目的:探讨不同浓度七氟醚诱导下环甲膜穿刺气道表面麻醉用于阻塞性睡眠呼吸暂停综合征(OSAS)患者纤维支气管镜(FOB)引导下气管插管中的可行性.方法:选取拟在全身麻醉诱导气管插管下进行择期手术的患者共 120 例.采用随机数字表法将其分为四组,每组 30 例,对照组(C 组)、呼气末七氟醚浓度 3％、4％、5％组(Ⅰ组、Ⅱ组、Ⅲ组).分别记录以下几个时间点:T0(诱导前)、T1(环甲膜穿刺前)、T2(环甲膜穿刺注药后)、T3(气管插管前)、T4(气管插管后 1～3 min)平均动脉压(MAP)、心率(HR)、动脉氧饱和度(SpO2)及血浆肾上腺素(E)、去甲肾上腺素(NE)和皮质醇(COR)的水平.同时记录阻塞评分和不良反应.结果:与 C 组比较,T0～T1 时,三组患者MAP、HR均显著下降(均P＜0.05),T1～T2 时及T3～T4 时,三组患者MAP均显著上升(均P＜0.05);T1～T2 时,Ⅰ组、Ⅱ组患者HR均显著上升(均P＜0.05),T3～T4 时,三组患者HR均显著上升(均P＜0.05).与C组比较,各时间点三组患者E、NE、COR水平均显著下降(均P＜0.05),与Ⅰ组比较,T1、T2、T3、T4 时间点,Ⅱ组、Ⅲ组患者NE水平均显著下降(均P＜0.05),与Ⅰ组比较,T2、T3、T4 时间点,Ⅲ组患者 COR 水平均显著下降(均P＜0.05).Ⅱ组阻塞评分最低(1.21±0.38)分.与 C 组 53.33％及Ⅰ组 33.33％比较,Ⅱ组、Ⅲ组(10.00％)不良反应发生率低(均P＜0.05).结论:4％七氟醚环甲膜穿刺气道表面麻醉法用于 OSAS患者 FOB引导下气管插管术时血流动力学平稳,应激反应轻,安全性高.

Objective Otolaryngology head and neck surgery is a discipline including ear, nose,throat and head and neck surgery, including ear, nose, throat, esophagus, thyroid, lateral skull base diseases, etc., its teaching has many knowledge points, complex content, interdisciplinary, strong professionalism.This paper discusses the application effect of micro-video and case-based flipped classroom teaching mode in undergraduate teaching. Methods A total of 100 undergraduate students enrolled in Shaanxi Provincial People’s Hospital from March to July 2020 were randomly divided into control and experimental groups, with 50 students from each group. The control group used the conventional teaching method, and the experimental group used the flipped classroom teaching method in the form of micro-videos and cases as the main form. After the end of the teaching course,the two groups of students are theoretically evaluated, and the evaluation of the two groups of teaching mode is understood. Results The basic knowledge and clinical case analysis were higher than those of the control group, and the difference between the two groups was significant（P＜0.05）; the satisfaction with teaching mode was higher than that of the control group, and the difference was significant（P＜0.05）. Conclusion Micro-video and case-based flipped classroom teaching model can improve the quality of teaching.

目的 探讨在不使用免疫抑制剂的情况下,十二烷基硫酸钠(sodium dodecyl sulfate,SDS)脱细胞方法用于气管异种移植的可行性.方法 采用健康家猪9只,体质量50～60 kg,雌雄不限.健康成年比格犬9只,体质量11～14.5 kg,雌雄不限.将获取的9段家猪气管随机分为3组:1％SDS处理组(气管管腔内浸泡1％SDS去黏膜),3％SDS处理组(气管管腔内浸泡3％SDS去黏膜)和3％SDS内外处理组(整个气管管腔内外均浸泡于3％SDS去黏膜).3组处理后的气管,在不使用任何免疫抑制剂的情况下,分别在9只犬背部进行异种异位埋植实验,通过组织学检查和大体观察了解脱细胞程度和埋植后气管的排斥反应情况.结果 苏木素-伊红(Hematoxylin-Eosin,HE)染色证实两组3％SDS脱细胞的效果较好,但3种脱细胞处理后气管的异种埋植实验均出现排斥反应.结论 不使用免疫抑制剂的情况下,单一使用SDS脱细胞方法在气管异种移植中是不适用的.

目的 探讨全身麻醉的睡眠呼吸暂停综合征患者术前无创呼吸机通气对其围术期氧合指标及苏醒质量的影响.方法 选取我院2015年1月～2017年3月收治的阻塞性睡眠呼吸暂停综合征患者104例为研究对象,随机分为观察组和对照组,每组52例.术前5～7 d,对照组实施单纯鼻导管给氧,观察组实施无创呼吸机吸氧治疗.两组患者在全身麻醉下行悬雍垂腭咽成型术.术中连续无创监测氧合指标,并记录两组术前(T0)、气管插管后30 min(T1)、气管插管后1 h(T2)、拔除气管导管30 min(T3)的血氧分压(PaO2)、氧合指数(OI);记录术后1、4、8、12、24、48 h疼痛视觉模拟(VAS)及伯格曼舒适度(BCS)评分;比较治疗前后睡眠有效率、睡眠潜伏期、呼吸暂停低通气指数(AHI)、微觉醒指数;并统计两组患者围拔管期呛咳、呼吸抑制、恶心呕吐、躁动、嗜睡等并发症发生率.结果 两组T1、T2、T3时段PaO2和OI水平明显高于T0,观察组T1、T2、T3时段PaO2、OI水平高于对照组(均P＜0.05).术后各时间段,观察组VAS评分与对照组无明显差异(P＞0.05),术后4、8、12、24 h,观察组BCS评分高于对照组(P＜0.05).观察组治疗后睡眠有效率、睡眠潜伏期与对照组无明显差异(P＞0.05),AHI、微觉醒指数明显低于对照组(均P＜0.05).观察组围术期并发症发生率(9.62％)低于对照组(26.92％)(P＜0.05).结论 术前无创呼吸机吸通气对睡眠呼吸暂停综合征患者全麻下行悬雍垂腭咽成型术,可在一定程度上改善围术期氧合指标,但对麻醉苏醒质量影响不明显.

目的 探讨口腔唾液胃蛋白酶检测对咽喉反流患者的诊断价值.方法 选取2017年1月至2018年10月陕西省人民医院收治的118例咽喉反流患者为研究对象,其中单纯咽喉炎94例,咽喉占位性病变24例,使用24 h双探头试管pH值监测法、酶联免疫吸附法对患者进行检查诊断,记录患者反流症状指数评分表和反流体征指数评分表诊断结果,并采用Kappa检验两种诊断方法一致性,ROC曲线检测口腔唾液胃蛋白酶检测法和24 h双探头试管pH值监测法对咽喉反流的诊断价值.结果 反流症状指数评分表和反流体征指数评分表评估的阳性率为56.78％,其中反流症状指数评分表评估阳性率为47.46％,反流体征指数评分表评估阳性率为9.32％;单纯咽喉炎患者Ryan指数阳性率为5.32％,咽喉占位性病变患者Ryan指数阳性率为29.17％,差异有显著统计学意义(P<0.01);单纯咽喉炎患者存在1次及以上pH<6.0反流情况阳性率为50.00％,明显低于咽喉占位性病变患者的70.83％,差异有统计学意义(P<0.05);患者症状发作15 min唾液胃蛋白酶阳性率为44.07％,明显高于其余时间段(晨起7.63％,餐后1 h 3.39％,睡前4.24％),差异均有统计学意义(P<0.05);单纯咽喉炎患者唾液胃蛋白酶阳性率为53.19％,明显低于咽喉占位性病变患者的83.33％,差异有统计学意义(P<0.05);构建两种检测方法ROC曲线,发现口腔唾液胃蛋白酶检测法诊断咽喉反流ROC曲线下面积分别为症状明显时0.874(0.722,1.000),餐后1 h 0.825(0.669,0.979),晨起0.760(0.601,0.918),大于24 h双探头试管pH值监测法[症状明显时0.736(0.718,1.000),餐后1 h 0.737(0.651,0.935),晨起0.682(0.593,0.829)],差异均有统计学意义(P<0.05).结论 口腔唾液胃蛋白酶检测法较之咽部pH检测法能更好检测诊断咽喉反流疾病,可推广应用.

目的:探讨血清非对称二甲基精氨酸(asymmetric dimethyl arginine,ADMA)、一氧化氮(nitric oxide,NO)在阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)相关的心脑血管疾病诊断中的应用价值.方法:选取2016年1月至2018年12月我院耳鼻喉科收治的126例OSAHS患者作为研究对象,同期64名体检健康者作为对照组.比较2组的临床实验室检查指标及血清学指标;分别采用酶联免疫吸附法和比色法检测血清ADMA、NO水平.应用Logistic回归分析影响OSAHS的危险因素,采用受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)评价血清ADMA、NO对OSAHS的诊断价值.结果:2组的年龄、性别、体质量指数、饮酒史、吸烟史、高血压史等一般资料比较差异无统计学意义(均P>0.05);研究组收缩压、舒张压、红细胞、红细胞比容(hematocrit,HCT)、总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、低密度脂蛋白胆固醇(low-density lipoprotein-cholesterol,LDL-C)、尿酸(uric acid,UA)和ADMA明显高于对照组,而高密度脂蛋白胆固醇(high-density lipoprotein-cholesterol,HDL-C)、NO水平显著低于对照组(均P<0.05).多因素Logistic回归分析显示,血清ADMA和NO是OSAHS相关的心脑血管疾病的独立危险因素(均P<0.05).ROC曲线分析显示,血清ADMA诊断OSAHS相关的心脑血管疾病曲线下面积(area under curve,AUC)为0.893,灵敏度为69.8％,特异度为98.4％;血清NO诊断OSAHS的AUC为0.828,灵敏度为65.1％,特异度为85.9％;ADMA/NO诊断的AUC为0.919,灵敏度为77.0％,特异度为96.9％;两者联合诊断AUC为0.940,灵敏度为85.7％,特异度为90.6％,明显优于ADMA、NO单独检测(P<0.05).结论:OSAHS患者血清ADMA水平升高,NO水平降低,两者水平变化对于OSAHS相关的心脑血管疾病有较好的临床诊断价值.

目的 总结临床PCR实验室参加室间质量评价活动的PT结果,探讨现场审核与否对室间质评结果的影响,进而分析实验室现场审核对其质量管理的影响.方法 统计分析2008～2019年陕西省临床检验中心PCR(HBV-DNA,HCV-RNA)参评实验室室间质评活动结果.结果 ①2008～2019年累计参评HBV-DNA的实验室次数为617次,其中通过现场审核的实验室累计数450次,合格单位累计数437次,平均能力比对96.4％,合格率97.1％;未通过现场审核的实验室累计数167次,合格单位累计数149次,平均能力比对88.3％,合格率89.2％;②2008～2019年累计参评HCV-RNA的实验室数为526次,其中通过现场审核的实验室累计数425次,合格单位累计数414次,平均能力比对96.6％,合格率97.4％;未通过现场审核的实验室累计数101次,合格单位累计数96次,平均能力比对92.9％,合格率95.0％;③HBV-DNA 2008～2019年累计合格率经 χ2检验,二者比较差异有统计学意义(χ2=15.888,P<0.001).结论 通过现场审核的PCR实验室能严格进行规范操作,有助于做好室间质评工作,有效提高临床检测的水平和质量.

Objective:To investigate the correlation between the types of unicate process (UP) superior attachment and the chronic frontal sinusitis without nasal polyps(CFSsNP).Method:The images of 240 sides of frontal recess were evaluated. The types of UP superior attachment was compared between the CFSsNP group and the control group. The correlation between UP the superior attachment and CFSsNP were analyzed. Result:Seven types of UP superior attachment were identified. The most common type in the two study groups was type 1(insertion into the lamina papyracea). The occurrence rate of type 1 of UP superior attachment in the CFSsNP group was significantly higher than that in the control group(59.8% and 36.4%,respectively P<0.01),but type 5(insertion into both the lamina papyracea and the skull base) was significantly less frequent in the CFSsNP group than in the control group(9.8%，28.8%,P<0.01). Logistic regression analysis revealed that the type 1 of UP superior attachment was an independent risk factor for CFSsNP(OR=1.181,P<0.05),and that type 5 of UP superior attachment was a protective factor for CFSsNP(OR=0.391,P<0.05). Conclusion:UP superior attachment varied significantly,with the most common type being type 1; This type is intimately related to CFSsNP.

To investigate the value of image-guided system in identifying the frontal recess cells.We collected 30 cases that underwent image-guided frontal sinus surgery from November 2014 to December 2015. These frontal recess cells were devided into 2 groups based upon their locations in the frontal sinus ostium. Group A consists of the agger nasi cells, type Ⅰfrontal cells, type Ⅱ frontal cells and suprabullar cells; group B consist of type Ⅲ frontal cells, type Ⅳ frontal cells, frontal bullar cells, interfrontal sinus septal cells and supraorbital ethmoid cells. Visual analogue scale (VAS) was used to evaluate the degree of demand of image guide system on the location of frontal recess cells, and then analyzed the value of image guided system on the frontal recess cells.In all 30 patients the imageguided frontal sinus surgery was successfully completed.The demand degree of image-guided system on frontal recess cells by VAS was slight for the agger nasi cells, type Ⅰfrontal cells, type Ⅱ frontal cells and suprabullar cells; the demand degree was general for the frontal bullar cells and interfrontal sinus septal cells; the demand degree was obvious for type Ⅲ frontal cells, type Ⅳ frontal cells and supraorbital ethmoid cells. Frontal recess cells of group B were more depended on image guided system than those of group A, and the difference was signicant( <0.01).Imageguided system is valuable in distinguishing for type Ⅲ frontal cells,type Ⅳ frontal cells supraorbital ethmoid cells and interfrontal sinus septal cells.Furthermore,it is significantly helpful for accurate removal of these frontal recess cells in endoscopic frontal sinus surgery.

目的:分析额隐窝气房与慢性额窦炎的相关性.方法:收集69例(慢性额窦炎组37例,对照组32例)符合病例选择标准的鼻窦CT影像,在图像工作站上进行轴位、冠状位、矢状位重建获得额隐窝区域影像(层厚0.6 mm,层距o.4 mm).根据Lee等的额隐窝气房CT分类判定标准,应用图像分析软件,观察慢性额窦炎组与对照组额隐窝气房的分布类型,比较两组的差异,应用Logistic回归分析额隐窝气房与慢性额窦炎的相关性.结果:获得128侧额隐窝区域三维影像,每组各64侧,其中Ⅲ型额气房、眶上筛房在慢性额窦炎组的出现率(分别为37.5％和70.3％)显著高于对照组(分别为1 2.5％和48.4％),差异均有统计学意义(均P＜0.01);其他类型气房在两组中的出现率差异无统计学意义.Logistic回归分析显示Ⅲ型额气房(OR=3.740,P=0.005)、眶上筛房(OR=2.242,P=0.031)与慢性额窦炎相关.结论:Ⅲ型额气房、眶上筛房可能是导致额窦引流通道狭窄的关键解剖因素,与慢性额窦炎密切相关.

BACKGROUND:Long-distance, large-range tracheal stenosis or defects are often seen in clinic, and laryngotracheal reconstruction is stil a difficult problem. OBJECTIVE:To investigate the effects of animal autologous cartilage transplantation in laryngotracheal reconstruction. METHODS:The cricoid cartilage and partial anterior tracheal wal from New Zealand rabbits were resected to prepare laryngotracheal defect models. Then, autologous costal perichondrium was taken for transplantation. After 8-24 weeks, surviving animals were sacrificed to observe the repair effects. RESULTS AND CONCLUSION:General observation showed that animals breathed and ate normaly, the implanted cartilage bonded tightly with the surrounding tissue, the wound healed wel without granulation tissue and scar formation, and there was a smooth inner surface covered by mucosa in the lumen. Under the light microscope, there was some mucosa generating at the wound site, and some fibroblasts and striated muscle cels existed in the outer layer, with a smal amount of new cartilage formation. There was also a linking between chondrocytes and muscle cels. These findings indicate that autologous cartilage transplantation can be applied for laryngotracheal reconstruction in animals, which has a good effect.

Objective:To investigate the clinical features,diagnosis and treatment of laryngeal contact granuloma.Methods:A total of 15 patients with laryngeal contact granuloma were retrospectively analyzed.Results: Pathological characteristics of laryngeal contact granuloma were granulation tissue hyperplasia,inflammatory cells infiltration and capillary hyperplasia.The follow-up period was 1 to 5 years.Among the 13 patients treated with operation,5 patients had recurrence,who finally reco-vered after the second operation combined with non-surgical therapies.Two patients received non-surgical therapies only and the lesions remained stable after 1 year.Conclusions: Laryngeal contact granuloma has tendency of recurrence and various etiological factors.Surgery combined with non-surgical therapies according to pathogenesis is necessary to prevent recurrence and improve cure rate.

To study the best concentration of calcium alginate gels combined with cartilage cells.Subculturing cartilage cells mixed with alginate gels to create a final cell concentration of 1× 107/ mL.Then 1 mL with different concentration of calcium solution 100、 200、 300、 400、 500 mmol/L was added separately,cure and solidified for 15 minutes to form calcium alginate beads.After 7 days culturing in vitro,HE and Masson staining were made to understand the growth condition of cartilage cells.By culturing,cartilage cells can abundantly amplify,and hold activity and proliferation in the concentration of 100、 200 and 300 mmol/L calcium alginate gels.Cartilage cells can not hold better activity and proliferation in the concentration of 400 mmol/L and 500 mmol/L calcium alginate gels.So,the concentration of calcium solution may increase to 300 mmol/L,which has no influence on the growth of cartilage cell,and can enhance the intensity of calcium alginate gels.