目的 通过腹腔注射醋酸去氨加压素(DDAVP)探讨建立大鼠膜迷路积水模型的可行性.方法 选取30只健康SD大鼠,随机分为正常组、对照组及实验组,不同时间节点分别给予不同剂量的DDAVP及生理盐水腹腔注射,17天后观察大鼠行为学变化,听觉脑干诱发电位(ABR)检测听力的变化,HE染色观察耳蜗形态结构的变化,耳蜗中阶(即蜗管)横截面积(SM)与中阶和前庭阶横截面积(SM+SV)之和的比值的变化.结果 实验组大鼠出现平衡障碍,ABRⅡ波阈值升高(P=0.000<0.05);且Ⅱ波(P=0.004<0.05)、Ⅴ波的潜伏期(P=0.000<0.05)及Ⅲ～Ⅴ波间期(P=0.006<0.05)明显延长.HE染色提示前庭膜向前庭阶膨隆或断裂,SM与SM+SV比值增大(P=0.000<0.05).结论 腹腔注射DDAVP可以诱导大鼠内耳膜迷路积水,成功建立膜迷路积水动物模型.

目的 探讨单核细胞趋化蛋白-1(monocyte chemotactic protein-1,MCP-1)及脂蛋白(a)[lipoprotein(a),LP(a)]与梅尼埃病的关系.方法 选取30只健康SD大鼠,分成正常组、对照组及实验组,每组10只,实验组腹腔注射醋酸去氨加压素(4μg·kg-1·d-1连续注射7 d后改为6μg·kg-1·d-1连续注射3 d)行膜迷路积水造模,对照组腹腔注射等量生理盐水,正常组不作处理,停药7 d后对三组动物行ABR检测,取耳蜗中阶横截面积(SM)/(中阶+前庭阶横截面积)(SM+SV)比值评价膜迷路积水情况.造模成功后通过免疫组化染色检测耳蜗组织中MCP-1的表达,通过酶联免疫吸附实验(ELISA)法检测血清中LP(a)的水平,对LP(a)水平与内耳积水程度及大鼠ABR各指标进行相关性分析.结果 实验组波 Ⅱ 阈值升高、波 Ⅱ 、Ⅴ 潜伏期及 Ⅲ-Ⅴ 波间期较正常组和对照组均延长,差异有统计学意义(P<0.05).实验组、对照组、正常组SM/(SM+SV)比值分别为0.45±0.04、0.34±0.02、0.35±0.01,前者显著大于后两者(P<0.05).实验组M C P-1在耳蜗螺旋器、血管纹螺旋韧带及神经节细胞组织表达明显,前庭膜上也有表达,其它两组无表达.实验组、对照组、正常组L P(a)水平分别为4.07±0.20、1.36±0.12、1.38±0.14 mg/L,前者显著高于后两者(P<0.001),LP(a)表达水平与膜迷路积水程度及ABR各指标间均呈正相关(P<0.001).结论 膜迷路积水模型大鼠耳蜗组织中MCP-1表达明显,血清LP(a)水平明显升高,且LP(a)水平与膜迷路积水程度及大鼠听力下降呈正相关,提示MCP-1和LP(a)可能与梅尼埃病的发生有关.

目的 探讨在新型冠状病毒肺炎防控期间通过制定梅尼埃病的调查问卷实现精准远程预约诊疗服务,减少院内人员流动、防止交叉感染和提高诊疗效率.方法 在2020年1月-2020年6月间通过电话或手机软件预约耳鼻喉门诊诊疗的梅尼埃病患者,随机分二组,问卷组65人,通过问卷形式预约来耳鼻喉门诊;普通问诊组71人,以普通问诊形式预约来耳鼻喉门诊,收集二组来院诊疗患者的确诊率并进行比较.将问卷所得分数通过受试者工作特征曲线(receiver operating characteristic curve,ROC),计算曲线下面积(area under curve,AUC),约登指数(youden index,YI).结果 问卷组患者确诊率为29.2％,普通问诊组来院确诊率为14.1％,二组比较发现差异有统计学意义(P＜0.05),问卷组确诊率显著高于普通问诊组(P=0.031).计算问卷组就诊患者所得分值后发现ROC曲线下面积AUC=0.733,95％的可信区间为(95％CI=0.608～0.857),最大约登指数YI=0.43,对应的诊断界值2.5.结论 通过梅尼埃病问卷表预约诊疗服务可提高确诊率,且具有中等强度的诊断价值,方便患者就医同时有助于减少医院人员流动,控制疫情.

目的 探讨破骨细胞分化因子(RANKL)及基质金属蛋白酶-2(MMP-2)在外耳道胆脂瘤(EACC)中的表达及意义.方法 采用免疫组化法分别对47例EACC和18例正常外耳道皮肤(对照组)进行RANKL及MMP-2的检测.结果 EACC组织中RANKL及MMP-2的阳性表达率分别为76.60％(36/47)和78.72％(37/47),均显著高于对照组,差异均有统计学意义(X2=22.983、21.177,P值均-0.05).EACC组织中RANKL及MMP-2的阳性表达与骨质破坏程度有关(P-0.05).RANKL及MMP-2共同阳性33例、共同阴性7例,相关性分析显示,两者之间呈正相关(r =0.572,P-0.05).结论 RANKL及MMP-2在EACC组织中的表达明显升高,且表达水平与骨质破坏程度有关,表明两者可能共同参与骨质吸收破坏过程.

Meniere's Disease is a disease of otology. The incidence of the disease has been increasing in recent years, but its pathogenesis is still unclear. So many researchers have further proved that the main pathological changes of the disease are [1] of membrane labyrinth accumulation through a large number of clinical and animal model experiments. Meanwhile, researchers are also starting to work on it. To find proteins and genes related to Meniere's disease, including lipoprotein (a) and monocyte chemoattractant protein -1, which are two proteins involved in immune, circulation, and inflammation, respectively, and the cause of Meniere's disease is produced under comprehensive factors. Circulatory and immune factors are one of the most important factors. This article reviews the relationship between lipoprotein (a) and monocyte chemoattractant protein-1 (MCP-1) and Meniere's disease.

外耳道胆脂瘤是一种囊性非肿瘤病变,可逐渐扩大,破坏周围结构引发骨质破坏,严重可导致各种颅内外并发症,降低患者的生活质量.到目前为止,引发骨质破坏的机制仍然是一个有争议的问题.近些年随着分子生物学的不断发展,该研究已经进入了新的领域,基质金属蛋白酶-2(matrix metalloproteinase-2,MMP-2)和核因子-κB配体的受体或激活因子/破骨细胞分化因子(receptor activator of nuclear factor-κB ligand,RANKL)在胆脂瘤中表达的上调和活性的异常参与了胆脂瘤的发生发展过程.本文将从MMP-2和RANKL的结构、来源、生物化学特性及其在外耳道胆脂瘤骨质破坏中的作用等方面做一综述.

Extramedullary relapse of acute lymphoblastic leukemia (ALL) in the mastoid after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare. In this paper, we describe such an uncommon case of extramedullary relapse of ALL in the mastoid. The patient, who had been diagnosed as having ALL and underwent an allo-HSCT from his matched sibling donor. Eight months after allo-HSCT, he presented with ear-ache, tinnitus. The middle ear mastoid CT revealed otomastoiditis. The patient underwent operation. After pathological examination, the definited diagnosis was made that the patient was extramedullary relapse of ALL in the mastoid. We should pay more attention to the patients with hemopathy, which can help to improve early diagnosis.

OBJECTIVE:To explore the effect of preoperative neutrophil lymphocyte ratio (NLR) on the prognosis of patients with laryngeal carcinoma.METHODS:Clinical data of 202 patients with laryngeal carcinoma treated from January 2004 to October 2009 were retrospective analyzed to determine the optimal critical value of NLR. To study whether NLR is an independent factor affecting the recurrence and 5-year survival rate of patients with laryngeal cancer after surgery, single factor and multivariate analyses were performed. The factors included age, gender, T stage, pathological differentiation, lymph node metastasis, primary tumor site and NLR value. The relationship between NLR and cervical lymph node metastasis was analyzed.RESULTS:The optimal critical value of NLR was 2.85, by which cases were divided into high NLR group (NLR≥2.85) and low NLR group (NLR<2.85). Single factor and multivariate analyses indicated that T staging, lymph node metastasis, primary tumor location, and NLR were the independent factors affecting the recurrence of laryngeal carcinoma. T stage and lymph node metastasis were the independent factors affecting 5-year survival rate of laryngeal carcinoma. The increase of NLR value increased the rate of cervical lymph node metastasis.CONCLUSION:Preoperative NLR level influences the recurrence and cervical lymph node metastasis of laryngeal carcinoma and can be considered a prognosis factor of laryngeal cancer.

Objective To explore the application value of low - dose spiral CT in the diagnosis of sinus le‐sions in children .Methods All of the 86 patients with sinus diseases in children were examined by spiral CT .All the patients were randomly divided into observation group (low dose group) and control group (conventional dose group) ,and the quality of the scanned images was qualitatively and quantitatively com ‐pared with that of the control group (n= 43) .And the CT volume volumetric dose index (CTDIvol) and the dose length product (DLP) were compared .Results There was no significant difference between the two groups in the subjective evaluation of image quality (P> 0 .05) ,the image noise value (SD) and the contrast noise ratio (CNR) were not significantly different ,both of which satisfied the diagnosis of sinus lesions (P > 0 .05) .And DLP values were significantly lower in the observation group than the control group (P< 0 .05) .Conclusion Low - dose spiral CT can be normal diagnosis of children with sinus le‐sions ,and does not affect the image quality ,while reducing the radiation dose in children ,more safe and reliable ,worthy of clinical popularization and application .

Objective To explore the prevalence and influencing factors of obstructive sleep apnoea syndrome(OSAS)among hypertensive patients. Methods Two hundred and ninety-eight hypertensive patients who used a portable OSAS monitoring device were selected as our subjects. Of which,197 patients who completed their OSAS monitoring were divided into OSAS group( 165 cases) and non-OSAS group. Stepwise linear regression and Logistic regression analysis were used to analyze the relevant factors correlated to AHI and OSAS with hypertension. Results The average age of the 197 patients(122 were males)were 59. 93 ± 10. 18 years old. The prevalence of OSAS was 83. 8% in hypertension patients. Body mass index( BMI),systolic pressure (SBP),diastolic pressure(DBP),low density lipoprotein cholesterol(LDL-C)and waist circumference in OSAS groups were(26. 37 ± 2. 77)kg/ m2 ,(159. 59 ± 14. 42)mmHg,(98. 71 ± 9. 40)mmHg,(2. 85 ± 0. 82)mmol/L,(90. 56 ± 8. 62)cm,higher than those in non-OSAS group((22. 43 ± 2. 04)kg/ m2 ,(146. 83 ± 4. 60) mmHg,(85. 51 ± 7. 52)mmHg,(2. 22 ± 0. 60)mmol/ l. ,(81. 84 ± 8. 00)cm). There were statistical differences between the two groups(t = - 7. 654,- 4. 945,- 7. 490,- 4. 110 and - 5. 289;P < 0. 001). BMI,SBP and DBP were positively associated with AHI,and they were in depended risk factors of OSAS(OR(95% CI)=2. 554(1. 408 - 4. 632),1. 432(1. 154 - 1. 777),1. 286(1. 058 - 1. 562);P < 0. 05). Conclusion The prevalence of OSAS is high in hypertension patients. Higher BMI,SBP,DBP are associated with OSAS in hypertension pateints.

自20世纪70年代应用激光质量喉癌以来，传统手术成功实现了巨大的突破，将本来需要开刀切除喉组织和创伤大以及较高风险的手术变得微创和简便，大大降低风险，在颈部皮肤无切口的情况下，从而达到最佳的治疗效果。在喉癌微创外科中激光显微外科手术（TLM）占有极为有利地位，不但可以完整切除早期癌瘤从而达到根治，还可缓解中晚期肿瘤患者的临床症状，具有极高的优越性，越来越多的临床医师选择此手术。

Objective To observe early stage morphosis of the traumatic tympanic membrane per‐foration caused by direct or indirect injury ,and to provide clinical guidance for identifying the injured manner of tympanic membrane perforation .Methods Clinical data of 439 patients with traumatic tym‐panicmembraneperforationwereanalyzedretrospectively.Results 34casesoftympanicmembrane perforation caused by direct injury (both for single ear) ,12 cases of perforation close round ,11 cases of irregular shape ,the other a total of 11 cases ;405 cases of tympanic membrane perforation caused by in‐direct injury ,a total of 442 ears ,153 tympanic membrane perforation of irregular shape ,132 ears of spindle shape ,108 ears of crack -like ,the other 49 ears .The tympanic membrane perforation usually close round or irregular shape caused by direct injury ,more introversive perforated edge ,surrounding perforation bleeding more ,may with the damaged external auditory canal ;The tympanic membrane per‐foration caused by indirect injury often irregular ,spindle or crack-like ,perforated edge sharp ,more ex‐troversive ,less bleeding around the perforation ,frequently with the no damaged external auditory canal . Conclusion Direct and indirect injury tympanic membrane perforation patterns ,perforated edge of the state ,the bleeding edge morphological characteristics can be identified the injured way of traumatic tympanic membrane perforation .

目的：探讨临床路径对高血压患者健康教育效果的影响。方法将184例高血压患者随机数字表法分为两组，对照组92例进行常规的健康教育，观察组92例按照规定的临床路径实施健康教育。比较两组患者干预前后高血压相关知识的知晓、血压自我监测重要性、健康生活方式采纳情况和满意度。结果观察组高血压相关知识的知晓、重视血压自我监测、健康生活方式采纳情况、满意度分别为93．47％、88．04％、89．13％、95．65％，均显著高于对照组的63．04％、23．91％、55．43％、84．78％（χ2＝25．03、76．77、19.43、6．16，均P＜0．05）。结论应用临床路径对高血压患者实施健康教育，可以帮助患者建立良好的生活方式，提高患者对健康知识的掌握及护理工作满意度，是一种有效的健康教育方式。

目的 探讨PDCA循环理论在慢性病门诊糖尿病合并高血压患者健康教育中的作用.方法 将我院2012年1-12月慢性病门诊就医的204例糖尿病合并高血压患者随机分二组,对照组102例进行常规的健康教育,观察组102例进行PDCA循环的健康教育方法,有针对性地制定治疗和控制计划,督导执行计划,检查执行情况,针对存在问题制订进一步干预计划,循环往复.结果 采用PDCA循环模式健康教育较常规健康护理,患者糖尿病合并高血压相关知识的知晓,合理饮食、体育锻炼、影响血糖和血压因素明显优于对照组(P＜0.01);健康生活方式采纳情况方面也优于对照组(x2=4.11,P＜0.05).结论 应用PDCA循环对患者健康教育可以提高患者对健康知识的掌握,帮助患者建立良好的生活方式,更有效地减缓痰病发展.

分泌性中耳炎（Otitis media with effusion，OME）是以中耳腔积液及听力下降为主要特征的中耳炎性疾病，此病名称不一，又称为非化脓性中耳炎、渗出性中耳炎等。临床较多见，发病率极高（尤其是儿童）[1]，是儿童最常见的致聋原因，多因儿童咽鼓管的宽、短、平、直的解剖特点，以及局部腺样体增生发育阻塞咽口所致。如能在疾病早期发现并予以适当的处理，可以起到良好的效果；若继续发展，可引起中耳粘连、硬化或胆固醇肉芽肿等病变，严重影响患者的听力；若听力损失较重，对患者的工作、生活，尤其是儿童的智力发育均有较大的影响。

外伤性鼓膜穿孔是耳鼻喉科门诊常见急诊.外伤性穿孔大部分源于掌拳击伤、爆炸伤等间接损伤,少部分源于挖耳或医源性等直接损伤.气压伤使外耳道压力瞬间骤升明显高于鼓室压,致鼓膜破裂穿孔.外伤性鼓膜穿孔因为中耳解剖结构的破坏常伴有不同程度的耳鸣、听力下降及耳痛等症状,严重时可伴有眩晕症状.对于外伤性鼓膜穿孔多数能自然愈合,但仍有部分患者鼓膜穿孔长时间不能愈合,遗留穿孔增加了中耳感染的风险,需要采取鼓膜成形手术,从而增加了患者的痛苦和经济负担.因此外伤性鼓膜穿孔的早期干预以加速愈合越来越被耳科学者重视[1].

目的观察不同程度变应性鼻支气管炎(ABR)患者血浆血小板活化因子乙酰水解酶(PAF-AH)的活性变化,并探讨其意义。方法 ABR患者87例(病例组),其中单纯变应性鼻炎(AR)患者25例,AR并变应性鼻炎伴气道高反应性(AHR)患者34例,AR并支气管哮喘(BA)患者28例;选择60例健康体检者为对照组。采用固相双抗体夹心ELISA法检测各组血浆PAF-AH活性。结果对照组血浆PAF-AH活性高于病例组(P<0.05);对照组、单纯AR者和AR并AHR者血浆PAF-AH活性均明显高于AR并BA者(P均<0.05)。结论 ABR患者血浆PAF-AH活性低于正常,PAF-AH活性降低可能与ABR的发病有关。

鼻息肉(nasal polyps,NP)是耳鼻咽喉科常见病,成人发病率为1%～2%,术后或保守治疗后复发率高.组织学特点为上皮增生、间质水肿、腺体水肿增生等改变,同时伴有炎性细胞浸润,以嗜酸性粒细胞浸润为主,尚可见淋巴细胞、浆细胞、中性粒细胞及巨噬细胞等.

面神经逆行诱发电位(facial nerve antidromical evoked potentials, FNAEP)是通过刺激颞骨外面神经分支,记录其向中枢侧面神经传导的动作电位变化,来估计颞骨内面神经的损伤程度[1].因为FNAEP是记录直接通过颞骨内面神经病变位置的电位,所以能在面神经损伤后立即进行检查,从而避免了传统电检查如面神经电图使诊断延迟3～5 d的缺点[1].但FNAEP因潜伏期较短、波幅较小、受刺激伪迹的影响较大而影响对其结果的分析.本文采用交替性电刺激,通过平均叠加技术使刺激伪迹减小,使FNAEP不受影响,以利得出准确的FNAEP测值.

掌击耳部可使外耳道气压突然增高,导致薄弱的鼓膜破裂穿孔.临床上常见的气压伤所致的鼓膜外伤,其穿孔主要位于鼓膜的前下方,且多为单发不规则或裂隙状穿孔.本文就3例因掌击伤致鼓膜紧张部2处穿孔病例,报告如下.