Objective:To investigate the value of three-dimensional (3D) CT in diagnosing cricoarytenoid dislocation.Methods:From January 2021 to December 2021, 31 patients with unilateral cricoarytenoid dislocation who had been treated by reduction forceps at the Affiliated BenQ Hospital of Nanjing Medical University were collected retrospectively, and their voice recovered or improved significantly after therapy. The preoperative CT images were reconstructed by volume rendering (VR). The dislocated side (left and right), type of dislocation (total dislocation and subluxation), and dislocation direction (anterior, posterior, internal and external dislocation) of cricoarytenoid dislocation were observed. According to arytenoid articular surface of cricoid cartilage exposed completely or not (caused by arytenoid displacement), they were divided into complete dislocation and subluxation. According to the direction of arytenoid displacement and the part of arytenoid articular surface of cricoid cartilage exposed, they were divided into anterior, posterior, internal and external dislocation. According to the shape of the vocal cords on laryngoscope, anterior and posterior dislocation of each case was judged, and then compared with that of CT.Results:On VR images, there were 28 cases of cricoarytenoid subluxation (90.3%, 28/31) and 3 cases of complete dislocation (9.7%, 3/31). Left cricoarytenoid dislocation was 26 cases (83.9%, 26/31) and right cricoarytenoid dislocation was 5 cases (16.1%, 5/31). Posterior dislocation was 28 cases (90.3%, 28/31) and anterior dislocation was 3 cases (9.7%, 3/31). There were 23 cases of internal dislocation (74.2%, 23/31), 2 cases of external dislocation (6.4%, 2/31), and 6 cases without obvious internal and external dislocation (19.4%, 6/31). Three cases of complete dislocation were left posterior internal dislocation.There were 24 cases of left posterior dislocation (77.4%, 24/31), 4 cases of right posterior dislocation (12.9%, 4/31), 2 cases of left anterior dislocation (6.4%, 2/31) and 1 case of right anterior dislocation (3.2%, 1/31). On laryngoscope, there were 19 cases of posterior dislocation (61.3%, 19/31), 9 cases of anterior dislocation (29.0%, 9/31), 3 cases were difficult to assess (9.7%, 3/31) because of aryepiglottic fold covering. Sixteen cases (55.2%, 16/28) were consistent with 3D CT, and 12 cases (42.8%, 12/28) were inconsistent.Conclusion:The 3D CT is a reliable method to evaluate cricoarytenoid dislocation, which can show dislocated side, type and direction of cricoarytenoid dislocation clearly.

目的:分析X射线小肠钡剂造影与CT小肠造影在克罗恩病(CD)临床诊断中的应用及其对诊断肠壁增厚及肠外并发症的应用价值.方法:回顾性选取医院收治的79例CD患者资料,所有患者分别采用X射线小肠钡剂造影及腹部CT小肠造影两种不同检查方式,对比两种检查方式对患者裂隙状溃疡、卵石征、多节段性病变、肠壁增厚、强化增加、蜂窝织炎、炎性包块、腹腔囊肿等病变征象的差异.结果:X射线钡剂小肠造影的裂隙状溃疡和卵石征诊断检出率分别为51.90％和50.63％;CT小肠造影诊断检出率均为0.00％;其差异有统计学意义(x2=7.417,x2=7.295;P<0.05);两种检查方式对多节段性病变诊断的检出率比较,差异无统计学意义(x2=1.688,P>0.05);CT小肠造影检查对强化增加、蜂窝织炎、炎性包块和腹腔囊肿诊断的检出率高于X射线钡剂小肠造影;其差异均有统计学意义(x2=10.070,x2=7.173,x2=4.770,x2=6.161;P<0.05).结论:X射线钡剂造影能较好的检出裂隙状溃疡与卵石征,但对肠壁增厚及肠外并发症无诊断能力.X射线钡剂造影与CT造影在CD临床诊断中各具优势,需结合两种检查方式的优势综合判定,最大程度改善患者治疗与预后.

目的 探讨通过减少显影剂剂量来改善头颈CTA锁骨下静脉线束硬化伪影的成效.方法 本研究共招集58位病患进行头颈部CTA检查,依据所注射的显影剂差异将所有病例分为三组,A组:注射60 mL碘克沙醇、40 mL生理盐水;B组:注射50 mL碘克沙醇、50 mL生理盐水;C组:注射40 mL碘克沙醇、60 mL生理盐水.测量和比较感兴趣血管处CT值的差异;由两位高年资医师定性评估各组CTA图像质量的差异.结果 统计分析的结果发现,三组病患之升主动脉、降主动脉、左颈总动脉、右颈总动脉、左大脑中动脉、右大脑中动脉的CT值并无显著差异(P>0.05),但C组锁骨下静脉的CT值显著较A、B组的CT值低(P<0.05);比较图像质量的定性分析结果显示,C组右锁骨下静脉线束硬化伪影为三组中最低(P<0.05),而三之组最大密度投影重建后的图像质量并无统计学差异(P>0.05).结论 适度减少显影剂剂量可以改善头颈部CTA锁骨下静脉的线束硬化伪影.

Objective:To reduce the re-radiation rate of X-ray in department of radiotherapy through applying quality management method of quality control circle (QCC).Methods: Through establishing QCC of department of radiotherapy, collecting all of advises, using various tools of quality management to analyze problem and propose improvement strategy for improving problem. The re-radiation rates of X-ray between pre-post improvement were compared to confirm the efficiency.Results: The re-radiation rate of X-ray reduced from 5.26％ to 3.89％ after the improvement strategy was implemented three months, and its magnitude of improvement was 26％.Conclusion:All of the improvement of QCC are divided into tangible result and intangible result. Through the implement of improving scheme, the shortened waiting time of imaging examination is tangible result, and the intangible result is that all of the members can more expertly use various analytical tools and methods and the cooperation is more closely among members during they take part in QCC.

总结提高喉癌病人家属应对能力的护理干预措施,包括入院护理干预、术前心理护理、健康宣教、术后护理干预及出院指导等,以提高病人家属的生活质量,从而也提高喉癌病人的生活质量。

目的:探讨改良口腔冲洗法在颌骨骨折患者中的应用效果。方法:将60例颌骨骨折患者按完全随机数字表法分为实验组和对照组各30例。实验组用改良的喉头喷雾器行口腔冲洗,对照组采用常规的口腔冲洗法。对患者的舒适度、并发症、操作时间进行比较。结果:在患者舒适度和操作时间上实验组明显优于对照组(P<0.05,P<0.01)。两组患者的并发症比较无统计学意义(P>0.05)。结论:改良的喉头喷雾器口腔冲洗法明显优于常规的口腔冲洗法,值得在临床推广应用。

介绍了耳鼻喉护理工作中常见危急不安全因素及防范对策。对气管切开、急性会厌炎、呼吸道异物引起的呼吸道阻塞采取了不同措施,预防呼吸道阻塞的发生;已经出现呼吸道阻塞症状的病人,正确的病情判断,及时正确的治疗,细心观察护理是成功治愈本病的关键;对鼻腔大出血病人要重视预防出血,并从心理、体位等方面控制出血。

[目的]探讨玻璃体切割联合玻璃体内注药治疗白内障摘除人工晶状体植入术后感染性眼内炎的护理。[方法]对3例(3眼)严重感染性眼内炎进行玻璃体切割联合玻璃体腔注药,配合局部滴眼及全身应用抗生素、皮质类固醇激素治疗。术前和术后进行整体护理。[结果]3例白内障术后感染性眼内炎均得到有效控制,眼痛缓解,3眼治疗后视力分别为0.4、0.8、0.8。[结论]对白内障摘除人工晶状体植入术后严重感染性眼内炎进行玻璃体切割联合玻璃体内注药治疗以及整体护理可有效控制感染,提高视力。

随着人们生活水平的提高,人口的老龄化,需要接受眼科手术的老年人越来越多.而老年人由于年龄特点,重要的生命器官出现不同程度的退化性病变,消化、吸收、修复、愈合等功能低下,与此同时还常常合并有高血压、冠心病、糖尿病等疾病,因此对手术的耐受力也出现不同程度的下降.这无疑对医护人员是一种压力和挑战.

1992年1月～2000年12月我院共收治65岁以上喉癌62例,其中12例行喉近全切除术.在围手术期,我们针对老年人反应慢、顾虑多、记忆力低下等特点,采取了进行式、分段护理,根据治疗进程和要求,选择不同的护理方式给予指导和照顾,现介绍如下.