目的 分析良性阵发性位置性眩晕(BPPV)患者耳石复位治疗后残余症状的影响因素,并探讨患者眼肌前庭诱发肌源性电位(oVEMP)对残余症状的预测价值.方法 选取2018年1至12月中国人民武装警察部队海警总队医院收治的BPPV患者274例,均采用耳石复位方法治疗.根据复位治疗成功后第3天有无残余头晕症状,患者分为残余症状组107例和无残余症状组167例.分析患者残余症状的独立危险因素,比较两组患者耳石复位治疗前后眩晕残障量表(DHI)评分和oVEMP各项参数.结果 BPPV病程及发病月份为患者残余症状的独立危险因素(均P<0.05).耳石复位治疗前、治疗1周、治疗半个月时,两组患者DHI评分比较差异均无统计学意义(均P>0.05);复位治疗1个月后,残余症状组DHI评分低于无残余症状组(P<0.05),oVEMP患侧的振幅比健侧增高(P<0.05).结论 耳石复位治疗后部分BPPV患者会有残余症状,残余症状可能与病程、发病月份、复位次数、是否合并内科疾病等因素有关,在临床工作中应重视并对其进行适当的干预.患者oVEMP的耳间振幅增高与残余症状有关,临床或可把oVEMP检测作为残余症状的预测方法.

咽部鱼刺异物在耳鼻咽喉头颈外科较为常见,迁徙至颈部也偶有报道,至于迁徙至颌下腺的鱼刺异物,董鹏飞等[1]曾报道1例,本院也发现颌下腺迁徙性异物1例,现报道如下.

目的:探讨医护一体化模式在耳鼻咽喉科门诊患者行为干预中的应用效果.方法:选取2015年8月～2016年11月医院耳鼻咽喉科门诊的186例就诊患者为研究对象,采用数字表法随机分为观察组和对照组,每组93例.对照组实施常规治疗和护理,不进行额外干预.观察组成立医护管理小组,实施管理干预.采用调查问卷了解两组干预前后自我管理行为情况,统计两组症状控制有效率和疾病复发率.结果:两组干预前自我管理行为评分无显著差异(P＞0.05),干预后观察组在症状管理、药物管理、饮食管理、环境管理评分上均显著高于对照组(P＜0.05);观察组的症状控制有效率显著高于对照组,疾病复发率显著低于对照组(P＜0.05).结论:针对耳鼻咽喉科门诊患者实施医护一体化管理,能够有效改善患者的自我管理行为,提高症状控制效果,减少疾病复发.

Objective Explore the factors affecting the effect of very severe sudden deafness treatment effect factors. Methods Summary of Zhejiang Armed Police Corps of Jiaxing hospital from 2010 to 2013, 135 cases with complete data very severe sudden deafness patients clinical data, analysis of factors affecting the effect. Results ①135 patients were cured, markedly effective and effective cases were 14(10.37%), 35 cases (25.93%) and 19 cases (14.07%), the effective rate was 50.37%(68/135), no efficiency was 49.63%(67/135); ②The effective rate of men and women were 51.43%(36/70), 49.23%(32/65), no significant difference between two groups(χ2=0.07,P>0.05);The effective rate of left and right side of the affected ear were 52.31%(34/65), 48.57(34/70), no significant difference between two groups (χ2=0.19,P>0.05); The effective rate of with vertigo and without vertigo were 36.54%(19/52), 59.04%(49/83), there was statistically significant difference (χ2=6.47,P<0.05);The effective rate of plus donlim lnjection and without donlim were 53.73%(36/67), 47.06%(32/68), no significant difference between two groups (χ2=0.60,P>0.05);The effective rate of duration of less than 3 days, 4~7 Day, 8~14 days, and more than 14 days were 58.01%(36/62), 51.92%(27/52), 50%(3/6), 13.33%(2/15), each stage had significant difference(χ2=9.75,P<0.05);The effective rate of under the age of 20 years, 21~40 years, 41~60 years and more than 60 years were 25%(2/8), 50%(15/30), 52%(39/75), 54.55%(12/22), no significant differences in each stage(χ2=2.29,P>0.05);The effective rate of treatent 7~14 days, 15~21 days, 22~28 days and more than 28 days were 51.50%(33/64), 48.72%(19/39), 57.14%(12/21), 36.36%(4/11), no significant differences in each stage (χ2=1.33,P>0.05). Conclusion The effective rate of very severe sudden deafness is low, with vertigo and duration of more than 14days is unfavorable factors affecting the efficacy.

甲状腺手术后出血是较为严重的并发症。据统计，甲状腺术后二次手术中出血占0．36％～4．30％［1］。如何在手术中进行防范，减少出血的发生，2012-01至2014-12笔者采用术中短暂气道加压对816例观察，可提高甲状腺术中出血的发现率，有效预防术后出血，取得良好效果。

近年来,胃食管反流病(GERD)的发病率呈上升趋势,其对咽喉部的影响已越来越受到临床的重视,笔者以五味麝香丸为主辛开苦降治疗40例,并与胃复安治疗38例作对照,取得较好疗效,现总结如下.

表面麻醉药是耳鼻咽喉手术及进行某些检查时的必需药品,但其毒性大,使用不当如大剂量高浓度可出现中毒,甚至死亡,故需严格控制用量.为方便计量,笔者改进设计了一种既可以统计单次喷雾时麻醉剂量,又可统计麻醉总量的简易喉头喷雾计量器.介绍如下.

患者,男,28岁.主诉咽部异物感伴口臭1年.1年前自觉咽部有异物感,进食后明显,可咳出食物残渣,口腔内有异味.但无吞咽困难及声嘶,无恶心、呕吐,无返酸、嗳气.体检:口咽稍红,双扁桃体体Ⅰ大小,无分泌物,会厌舌面可见淋巴组织,右侧梨状窝底部与左侧相比欠光滑.纤维喉镜检查:右侧梨状窝粘膜不光滑,有皱褶.CT检查:右侧会厌软骨旁有一1.5 cm×0.5 cm×1.1 cm大小含气及软组织密度区,其上端与喉腔气体影相通.吞钡造影示:右下咽憩室.于2000年11月28日全麻下行颈外进路右下咽憩室切除术.术中见右侧梨状窝外侧有一深1.5 cm、直径1.0 cm、内充满食物残渣及钡胶浆的囊袋,开口于右侧梨状窝外侧.手术完整切除囊袋,并放置负压引流管及鼻饲管.术后第1天拔除负压引流管,术后第6天拆线,第7天拔除鼻饲管,从口咽进食.术后病理:囊壁样组织一块,约1.5 cm×1.2 cm×0.1 cm,镜下示粘膜组织,表面被覆鳞上皮增生,间质内少量慢性炎细胞浸润.术后随访6个月,症状消失,未见复发.