鼻内镜下鼻窦炎手术的护理体会

目的探讨鼻内镜下鼻窦炎手术的护理体会。方法对医院收治的120例鼻窦炎患者,实施鼻内镜下鼻窦炎术前与术后护理。结果 120例鼻窦炎患者在实施手术的过程中,通过采取术前与术后的护理,其治疗的有效率得到了明显的提高,术后并发症没有出现比较严重的情况。结论鼻窦炎患者在实施鼻内镜手术治疗后,通过采取一定的护理措施可以有效的保证鼻内镜手术治疗的效果,其可以广泛的应用在临床鼻内镜下鼻窦炎手术的护理中。     

鼻内镜治疗鼻窦炎伴鼻息肉42例疗效分析

目的分析与探讨鼻内镜手术对于鼻窦炎伴鼻息肉的临床治疗效果。方法选取本院2009年5月～2011年4月期间收治的鼻窦炎伴鼻息肉患者共42例,对其进行鼻内镜下切除鼻息肉与治疗鼻窦炎,总结与分析采用该方法治疗的临床效果与安全性。结果所以患者在接受鼻内镜下手术治疗后,6个月随访结果显示治愈35例（83.3%）,好转5例（11.9%）,无效2例（4.8%）。在手术过程中未有患者发生严重并发症,均顺利完成手术。结论利用鼻内镜手术对鼻窦炎伴鼻息肉进行治疗能够取得较为显著的临床疗效,且安全系数较高,因此耳鼻喉科医生应熟悉鼻内镜手术的应用范围与操作方法,让该方法得到推广与应用。     

鼻内镜手术治疗慢性鼻窦炎的围术期护理

目的探讨鼻内镜手术治疗慢性鼻窦炎的围术期护理措施和疗效。方法选择我院治疗的100例慢性鼻窦炎患者的临床资料,所有患者都采用鼻内镜手术治疗,在术前、术中、术后的护理中总结分析所有患者的临床疗效。结果护理后总有效率是90%(90/100),患者在手术后症状较轻微,患者当中有7例出血情况出现,鼻窦粘连状况2例,眼眶血肿状况1例,都未出现术后并发症。结论加强慢性鼻窦炎患者鼻内镜手术治疗的围术期护理,可提高鼻内镜手术成功的疗效,降低发生并发症的可能性。     

鼻内镜下治疗慢性鼻窦炎的临床疗效

目的探讨鼻内镜下治疗慢性鼻窦炎患者的临床疗效。方法对我院2012年1月至2013年12月收治采用鼻内镜手术治疗的160例慢性鼻窦炎患者进行回顾分析,并与同期收治采用传统手术的160例患者进行对比。结果观察组患者手术时间、出血量明显优于对照组（P〈0.05）,两组患者住院时间比较差异无统计学意义（P〉0.05）。观察组总有效率为96.2%,对照组总有效率为76.2%（P〈0.05）。结论鼻内镜下手术创伤小,患者身体恢复快,是治疗慢性鼻窦炎的有效方法。     

鼻内镜下鼻息肉及鼻窦炎手术护理分析

目的探讨鼻内镜下鼻息肉及鼻窦炎的手术护理方法及临床疗效。方法选取我院收治的70例行鼻内镜手术治疗鼻息肉及鼻窦炎患者,对其临床资料进行回顾行分析。结果 70例患者中42例治愈,25例为好转,3例为无效,治愈率为60.00%,总有效率为95.71%;术中4例患者出血量为200ml,术后3例患者发生鼻腔粘连现象,给予针对性治疗后症状均消失,无严重并发症发生。结论给予鼻内镜下鼻息肉及鼻窦炎患者针对性护理可有效提高治疗效果,减少并发症,临床效果显著,值得推广和应用。     

经鼻内镜鼻窦术治疗慢性鼻窦炎的临床观察

目的观察经鼻内镜鼻窦术治疗慢性鼻窦炎的治疗效果。方法本组94例慢性鼻窦炎患者的主观症状主要有鼻塞、多涕(黏涕或脓涕)、鼻涕倒流、鼻部疼痛、头痛及长期鼻塞引起的嗅觉减退、耳闷塞感,由鼻涕倒流刺激造成的咳嗽等,应用经鼻内镜鼻窦术治疗慢性鼻窦炎。结果按照1997年海口会议内窥镜鼻窦手术疗效评定标准,术后疗效为：治愈74例78.7%,好转14例14.9%,无效6例6.4%,总有效率93.6%,无一例鼻腔粘连、鼻中隔穿孔、脑脊液鼻漏及眼眶损伤。结论经鼻内镜鼻窦手术治疗慢性鼻窦炎是一种安全、行之有效的方法。     

鼻内镜手术治疗慢性鼻窦炎鼻息肉临床疗效

近几年,功能性鼻内镜外科(FESS)理论进入我国,鼻内镜下进行鼻窦炎、鼻息肉手术己取代了传统和常规的鼻息肉手术。鼻内镜手术可清除鼻腔、窦口鼻道复合体,能有效保证鼻窦腔气流通畅,是手术治疗慢性鼻窦炎和鼻息肉的新途径,有着广阔的前景[1]。笔者收集我院2009年5月至2013年1月住院治疗的128例病例,采取鼻内镜的手术方法,坚持术后随访,临床疗效较满意。1资料与方法 1.1一般资料本组收集我院2009年5月至2013     

98例鼻窦炎手术患者的围手术期护理体会

目的对鼻窦炎患者围手术期护理过程和效果进行总结与归纳。方法分别对98例患者进行鼻内镜检测以便确认病况,将术前、术中、术后的心理指导情况加以回顾性分析。结果在本院选取的98例鼻窦炎患者中,完全治愈86例,病痛明显改善7例,痊愈率为88%,有效率是95%。结论利用鼻内镜手术治疗方法诊治鼻窦炎,在术前、术中、术后各期间给予良好心理准备以及护理举措,为术后疗效和恢复情况打下坚实基础。     

鼻内镜下手术治疗慢性鼻窦炎临床疗效分析

目的观察鼻内窥镜下手术治疗慢性鼻窦炎的临床效果,提高临床治疗水平。方法选取我院自2011年3月~2012年8月收治的100例慢性鼻窦炎患者作为研究对象,将其随机分为两组。50例对照组患者采用传统的Wigand术式治疗,而50例治疗组患者在全麻下行鼻内窥镜手术,对于合并鼻中隔偏曲的患者两组均同时行鼻中隔矫正术。结果 50例治疗组患者经过上述治疗之后,治愈43例(86%),好转6例(12%),无效1例(2%),总有效率98%,而50例对照组患者,治愈33例(66%),好转5例(10%),无效12例(24%),总有效率76%,具有显著差异,P<0.01。结论鼻内镜下手术治疗慢性鼻窦炎较为安全,临床疗效好,没有不良反应及并发症,值得临床推广应用。     

经鼻内镜行鼻窦炎手术或鼻息肉摘除术的围术期护理措施

目的探讨经鼻内镜行鼻窦炎手术或鼻息肉摘除术的围术期护理方法。方法选取我院耳鼻喉科在2012年1月至2014年1月收治的鼻窦炎、鼻息肉患者共80例,将其随机分为两组,对照组患者给予常规护理,观察组患者给予整个围术期护理,并比较两组护理效果。结果观察组并发症发生率(2.5%)明显小于对照组(15.0%),观察组(97.5%)护理满意度明显高于对照组(82.5%),差异均有统计学意义(P<0.05)。结论对行鼻内镜手术的鼻窦炎和鼻息肉患者加强围术期护理可明显降低并发症发生率,提高患者护理满意度。     

Disease-related expenditures and revision rates in chronic rhinosinusitis patients after endoscopic sinus surgery

Aims: The objective of this study was to quantify the treatment costs and revision surgery rates in chronic rhinosinusitis (CRS) patients, with and without nasal polyposis (CRSwNP and CRSsNP), who require treatment with endoscopic sinus surgery (ESS). The additive contributions of nasal polyposis (NP) and revision surgery to 1-year costs were a primary focus.

Materials and methods: Adults (aged 18–64 years) undergoing ESS for CRS in 2012–2015 were identified within the Blue Health Intelligence database and used to estimate revision rates. Patients with ±1 year of enrollment around the index ESS were used to estimate 1-year healthcare expenditures. Revision ESS rates were evaluated via Kaplan-Meier and Cox regression models. Disease-related healthcare and pharmacy expenditures were modeled with generalized linear regression to assess the impact of baseline patient characteristics.

Results: A total of 86,052 patients underwent ESS for CRS (43.5?±?12.4 years; 49.3% male), and a sub-set of 23,542 patients were available for 1-year healthcare expenditure analysis (44.0?±?12.1 years; 50.0% male). Revision ESS rates within 1 year were 3.5% in the CRSwNP cohort and 1.6% in the CRSsNP cohort. NP, deviated septum, gender, and region were statistically significant predictors of revision surgery. Mean 1-year treatment expenditures, including the index ESS, were $8,824 for CRSsNP and $11,166 for CRSwNP patients without revision ESS. CRSwNP doubled the risk of revision surgery in the first year after ESS compared with CRSsNP and cost 24% more in the absence of a second procedure. Revision ESS within the first year increased mean 1-year expenditures by $11,150 and $13,139 for CRSsNP and CRSwNP, respectively.

Limitations: The primary limitation was the limited length of follow-up available for estimating revision ESS rates.

Conclusions: In a large commercially insured US population, disease-related expenditures for patients having ESS for CRS are substantial, as are the additive impacts of NP and revision surgery.     

Impact of ocular symptoms on quality of life (QoL), work productivity and resource utilisation in allergic rhinitis patients – an observational,cross sectional study in four countries in Europe

Abstract

Objective:

It is hypothesised that the presence of ocular, in addition to nasal, symptoms among patients with allergic rhinitis (AR) results in poorer quality of life, reduced work productivity and increased resource utilisation. This study investigated the impact on quality of life, burden of illness and healthcare resources among 1640 AR patients.

Methods:

Data were drawn from an observational cross-sectional study of consulting patients undertaken in May/June 2008 in four European countries. Doctors provided records for the next four to five patients presenting with AR who filled out a self-completion survey which included the Work Productivity and Activity Impairment Allergic Specific Questionnaire (WPAI:AS), the Mini Rhinoconjunctivitis Quality of Life Questionnaire (RQOLQ) and the Pittsburgh Sleep Quality Index (PSQI). Propensity scoring allied to regression-type analysis was used to assess the extra burden associated with ocular symptoms utilising two comparison groups (patients with nasal-only symptoms versus those with nasal and ocular symptoms). The analysis controlled for differences between the groups on confounding variables age, gender, smoking status and co-morbidities. The analysis was conducted twice, once controlling for differences between the groups in nasal severity and once without, recognising that it is not clear whether or not increased nasal severity symptoms are naturally associated with ocular symptoms. The severity of ocular symptoms as opposed to their presence alone was also assessed on outcome measures using regression type methods.

Results:

A total of 1009 patient records met the inclusion criteria, of whom 69% presented with both ocular and nasal symptoms. The results show that the presence of ocular symptoms reduces quality of life, reduces work productivity and increases resource utilisation irrespective of whether differences in severity of nasal symptoms are accounted for between the comparison groups. Patients with nasal and ocular symptoms require more healthcare consultations. All work-related domains were statistically different, with the presence of ocular symptoms associated with greater impact on work hours missed and impairment while working. For each of the above this was the case regardless of whether or not adjustment was made for nasal severity (both p?<?0.05). Patients with nasal and ocular symptoms also record an additional half a day more time off work in the last 3 months as a result of AR (nasal severity unadjusted or adjusted, both p?<?0.05). Clinically meaningful differences were found in overall quality of life score as represented by RQLQ, with a mean score increase of 0.6 (nasal severity unadjusted) and 0.5 (nasal severity adjusted) associated with the presence of ocular symptoms (both p?<?0.05). With regard to sleep quality, the presence of ocular symptoms was associated with a mean increase in PSQI of 1 when no adjustment was made for nasal severity (p?<?0.05). When nasal severity was adjusted for, no significant difference was observed. Similarly, for the number of prescribed medications, when no adjustment was made for nasal severity, patients with ocular symptoms were observed to receive a significantly higher number of AR drugs (+0.19, p?<?0.05) whereas with nasal severity adjusted for the difference was +0.17 which was not significant. In addition, with the exception of the number of AR drugs prescribed, for all outcome variables, the severity of ocular symptoms, and not just their presence, had a detrimental impact on the outcome.

Limitations:

Since patients were recruited via the physician, the study aim was to represent the consulting population. In addition, it cannot be fully excluded that the likelihood for an individual patient to complete a questionnaire is influenced by differences in patient typology compared with those patients who chose not to complete. Given the geographical dispersion of the sample patients, it may be reasonable to assume possible differences in the intensity of the AR season based on latitude.

Conclusion:

The added presence of ocular symptoms in AR patients suffering with nasal symptoms deteriorates patients’ quality of life, leads to greater lost productivity and places higher burden on resource utilisation. Studies are therefore needed to test whether treatment options that address ocular in addition to nasal symptoms will improve quality of life and reduce both direct and indirect resource use associated with AR.     

保乳手术治疗早期老年乳腺癌的临床价值

目的探讨保乳手术治疗早期老年乳腺癌的临床价值。方法将我院近期收治的早期老年乳腺癌患者150例,随机分为治疗组和对照组,各75例,治疗组患者进行保乳手术,对照组患者进行传统手术,对比分析两组患者经过手术后临床疗效,以及生活质量等。结果治疗组患者的手术中出血量、拔引流管时间、总的引流量及术后并发症显著优于对照组患者(P<0.05),同时治疗组患者经手术治疗后其生活质量高于对照组患者(P<0.05)。结论相比于传统的手术保乳手术具有手术后恢复时间短、并发症少及患者生活质量高等方面的优势,在临床治疗上可以进行大力推广。     

手术治疗急性梗阻性大肠癌临床探讨(附168例报告)

目的 探讨急性梗阻性大肠癌的手术治疗原则及预后.方法 分析168 例急性梗阻性大肠癌的手术治疗临床资料,其中右半结肠癌18 例,左半结肠癌60 例,直肠癌90 例.168 例中Dukes B 期24 例,C期80例,D期64 例.168 例均手术治疗,其中行结肠造口18 例,miles 手术64 例,Hartmann 手术18 例,一期切除吻合加肠外置术12 例,结肠灌洗一期切除吻合56 例.结果 治愈164 例,死亡4 例.未能切除癌肿的2 例患者术后5 月死亡.结论 手术治疗是解除急性梗阻性大肠癌的唯一方法.应根据患者的不同情况选择合理的手术方式.     

关于超声在经皮射频消融治疗肾脏肿瘤中的应用研究

目的 对经皮超声引导下射频消融术临床疗效的肯定报道.方法 对20 例肾脏肿瘤患者接受引导经皮射频消融术治疗.结果 手术全部成功.结论 经皮超声引导下射频治疗肿瘤是一种微创手术,损伤小、并发症少,术后恢复快等优点,但其更远期的疗效还有待于进一步积累病例和长期随访观察.     

髋关节置换术后常见的并发症及治疗

目的探讨髋关节置换术后常见的并发症以及治疗方法。方法收集我院50例老年患者髋关节置换术后的病例,总结出现并发症的情况,分析病因以及相应的治疗对策。结果 50例老年患者出现并发症的有7例,占14%;肺内感染1例,占2%;深静脉血栓1例,占2%;髋关节感染1例,占2%;泌尿系感染2例,占4%;肺内感染1例,占2%;假体周围骨折1例,占2%;假体脱位1例,占2%。结论人工髋关节置换术是近年来普遍应用于老年患者的髋关节重建,只要我们术前充分准备,术中精细操作,术后合理处置是防止术后并发症的有效方法。     

短肽型肠内营养剂对结直肠癌围手术期患者的影响

目的探讨短肽型肠内营养剂对结直肠癌围手术期患者的影响。方法选取2017年6月至2019年8月滨州医学院附属医院收治的结直肠癌手术患者104例作为研究对象,随机分为试验组和对照组,各52例。试验组采用短肽型肠内营养剂进行营养支持,对照组患者采用传统清洁灌肠,比较患者手术前1 d及术后1 d、3 d、7 d IgC、IgA、IgM、CD3^+、CD4^+、CD8^+水平和术中肠道清洁情况。结果术后7 d,CD3^+、CD4^+逐渐升高,试验组的升高情况明显优于对照组,差异有统计学意义(P<0.05)。试验组患者术中肠道清洁情况与对照组比较,差异无统计学意义(P>0.05)。结论对结直肠癌患者围手术期采用短肽型肠内营养剂进行治疗,有利于患者术后免疫功能恢复。     

糖尿病黄斑水肿的治疗现状

激光光凝是治疗糖尿病黄斑水肿的常用方法,但会损伤视网膜结构,发生不良事件;糖皮质激素类药物可减轻炎症反应,但可能导致眼压升高,影响视网膜血流;抗血管内皮生长因子可一定程度减轻黄斑水肿,但需长期用药;而手术治疗效果不一,对术者操作经验要求较高,应根据具体情况选择手术方式,没有研究证明手术疗效优于激光光凝。药物治疗、手术治疗、激光光凝治疗等均可有效治疗糖尿病黄斑水肿,但效果不同,应根据患者具体情况选择合适的治疗方法。     

中药外敷与灌肠治疗复发性子宫内膜异位症及控制其复发的临床应用

目的研究使用中药进行外敷及灌肠对复发性的子宫内膜异位症的治疗和控制其复发的方法。方法将我院2010年3月至2011年4月收治的子宫内膜异位症不使用中药治疗的138例患者作为对照组,2011年4月至2012年3月收治的子宫内膜异位症使用中药治疗的176例患者作为治疗A组,另将外院转入出现复发的32例患者作为治疗B组。比较三组患者的治疗效果。结果术后使用中药灌肠及外敷的组在复发率方面明显低于未使用中药外敷及灌肠的组,从外院转入复发的病例,使用中药外敷及灌肠后效果明显。结论使用中药进行中药外敷及灌肠对子宫内膜异位症保守性手术的辅助治疗是非常有效的,且无副作用。     

经皮气管切开术围术期护理体会

目的探讨重症监护病房微创气管切开术患者围手术期的护理.方法对气管切开患者充分术前准备,术中生命体征监测,加强气道护理及并发症处理等方法,保证手术顺利进行.结果通过围术期的配合及护理,60例患者全部顺利完成手术.结论熟练的配合与护理经皮气管切开术操作更快捷、准确.