【摘要】 目的 探討乳突根治術后耳內窺鏡換藥與常規換藥相比是否具有優勢。 方法 2003年3月-2008年10月對89例共89只耳行開放式乳突根治術患者按隨機數字表法隨機分為試驗組及對照組，試驗組45例45只耳采用耳內窺鏡換藥，對照組44例44只耳常規換藥；分別觀察試驗組和對照組的干耳人數及干耳的時間，計算干耳率及干耳的平均時間。 結果 試驗組45只耳中42只干耳，干耳率93.3％；對照組44只耳中40只干耳，干耳率90.9％。兩組比較差異無統計學意義（Pgt;0.05）。試驗組42例干耳患者平均干耳時間為術后（50.8±13.4） d，對照組40例干耳患者平均干耳時間為術后（60.7±12.2） d；兩組比較，差異有統計學意義（Plt;0.001）。 結論 中耳乳突根治術后耳內窺鏡下換藥與常規換藥相比不能顯著提高干耳率，但能有效縮短干耳時間。【Abstract】 Objective To evaluate the application of otoendoscope in dressing change after mastoidectomy. Method Between March 2003 and October 2008, 89 patients (89 ears) underwent mastoidectomy in Department of Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University and in Department of Otolaryngology, Nuclear Industry 416 Hospital of Chengdu. The patients were randomly divided into two groups by simple randomization (trial group and control group). Forty-five patients in the trial group underwent the dressing change under otoendoscope, while 44 patients in the control group under the routine method. The ear drying rate and the ear drying time in the two groups were observed. Results The ear drying rate was 93.3% (42 dry ears)in the trial group, and was 90.9% (40 dry ears) in the control group; the difference between the two groups was not significant (Pgt;0.01). The ear drying time was (50.8±13.4) days in the trial group and was (60.7±12.2) days in the control groups; the difference between the two groups was significant (Plt;0.001). Conclusion Dressing change under the otoendoscope after mastoidectomy may not improve the ear drying rate but can shorten the ear drying time.
ObjectiveTo systematically evaluate the effect of Dexmedetomidine (Dex) on postoperative cognitive dysfunction (POCD) of Chinese patients undergoing abdominal surgeries. MethodsWe searched databases including PubMed, Web of Science, CNKI, CBM, VIP and WanFang Data from inception to April 2015, to collect randomized controlled trials (RCTs) about evaluating the effect of Dex on POCD of Chinese patients undergoing abdominal surgeries. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis. ResultsA total of 8 RCTs were included. The results of meta-analysis showed that:compared with the control group, the MMSE scores of the Dex group were higher after surgeries in the first day (MD=1.46, 95%CI 0.98 to 1.95, P<0.000 01), the second day (MD=2.46, 95%CI 2.11 to 2.81, P<0.000 01), the third day (MD=1.81, 95%CI 0.37 to 3.25, P=0.01) and the seventh day (WMD=2.03, 95%CI 1.64 to 2.43, P<0.000 01). ConclusionCurrent evidence shows that the usage of Dex during abdominal surgeries can reduce the incidence of POCD in Chinese patients. Due to the limited quantity and quality of included studies, more high quality studies are needed to verify the above conclusion.
慢性阻塞性肺疾病( COPD) 是由吸煙誘發, 以氣流持續受限為特征, 與CD4 + T 細胞及CD8 + T 細胞密切相關的由炎癥及自身免疫反應引起的疾病[ 1] 。CD8 + T 細胞發揮效應及其所受調節的機制是COPD 炎癥持續放大且戒煙后也不能緩解的關鍵, 對其在COPD 炎癥中免疫作用及機制的研究有助于突破COPD 抗炎治療和免疫調節治療的難點, 對遏制甚至逆轉COPD 炎癥發展進展過程具有重要意義。Tc17 細胞是近年發現的一種分泌前炎癥細胞因子IL-17 的CD8 + T 細胞亞群, 其分泌IL-17、IL-21、 IL-22等細胞因子, 與肺部炎癥、哮喘、類風濕性關節炎等炎癥免疫性疾病關系密切。在COPD 的肺部炎癥中, Tc17 細胞很可能是連接CD4 + T 細胞和CD8 + T 細胞的另一條重要途徑, 共同參與COPD 的炎癥和免疫方面的機制。
目的 探討伴顳下頜關節紊亂病（TMD）的成人正畸患者的心理社會因素。 方法 2009年5月－2011年12月伴TMD的成人正畸患者42例為觀察組，無矯正要求、伴TMD的錯牙合患者50例為對照組。采用九十項癥狀清單（SCL-90）、艾森克人格問卷（EPQ）進行測試，同時進行TMD調查。 結果 觀察組與對照組相比，得分較高的有強迫、焦慮、抑郁、人際關系敏感等因素，差異有統計學意義（P＜0.05）；觀察組患者P量表、N量表得分高于對照組，差異有統計學意義（P＜0.05）。 結論 伴TMD的成人正畸患者心理健康問題普遍存在,傾向于神經質和精神質的人格特征。
ObjectiveTo compare the clinical outcomes of laparoscopic magnetic compression cholangiojejunostomy (LMCCJ) with laparoscopic hand-sutured cholangiojejunostomy (LHSCJ). MethodsA retrospective case-control study was performed. From January 2019 to May 2022, 37 patients, who underwent laparoscopic treatment in this hospital, were enrolled in this study. There were 16 cases in the LMCCJ group and 21 cases in the LHSCJ group. The demographic information, procedure time to complete bilioenteric reconstruction, postoperative hospital stay, operative complications, magnets expulsion time, and follow-up results were collected and analyzed. ResultsThere were no statistical differences in the baseline data such as the gender, age, composition of primary diseases, preoperative total bilirubin, and preoperative common bile duct diameter between the two groups (P＞0.05). The outer diameter of the magnets was (10.50±0.97) mm, the expulsion time of the magnets was (49.69±37.58) d, and the expulsion rate of the magnets was 100% (16/16). There was no intestinal obstruction or gastrointestinal perforation caused by the retention of the magnets. The procedure time to complete bilioenteric reconstruction in the LMCCJ group was statistically shorter than that in the LHSCJ group [(11.31±3.40) min vs. (24.81±3.40) min, t=11.96, P＜0.01]. There was no statistical difference in the total bilirubin level at the first week after surgery between the two groups (U=142.0, P=0.80). The postoperative hospital stay in the LMCCJ group was longer than that in the LHSCJ group [(28.31±14.11) d vs. (16.19±7.56) d, t=3.36, P＜0.01]. During the perioperative period, there was no bleeding or biliary infection in the two groups, but one case of biliary leak in the LHSCJ group. In all 37 patients were followed-up for (548.8±259.2) d. During the follow-up period, the incidence rates of biliary intestinal anastomosis stenosis, tumor recurrence, and mortality had no statistical differences between the two groups (P＞0.05). ConclusionFrom the results of comparative analysis in this study, it can be concluded that LMCCJ is not only safe equally, but also easier and less time-consuming as compared with LHSCJ.
目的 比較更昔洛韋聯合甲潑尼龍綜合療法和甲潑尼龍綜合療法治療病毒性視神經炎的療效。 方法 將2008年10月－2010年3月入院41例（60只眼）病毒抗體檢測陽性的病毒性視神經炎患者隨機分為治療組，21例30只眼）和對照組（20例30只眼）。于治療前和治療第3、7、14、30、90、180天觀察兩組患者的視力、視野。 結果 兩組患者的視力、平均視野缺損治療組采用更昔洛韋聯合甲潑尼龍綜合療法，對照組采用甲潑尼龍綜合療法。均隨時間得到改善（P＜0.001）。兩組患者視力在治療的第3天開始恢復，30 d治療組視力明顯優于對照組（P＜0.05），治療180 d時兩組視力改善無差異（P＞0.05）；治療組與對照組分別在第7天和第14天平均視野缺損開始恢復（P＜0.001）。 結論 更昔洛韋聯合甲潑尼龍綜合療法較單純甲潑尼龍綜合療法治療病毒性視神經炎能更快提高患者視力、恢復視野、改善患者視覺質量。
ObjectiveTo summarize the effectiveness of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after internal fixation of the proximal humeral fracture.MethodsBetween June 2014 and January 2018, 17 patients with deep infection and humeral head necrosis or bone nonunion after internal fixation of proximal humeral fractures were treated. There were 8 males and 9 females, aged from 52 to 78 years (mean, 63.8 years). The infection occurred at 19-66 months after the initial internal fixation (mean, 34.8 months). Microbial culture of joint fluid was positive in 14 cases and negative in 3 cases. The preoperative Constant score, American shoulder and elbow surgeons (ASES) score, and visual analogue scale (VAS) score were 36.41±8.65, 31.06±7.43, and 7.29±0.99, respectively. The preoperative ranges of forward flexion, abduction, external rotation were (45.88±12.46), (42.18±12.31), and (16.76±4.92)°, respectively. The preoperative range of internal rotation was buttock in 9 cases, lumbosacral joint in 3 cases, L3 in 5 cases. At the first-stage surgery, the thorough debridement was done and the antibiotic-impregnated bone cement spacer was placed after the removal of internal fixation. After the infections disappeared, the two-stage reverse total shoulder arthroplasty was performed. The mean interval between the two procedures was 4.2 months (range, 3.0-6.5 months).ResultsAll the incisions healed primarily and no complications such as recurrent infection or vascular nerve injury occurred. All patients were followed up 15-32 months (mean, 22.0 months). At last follow-up, the ranges of forward flexion, abduction, and external rotation were (109.00±23.66), (98.53±16.92), (41.41±6.82)°, respectively; and the range of internal rotation was lumbosacral joint in 5 cases, L3 in 8 cases, T12 in 4 cases. The range of motion of shoulder joints at last follow-up was significant improved when compared with the preoperative range of motion (P<0.05). The Constant score (64.88±8.70), ASES score (65.18±8.10), and VAS score (2.94±1.25) were significantly superior to the preoperative scores (P<0.05). X-ray films showed that no prosthesis loosening occurred.ConclusionTwo-stage reverse total shoulder arthroplasty is an effective treatment for the postoperative deep infection after internal fixation of the proximal humeral fracture, which has advantages of low risk of infection recurrence, good shoulder function, and satisfactory short-term effectiveness.