老年人慢性鼻窦炎鼻内镜围手术期处理

慢性鼻窦炎、鼻息肉是老年人的常见病,保守治疗往往效果欠佳,但因老年人多体质差,常伴有心、肺等并发症,且传统的鼻窦手术方法创伤较大,手术治疗较为棘手,故常放弃手术.     

老年慢性鼻-鼻窦炎鼻息肉患者功能性鼻内镜围手术期治疗

目的:探讨老年慢性鼻-鼻窦炎鼻息肉患者在鼻内镜术围手术期的治疗特点。方法:回顾分析187例老年慢性鼻-鼻窦炎鼻息肉患者(年龄≥60岁)的临床资料。结果:经系统有针对性围手术期治疗后,治愈132例(72.5%),好转43例(23.6%),无效7例,总有效率96%,无一例发生手术并发症。结论:老年患者经系统有针对性的围手术期治疗后行鼻内镜手术是安全有效的。     

慢性鼻-鼻窦炎-鼻息肉伴哮喘患者鼻内镜围手术期药物治疗

目的 探讨慢性鼻-鼻窦炎-鼻息肉(CRSwNP)伴支气管哮喘患者鼻内镜围手术期药物治疗原则及效果。方法 收集2010年6月至2013年12月山东大学齐鲁医院耳鼻咽喉科收治的109例CRSwNP伴支气管哮喘患者行鼻内镜手术(ESS)的临床资料。术前均对哮喘进行全面评估, 哮喘完全控制6个月后行ESS手术治疗, 围手术期采用雾化吸入及全身糖皮质激素等药物治疗。结果 围手术期无哮喘急性发作, 仅1例患者术后第2天因口服镇痛剂出现喘息;术后随访1~3年, 采用鼻内镜检查并行ESS临床疗效评估, 病情完全控制者5例(4.59%), 病情部分控制者94例(86.24%), 病情未控制10例(9.17%);仅1例术后13个月因股骨头坏死行手术治疗。结论 全面细致的哮喘病情评估和ESS围手术期药物治疗有利于防止围手术期哮喘发作及控制术后CRSwNP患者鼻息肉复发, 有利于提高手术疗效。     

892例慢性鼻－鼻窦炎患者内镜鼻窦手术围手术期临床分析

目的 探讨内镜鼻窦手术围手术期处理原则及注意事项。方法 分析892例内镜鼻窦手术患者术后随访及手术1年后治疗效果。 结果 根据慢性鼻－鼻窦炎诊断和治疗指南2008年南昌标准,以手术后1年为近期疗效评估时间,采用Lund-Kennedy评分法进行鼻内镜检查量化评估,892例中治愈759例（82.5%）,好转133例（15%）,无效22例（2.5%）,均为慢性鼻－鼻窦炎伴有鼻息肉的患者。手术并发症为眶纸板损伤27例,脑脊液鼻漏11例,术后大出血1例,筛顶损伤6例,多数并发症发生于手术后初期。 结论 认真的围手术期治疗、建立术后严格的鼻内镜随访换药制度是防止手术并发症、提高手术疗效的关键。     

加强慢性鼻-鼻窦炎围手术期综合治疗

经鼻内镜鼻窦手术（endoscopic sinus surgery，ESS）本身并不能直接治疗慢性鼻-鼻窦炎（chronic rhinosinusitis，CRS），手术的主要目的是为鼻窦黏膜形态与功能的改善与恢复创造一个结构合理、通气良好、引流通畅的局部环境。围绕着提高手术质量和效果所进行的系列药物治疗和辅助处理的过程，称为围手术期综合治疗。     

加强围手术期综合治疗在慢性鼻-鼻窦炎的疗效分析

目的探讨加强围手术期综合治疗对慢性鼻-鼻窦炎的作用。方法选取2017年2月~2019年3月具有典型临床症状和体征经CT摄片确诊,接受手术治疗的慢性鼻-鼻窦炎患者107例,加强术前1周及术后3月的围手术期综合治疗,观察其疗效。结果术后一年后,根据内镜检查鼻腔和术后鼻腔恢复情况,病情完全控制87例,病情部分控11例,病情未控9例,总有效率91.6%。结论对手术治疗的慢性鼻-鼻窦炎患者加强围手术期综合治疗具有积极意义。     

慢性鼻-鼻窦炎伴哮喘患者鼻内镜围手术期临床观察

目的：探讨慢性鼻-鼻窦炎伴哮喘患者鼻内镜围手术期处理,以减少并发症及不良事件的发生,提高治愈率。方法：对152例慢性鼻-鼻窦炎伴哮喘患者鼻内镜围手术期的临床资料进行回顾性分析。结果：经过规范的围手术期治疗,全部患者术前哮喘控制情况良好,116例患者术毕返回病房后13例哮喘不同程度发作;35例术毕直接送往ICU观察24~48h,返回病房后1例哮喘急性发作;1例术毕拔管后即刻出现哮喘发作;以上患者经治疗后均好转。术后随访1年,恢复良好。结论：应充分认识慢性鼻-鼻窦炎与哮喘的密切关系,规范围手术期处理,掌握哮喘急性发作时的处理原则。只要做好充分围手术期准备,伴哮喘的鼻内镜手术是安全的,并可有良好的疗效。     

鼻内镜手术的围术期治疗

目的：观察内镜鼻窦手术围术期治疗对其疗效的影响。方法：123例鼻窦炎、鼻息肉行内镜鼻窦手术，术前2周、术后3个月内予局部及全身用药治疗，定期随访6个月以上。结果：治愈80例（65％），好转31例（25.2％），无效12例（9.8％），总有效率90.2％。结论：围术期治疗是降低鼻内镜手术术后复发率及并发症的重要环节。     

肾上腺糖皮质激素在慢性鼻窦炎和鼻息肉围手术期应用的不良反应

目的：探讨肾上腺糖皮质激素在慢性鼻窦炎和鼻息肉围手术期的临床应用范围，疗效及不良反应。方法：1997年1月－2000年7月对慢性鼻窦炎，鼻息肉患者施行鼻内镜手术期间，应用糖皮质激素治疗的704例中26例出现不良反应患者进行回顾性分析。结果：血象异常15例，血压升高5例，两者兼而有之2例，消化道出血2例，结核病灶扩散2例。结论：术前详询病史，完善检查，严格适应证，规范用药是避免不良反应发生的重要措施。     

慢性鼻窦炎内镜术的围手术期护理

慢性鼻窦炎是耳鼻咽喉科常见疾病,较急性鼻窦炎更为常见.近年来其发病率有增加的趋势.在治疗上,由于鼻内镜应用技术的飞速发展及日渐成熟.慢性鼻窦炎的治疗观念及治疗方法均有了新的变化及提高.功能性鼻内镜手术将传统根治性大部分或全部刮除窦内黏膜的破坏性手术变为根据病变程度、在彻底清除病变的基础上,尽可能保留鼻腔及鼻窦的正常黏膜及鼻窦黏膜的形态和生理功能恢复的手术[1].对于这种功能性鼻窦手术,做好围手术期的护理,对患者的手术及康复有重要意义.     

鼻内镜治疗慢性鼻-鼻窦炎疗效及影响因素分析

目的探讨慢性鼻-鼻窦炎术后疗效及影响疗效的相关因素。方法回顾性分析200例经鼻内镜手术的慢性鼻一鼻窦炎患者的临床资料,通过t检验了解术后疗效,Logistic回归模型分析影响慢性鼻-鼻窦炎患者手术预后的诸因素。结果患者术后症状明显改善,相关因素分析表明慢性鼻-鼻窦炎患者是否伴有鼻息肉、是否长期应用鼻减充血剂、是否有前期鼻窦手术史、是否伴变应性鼻炎病史、是否坚持鼻内镜术后的综合治疗是影响慢性鼻-鼻窦炎手术预后的相关因素。结论功能性鼻内镜手术作为治疗慢性鼻-鼻窦炎、鼻息肉最有效的临床方法之一,能够明显地改善患者的症状,同时强调鼻内镜术后的综合治疗,包括术后随访和鼻腔清理,鼻内糖皮质激素、黏液稀化剂和抗生素的联合应用。     

The role of bone in chronic rhinosinusitis

OBJECTIVES: To evaluate and confirm the histological inflammatory changes that occur in bone and in the overlying mucosa in experimentally induced chronic rhinosinusitis and to evaluate differences in the inflammatory patterns that may occur with different organisms. STUDY DESIGN: Histological study of induced maxillary rhinosinusitis in 29 New Zealand White rabbits (15 with, 14 with ) 7 to 9 weeks after infection. METHODS: Following maxillary sinus ostial infection, unilateral chronic bacterial rhinosinusitis was induced in 29 New Zealand White Rabbits, using (n = 15) and (n = 14). The pathogenic organism was confirmed by culture, and the rabbits were sacrificed at predetermined time intervals (7, 8, and 9 wk) from the time of infection. Following harvest, en bloc sinus sections were mounted, stained, and analyzed. Specific attention was given to identifying histological changes in paranasal sinus bones on both sides. RESULTS: All animals (29 of 29) demonstrated histological evidence of operative occlusion on the side of the original inoculum, and all were culture-positive for the inoculated organism at death. Histological evidence of chronic rhinosinusitis in the inoculated sinus was demonstrated in 86% of animals (25 of 29). Evidence of chronic osteomyelitis in the noninfected side was seen in 15 of 29 animals (52%) overall, or 9 of 15 animals (60%) infected with pseudomonas and 6 of 14 (43%) animals infected with staphylococcus organisms. CONCLUSIONS: The study provides further evidence that bacterial rhinosinusitis can involve bone at a distance from the site of primary infection, thereby suggesting that infectious agents may spread through bony structures in the pathogenesis of chronic rhinosinusitis.     

手术治疗慢性鼻窦炎对控制支气管哮喘发作疗效的初步观察

目的探讨慢性鼻窦炎合并支气管哮喘患者在手术治疗慢性鼻窦炎后支气管哮喘的发作情况。方法选取2001～2007年我院收治的慢性鼻窦炎且合并支气管哮喘的手术患者40例行鼻内镜下手术,术后平均随访(5.4±2.0)年,观察鼻窦炎术后哮喘发作情况。结果术后1年随访结果显示,支气管哮喘治愈6例(15.0%),好转18例(45.0%);术后3年随访结果显示,支气管哮喘治愈18例(45.0%),好转14例(35.0%)。结论多数慢性鼻窦炎合并支气管哮喘患者经鼻内镜手术治疗后支气管哮喘症状明显改善,部分患者甚至可以治愈。     

腺样体切除术在治疗儿童慢性鼻窦炎中的意义

目的探讨腺样体切除在儿童慢性鼻窦炎治疗中的作用。方法回顾分析1999年3月~2003年10月在我科住院治疗,接受腺样体切除术的150例儿童慢性鼻窦炎的临床资料。结果随访6个月,参照1997年海口会议鼻窦炎疗效判断标准,150例中治愈98例(治愈率65.3%),好转41例(27.3%),无效11例(占7.3%),术中无任何并发症,总有效率为92.7%。结论Ⅰ型、Ⅱ型1期、Ⅱ型2期的儿童慢性鼻窦炎的治疗以切除阻塞鼻腔通气的腺样体,配合积极的内科治疗,可以达到治愈儿童慢性鼻窦炎的目的;Ⅱ型3期及Ⅲ型病人应行鼻内镜下鼻窦手术加腺样体切除术。     

鼻内镜术后不同填塞材料对术后黏膜转归的影响

目的 探讨鼻内镜手术后,鼻腔不同填塞材料对慢性鼻窦炎患者鼻窦术腔黏膜转归的影响。 方法 对入选的167例鼻窦炎患者按填塞材料的不同分为纳吸棉组(A组,n=93)和膨胀海绵组(B组,n=74)。两组患者均执行同样的入院前治疗,由同一高年资医师手术,并给予相同的术后用药及复查换药周期安排,通过比较视觉模拟评分法(VAS)、术前Lund-Mackay鼻窦CT评分、术后鼻内镜Lund-Kennedy评分,比较两组术后鼻窦术腔黏膜恢复情况。 结果 A、B组间术前Lund-Mackay、VAS和Lund-Kennedy分值差异均无统计学意义(P>0.05);两组Lund-Kennedy术后评分差异有统计学意义(P<0.01),且各时间点A组分值低于B组(P<0.01);两组VAS术后不同时间点评分组间差异均有统计学意义(P<0.01),术后4周及12周均显示A组评分低于B组,A组症状后期改善更佳。A组5例、B组7例12周时术腔局部水肿明显,囊泡增生,组织重塑不良,有息肉复发迹象,结合术后病理,给予个体化治疗方案等处理后,黏膜修复明显改善。 结论 鼻内镜术后纳吸棉填塞可促进术腔黏膜良性转归过程。     

Symptom control in chronic rhinosinusitis is an independent predictor of productivity loss

AimsSinonasal symptoms cause significant productivity losses in patients with chronic rhinosinusitis (CRS). Patient-perceived CRS symptom control is a longitudinal measure of CRS symptomatology and is directly associated with general health-related quality of life (QOL) in patients with CRS. The aim of this study was to better understand the relationship between symptom control and productivity loss in CRS.Materials and methodsProspective cross-sectional cohort study of 200 patients with CRS. Patients categorized their CRS symptom control as “Not at all”, “A little”, “Somewhat”, “Very”, and “Completely”. Lost productivity was assessed by determining the number of work and/or school days missed in the last 3 months due to CRS symptoms. Sinonasal symptom severity was measured using the 22-item Sinonasal Outcomes Test (SNOT-22). Associations were sought between lost productivity and patient-perceived CRS symptom control.ObjectiveTo determine the association between patient-perceived longitudinal symptom control and productivity in patients with CRS.ResultsA total of 200 participants (48% male, 52% female), with a mean age of 52 years (Standard Deviation [SD]: 16) were enrolled. The mean SNOT-22 score of participants was 33.5 (SD: 22.4). Participants missed a mean of 3 days (SD: 10) of work or school due to CRS. CRS symptom control classified as “not at all” was associated with 11 days of lost productivity due to CRS on univariate analysis (β = 11.16, 95% CI: 5.39–16.94, P < 0.001) and 8 days of lost productivity on multivariate analysis (β = 8.02, 95% CI: 1.92–14.13, P = 0.011). None of the other categories of patient-reported CRS symptom control were associated with lost productivity due to CRS.ConclusionsPatient-perceived control of CRS symptoms, an important metric previously shown to be significantly associated with QOL in CRS patients, is independently associated with lost productivity. These results motivate longitudinal studies to determine if improvement of CRS symptom control may reduce losses in productivity.     

Rate of allergic fungal etiology of chronic rhinosinusitis in Turkish population

The aim of this study is to investigate intranasal fungal incidence in Turkish patients with chronic rhinosinusitis (CRS). One hundred patients with CRS and 40 healthy subjects as a control group were included in the prospective study. Nasal lavage samples were investigated for the presence of fungus, using new culture techniques and histopathologic examination. Epidermal and intradermal hypersensitivity tests were used to find out fungal atopy. Levels of serum eosinophils, total IgE and presence of fungus-specific IgE were investigated in the blood samples. Quantitative parameters were analyzed using Pearson χ² test. Allergic fungal sinusitis (AFS) was diagnosed in 13(13%) patients. There was no fungal growth in the control group. Eosinophilic mucin was detected in 94% of patients. Clinical and laboratory parameters of CRS were not significantly different in patient groups with or without intranasal fungi. As a result, fungal incidence was not as high as expected in Turkish patients with CRS. Furthermore, no significant correlation could be found between presence of intranasal fungus and type-1 hypersensitivity in patients with CRS.     

黏蛋白基因MUC2在慢性鼻-鼻窦炎筛窦黏膜中的表达

目的：定量检测慢性鼻-鼻窦炎（CRS）筛窦黏膜中黏蛋白基因MUC2的表达,探讨其在CRS黏液过量分泌中的意义。方法：采用荧光定量RT-PCR检测32例CRS患者（CRS组）和8例正常筛窦黏膜患者（正常对照组）中MUC2 mRNA的表达。结果：MUC2 mRNA在CRS组中的表达[（10．55±3．31）×10^10拷贝／g]较正常对照组[（1．40±0．44）×10^10拷贝／g]增高,两组间差异有统计学意义（P〈0．01）。结论：MUC2 mRNA在CRS筛窦黏膜中表达上调,可能是CRS黏液过度分泌的重要因素之一。     

IL-32在慢性鼻窦炎组织中的表达及机理研究

目的探讨白介素-32（interleukin-32,IL-32）在慢性鼻窦炎组织中的表达及其致病机理。方法收集40例慢性鼻窦炎患者,同期选取20例行鼻部手术患者的正常组织作为对照者,采用酶联免疫吸附（ELISA）法检测两组鼻组织中IL-32蛋白;采取即用型EnVisionTMSuper/HRP检测试剂盒检测两组鼻黏膜组织中CD3＋和CD68＋表达。结果慢性鼻窦炎鼻黏膜组织中IL-32表达高于对照组（P〈0.01）,慢性鼻窦炎鼻黏膜组织中CD3＋细胞计数（55.36±23.53）个/mm2显著高于正常对照组（28.27±11.43）个/mm2（P〈0.01）;慢性鼻窦炎鼻黏膜组织中CD68＋细胞计数（7.65±2.27）个/mm2高于对照组（5.98±2.10）个/mm2（t=2.741,P〈0.01）。且慢性鼻窦炎鼻黏膜组织中IL-32与CD3＋和CD68＋表达呈正相关（P〈0.05）。结论 IL-32可能通过招募炎症细胞,参与慢性鼻窦炎的发病。     

应用PCR技术研究真菌在鼻息肉及鼻窦炎发病中的作用

目的：探讨真菌在慢性鼻窦炎、鼻息肉患者中的致病作用。方法：采用PCR方法分别检测66例慢性鼻窦炎患者（鼻窦炎组）生理盐水冲洗前、后的鼻息肉及鼻窦黏膜的真菌,同时检测21例正常志愿者（对照组）的鼻腔分泌物中的真菌,应用Y。检验比较其差异性。结果：鼻息肉组真菌阳性率：息肉为89．2％,黏膜为89．4％,分别与对照组（66．7％）比较,差异均有统计学意义（均P〈0.05）;用生理盐水冲洗后,鼻息肉组真菌阳性率：息肉为7．14％,黏膜为2．63％,分别与冲洗前比较,差异均有统计学意义（均P〈0.05）。结论：真菌在鼻息肉和鼻窦炎的发病中可能发挥重要作用,PCR技术在真菌检测中有重要意义。