扫描,测定腺样体/鼻咽腔比率(A/N比值)来评定腺样体的大小,采用视觉模拟量表(VAS)供患者对疾病程度和生活质量所受的影响程度进行自我评估,依据症状发作的频度,持续时间,对睡眠、学习及工作的影响程度评分。应用Spearman秩相关对二者相关性进行分析。结果60例腺样体肥大患儿中,合并变应性鼻炎20例,占33.3%。腺样体肥大1级患儿4例,视觉模拟量表(VAS)评分为1-4分;2级6例,视觉模拟量表(VAS)评分2-7分;3级10例,视觉模拟量表(VAS)评分4-10分。腺样体肥大等级越高,视觉模拟量表(VAS)评分也越高。腺样体肥大与合并变应性鼻炎呈正相关。结论儿童腺样体肥大和变应性鼻炎具有显著相关性,腺样体肥大也是造成变应性鼻炎患病的因素之一。儿童变应性鼻炎的临床治疗,明确主要病因与腺样体肥大有关时,可采用对腺样体肥大的专业治疗,可有效消除变应性鼻炎的病源,改善患儿变应性鼻炎的症状,提升患儿的生活质量。     

腺样体肥大患儿血清特异性及总IgE检测结果分析

目的 初步分析腺样体肥大患儿血清特异性IgE分布及总IgE水平,探讨特异性IgE及总IgE水平与腺样体大小的关系.方法 回顾性分析2018年8月16日-2020年10月19日进行腺样体手术的186例腺样体肥大患儿的血清特异性IgE、总IgE检测结果,分析腺样体肥大患儿血清IgE分布情况,并比较患儿腺样体肥大程度与血清特...     

Prevalence of adenoid hypertrophy and nocturnal enuresis in primary school children in Istanbul, Turkey

OBJECTIVE: The purpose of this study is to investigate the prevalence of an existing relationship between adenoid hypertrophy and nocturnal enuresis in primary school children. METHODS: The study was performed in four primary schools that were chosen randomly in Kartal, Istanbul. The children's parents were asked to fill out a questionnaire that included questions concerning the associated symptoms of adenoid hypertrophy and nocturnal enuresis. The interrelations between adenoid hypertrophy and nocturnal enuresis items were examined by X2 tests. RESULTS: The study population consisted of 1132 (625 girls, 621 boys) primary school children between 5 and 14 years of age (mean 9.59+/-2.60 years). The children were divided into three groups with 5-7 years old children in Group I (n=232), 8-10 years old children in Group II (n=506) and 11-14 years old children in Group III (n=394). Of the 1132 distributed questionnaires, 1090 (87.4%) were filled in adequately and were accepted for evaluation. Prevalence of adenoid hypertrophy in school children was found to be 58 in Group I (27%), 94 in Group II (19.5%) and 78 in Group III (19.9%). Prevalence of nocturnal enuresis in school children was found to be 35 in Group I (15.1%), 51 in Group II (10.1%) and 18 in Group III (4.6%). No statistically significant association was present between adenoid hypertrophy and nocturnal enuresis in either Group I, II or III school children. CONCLUSION: In contrast to previous studies, our prevalence study did not find an association between adenoid hypertrophy and nocturnal enuresis. Thus, this prevalence study provides otolaryngologists new and interesting information.     

Comparison of the surface and core bacteria in tonsillar and adenoid tissue with Beta-lactamase production

Adenoidectomy and tonsillectomy, indicated for children with recurrent or persistent symptoms of infection or hypertrophy, are among the most frequent operations performed in children. This study was carried out for investigating the microbial flora of the tonsils and adenoids regarding to core and surface microorganisms and also pathogen microrganisms' beta-lactamase production rate. Cultures were taken from the core and surface of tonsils and adenoids of the 91 patients at the time of the surgery for tonsillectomy and adenoidectomy. Aerobic and anaerobic cultures were inoculated and identified. Beta-lactamase production was detected also. The most frequently isolated aerobic microorganisms were Streptococcus viridans and Neisseria spp. The number of the microorganisms isolated from the tonsil core compared to the surface of the tonsils was found statistically insignificant (P?>?0.05). The number of the adenoid surface aerobic microorganisms was found higher from the adenoid core (P??0.05). The togetherness of Staphylococcus aureus and other beta-lactamase producing bacteria was found statistically significant (P?相似文献   

Pulmonary function studies in adenoid hypertrophy

Tests of pulmonary function were performed on children with severe adenoid hypertrophy, before and one month after adenoidectomy.Five types of subjects were selected: (1) normal; (2) cases with isolated increase of residual volume (RV); (3) supernormal type with increased RV; (4) obstructive type of ventilatory defect, and (5) restrictive type of ventilatory defect.Following adenoidectomy there is an objective evidence of improved pulmonary function.The data suggest that 65.7% of clinically normal children with adenoid hypertrophy show pulmonary function abnormalities.     

An analysis of the incidence of adenoid hypertrophy in allergic children

INTRODUCTION: The adenoidectomy is the most often made operation in small children but the reasons of adenoid hypertrophy are not completely explained. Some researches show that in part of children, allergy can be a risk factor for adenoid hypertrophy. The main aim of this study was the analysis of adenoid hypertrophy in children with different allergic diseases. MATERIAL AND METHODS: Two separate groups of children were examined. The study group consisted of 436 children between 4 and 9 years old with allergic rhinitis and/or bronchial asthma and/or atopic dermatitis hypersensitive to house dust mites (interview, positive skin-prick test results). The control group consisted of 229 non-atopic children (negative interview and skin-prick tests) in the similar age. In the both groups we examined the incidence of adenoid hypertrophy and its dependence of the kind of allergic disease, age, sex, infections, results of skin-prick test and other sensitization. RESULTS: The probability of adenoid hypertrophy was statistically more significant (logistic regression analysis) only in children from the study group with allergic rhinitis. There were no differences in adenoid hypertrophy incidence between children with other allergic diseases and the control group. The children from the study group with adenoid hypertrophy were more often hypersensitive to pollen and moulds allergens than the children without adenoid hypertrophy (chi square test). But there were no differences in the incidence of infection, age, sex and results of skin-prick tests. CONCLUSION: The result of our study suggests that the chance of adenoid hypertrophy in allergic children hypersensitive to dust mites is greater only in them with allergic rhinitis.     

Differential bacteriology in adenoid disease.

In order to define the differential bacteriology in adenoid disease, adenoids were obtained from 10 children with adenoid hypertrophy and 29 children with chronic adenoiditis. The patients' ages ranged from 18 months to 13 years. After removal of the adenoids, the surface organisms were destroyed by alcohol and flame disinfection. One gram of tissue was sampled for aerobic and anaerobic culture. There was an average of 4.8 isolates per specimen, with 4.2 aerobes and 0.6 anaerobes. The most common isolates were: Haemophilus influenzae (84%), diphtheroids (66%), non-pathogenic Neisseria species (66%), alpha-hemolytic streptococci (64%) and non-hemolytic streptococci (59%). Anaerobes were present in 56% of all cases. The distribution of organisms was similar, regardless of clinical diagnosis. Only eight (21%) of the 39 cases had 'significant' (> or = 10(5) organisms/gm) colony counts. Our study detected no difference in either organism distribution or in total colony counts in chronic adenoiditis vs. adenoid hypertrophy.     

OSA-18量表评估腺样体肥大儿童生活质量

目的 采用儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)疾病特异性生活质量调查(OSA-18)量表, 评估腺样体肥大患儿生活质量, 以期了解OSA-18量表是否可作为临床评估腺样体肥大患儿生活质量状况的指标。方法 对符合入选标准的腺样体肥大患儿56例, 行电子鼻咽镜及多导睡眠监测(PSG)检查, 并采用OSA-18量表对其进行生活质量评估, 分析腺样体肥大病情程度与OSA-18评分的相关性。结果 80.36%的腺样体肥大患儿生活质量受到明显影响, OSA-18总体评分为"中度+重度"。OSA-18总体评分与呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO₂)及腺样体大小存在明显的相关关系。结论 腺样体肥大程度与OSA-18评分之间存在相关性, OSA-18量表评分可作为临床评估腺样体肥大患儿生活质量状况的指标。