目的 探讨医联体“专全结合”模式下儿童哮喘合并过敏性鼻炎分级管理与疗效.方法 选择201 7年112月本院收治的儿童哮喘合并过敏性鼻炎患儿随机分为对照组、研究组,各110例.所有患儿病情稳定后下转社区卫生服务中心进行健康管理,对照组采用常规性延伸管理模式,提供健康教育、用药指导、生活方式干预等服务,若病情加重则及时上转,研究组采用医联体“专全结合”模式进行规范化管理,包括组建疾病管理团队、规范诊疗路径、完善药品目录及检测功能及分级管理等.比较分析两组哮喘、过敏性鼻炎控制情况及患儿家长的认可度和满意度.结果 管理6个月后,研究组C ACT评分[(24.61±2.62)分vs.(20.30±2.97)分]、PEF水平[(91.32±5.23)％ vs.(78.12±4.48)％]较管理前明显升高,过敏性鼻炎体征评分明显下降[(0.93±0.25) vs.(2.04±0.42)分],且均明显优于对照组(P＜0.05).研究组管理期间哮喘急性发作次数[(2.59±0.37)次vs.(2.14±0.32)次]、住院时间[(8.76±0.85)d vs.(9.41±1.31)d]、医疗费用[(5 028.71±1 037.30)元vs.(6 273.20±1 739.41)元]均较对照组明显减少,患儿家长对服务的认可度(93.6％ vs.85.5％)和满意度(91.8％ vs.82.7％)均显著升高(P＜0.05).结论 医联体“专全结合”模式下儿童哮喘合并过敏性鼻炎分级管理有助于优化医疗资源的配置,实现医院、社区的同质化管理,对患儿病情控制及患者满意度具有积极的意义.
喉癌是头颈部常见的肿瘤之一,细胞外基质蛋白1(ex tracellular matrix protein 1,ECM1)具有促进血管内皮细胞和血管形成的功能,与肿瘤的发生、发展密切相关.本文就ECM1的分子结构、生物学功能、相互作用分子及其在喉癌中的研究进展进行了阐述.
OBJECTIVE To investigate the advantage of preserving the parotid masseter muscle fascia,great auricular nerve and Stensen's duct in modified superficial parotidectomy.METHODS The parotid masseter muscle fascia,great auricular nerve and Stensen's duct were preserved during partial parotidectomy in 56 cases with benign parotid gland tumor.All of the patients were received negative pressure drainage and local pressure dressing after the surgery.RESULTS All cases had a follow-up after operation,no recurrence occurred.Facial nerve impaired was developed in 3 cases,all of them were slightly unilateral drooping of the angle of the mouth,and developed gas leakage when air-blowing.Six cases developed ear lobe numb syndrome temporarily.All of the cases developed local mild hollow malformation in the operation area.CONCLUSION Preserving parotid masseter muscle fascia,great auricular nerve and Stensen's duct in superflcial parotidectomy can reduce the postoperative complications.
阻塞性睡眠呼吸暂停低通气综合征(obstruaive sleep apnea hypopnea syndrome,OSAHS)是一种涉及多种基因、环境因素、生长因素的复杂疾病.本文通过探讨浆细胞膜糖蛋白-1(Plasma cell membrane glycoprotein-1,PC-1)与胰岛素抵抗(Insulin resistance,IR)、OSAHS与肥胖、OSAHS的遗传分子水平研究进展、OSAHS与IR、PC-1及其基因多态与OSAHS相互间的关系,得出在控制OSAHS中IR是关键因素,而PC-l及其基因多态性的研究为IR及与其相关的OSAHS危险因素的预测和防治提供了一种新思路.希望在不久的将来可以确定OSAHS的遗传模式,并找到具体遗传物质,为其基因水平的治疗奠定基础.
<正>1病例介绍患者,女,27岁。因"渐进性右侧鼻塞3月"2008年11月前来就诊。门诊行间接鼻镜检查见右侧鼻底及总鼻道中部见一团不规则异物嵌顿,呈褐中带黄绿色,用耵聍钩触之有坚硬石质感,固定于鼻底、总鼻道与鼻中隔之间的自然腔道内,不能
Objective To study the value of electronic laryngoscope application in exploring and taking out the hypopharyngeal foreign body.Methods Thirty-five cases from outpatients were explored and taken out their foreign bodies through Olympus electronic laryngoscope.Results All 35 cases were obstructed by fish bones.The obstructs were located at epiglottic vallecula(7 cases),the root of the tongue(12 cases),the lateral of the hypopharynx(9 cases) and piriform(7 cases).There were no complications for all cases.Conclusion Exploring and taking out the hypopharyngeal foreign body by using electronic laryngoscope is easy to operate,with a clear vision and safe,suitable for all individuals.There is only little pain,minimal wound.It is worth spreading the application.
目的 总结电子喉镜在摘除带蒂声带息肉中的优势.方法 对2008年11月至2009年10月我院门诊治疗的10例带蒂声带息肉患者经电子喉镜下摘除手术的临床分析.结果 经局部黏膜表面麻醉,经鼻进入喉镜,手术过程顺利,结果良好,声嘶症状均消失.结论 电子喉镜在治疗声带息肉方面疗效肯定,并发症少,操作方便,适应各级医院使用.
Objective To study the levels of specific clinic allergen and serum immunoglobulin E(IgE) in patients with allergic rhinitis.Methods The specific allergens and total serum IgE were detected by enzyme immunoassay method.Results The dermatophagoides farinae and pteronyssinus(62/118) were the most common allergen in inhalation group in 118 patients with allergic disease.Dogly or feline scurf was the next(35/118),then were ambrosia artemisiiofolia and muguort(14/118),cockroach(12/118),cypress,elm,Surname.Cottenuood(8/118),humulus scandens(7/118),polyvalent fungus(6/118).In food group the most common allergen was mutton or beef(13/118),then was cashew,peanut,soybean(11/118),wheat(10/118),milk(9/118),fish,shrimp,crab(5/118),mango(4/118),egg,chicken,yolk(1/118).The positive rates of total IgE level was 35.59 %.Conclusion Enzyme immunoassay method may helpful to find the relevant allergen and provide foundation on the prevention and treatment of allergic rhinitis.
<正>1临床资料患者女,51岁,主因左侧咽部异物不适感半年余,于2006年5月8日入院。无疼痛发热,无呼吸及吞咽不适,在外院诊断为“扁桃体肥大”,曾抗炎治疗,效果不佳。门诊MRI示“左侧咽旁间隙占位,脂肪瘤或皮样囊肿”。
