【摘要】 目的 觀察鼻內鏡下激光治療變應性鼻炎的療效。 方法 2005年6月－2008年7月采用鼻內鏡下Nd:YAG激光治療變應性鼻炎患者384例，其中男206例，女178例；年齡13~74歲，平均31歲。病程1~33年，平均7.7年。按照2004年制定的《變應性鼻炎診治原則及推薦方案》評分均gt;6分。術前及術后1、6、24個月時分別對患者癥狀和體征進行評分和分析。 結果 所有患者均獲隨訪，隨訪時間1~24個月，平均22.7個月。其中術后1、6、24個月分別有384、380和358例患者獲隨訪。統計術前及術后1、6、24個月時癥狀以及體征評分總分分別為（11.32±1.03）、（3.06±1.17）、（3.32±1.37）、（4.09±2.03）分，術后各時間點評分均較術前顯著改善，差異有統計學意義（Plt;0.05）；術后各時間點間差異均有統計學意義（Plt;0.05），其中以術后1個月效果最好。 結論 鼻內鏡下激光治療變應性鼻炎療效確切，但遠期有一定復發率。【Abstract】 Objective To explore the clinical efficacy of operation by laser under nasal endoscope for the treatment of allergic rhinitis. Methods A total of 384 patients with allergic rhinitis undergoing operation by Nd : YAG laser under nasal endoscope from June 2005 to July 2008 were enrolled in the study, including 208 males and 178 females with their age ranged from 13 to 74 years old averaging at 31.2 years. The course of the disease ranged from 1 to 33 years averaging at 7.7 years. According to The Treatment Principle and Recommending Program for Allergic Rhinitis regulated in 2004, the scores of these cases were all higher than 6. Scoring and analysis of patients’ symptoms and body signs were performed before operation and 1, 6, and 24 months after operation. Results All the patients were followed up with the time period ranged from 1 to 24 months averaging at 22.7 months. A total of 384, 380 and 358 patients were followed up respectively 1, 6, and 24 months after operation. The general score of symptoms and body signs before operation, 1, 6, 24 months after operation were respectively 11.32±1.03, 3.06±1.17, 3.32±1.37, and 4.09±2.03. The scores after operation were significantly better than that before operation (Plt;0.05). The curative effect at the first month was the best. Conclusion Operation by laser under nasal endoscope is one of the valid, feasible methods for the treatment of allergic rhinitis, but during the long-term period, recurrence in some cases is possible.
Ambulatory surgery has been vigorously promoted in China while there is a lack of unified management norms. Shanghai has a long-term pilot operation of ambulatory surgery in China, which has a certain management foundation. And it has actively promoted the standardized management since 2014. This article introduces the development and preparation of the Shanghai local standard The Hospital Management Specification of Ambulatory Surgery and the main structure and key technical content of the standard, in order to promote the standardization of ambulatory surgery management for reference.
【摘要】 目的 比較3種方法治療鼻前庭囊腫的優缺點，探討鼻前庭囊腫的最佳治療方法。 方法 2002年1月-2008年6月收治鼻前庭囊腫患者84例，隨機分為3組，分別采用微波、鼻前庭揭蓋術和唇齦溝切口徑路鼻前庭囊腫切除術治療。 結果 84例患者均治愈。3組治療時間和出血量比較均有統計學意義（Plt;0.05）。術后4例發生感染，分別為鼻前庭揭蓋術組1例（3.57%），唇齦溝切口徑路鼻前庭囊腫切除術組3例（10.71%）。隨訪1年，僅微波治療組3例患者（10.71%）因囊腫壁殘留復發，行鼻內鏡下鼻前庭囊腫揭蓋術后治愈。 結論 鼻內鏡下鼻前庭囊腫；揭蓋術具有精確、微創、手術時間短、并發癥少、復發率低等優點。【Abstract】 Objective To identify the best treatment method for nasal vestibular cyst by comparing three kinds of operative methods. Methods Eighty-four patients with nasal vestibular cyst in this department were divided into three groups from January 2002 to June 2008. They were operated by microwave, uncover method under nasal endoscope and cyst cxcision by crevicular lip approach, respectively. Results All of the 84 patients were cured with 4 infected: one patient (3.57%) was operated by uncover method under nasal endoscope and three patients (10.71%) were operated by cyst excisionby crevicular lip approach. On the contrast of quality of blooding and operating time, there was significant difference among the three operative methods (Plt;0.05). Only three patients (10.71%) operated by microwave recurred after one year of follow-up caused by remained cyst, which were cured after reoperated by uncover method under nasal endoscope. Conclusion Uncover method under nasal endoscope is an effective operation for treating nasal vestibular cyst with such advantages as less trauma, precise operation, short operative time, and less recurrence.
Objective To explore the short term and long term effectiveness of the problem-based learning (PBL) in clinical skill training. Methods A total of 162 clinical medicine undergraduates in Grade 2003 (7-years study) and 2004 (5-year study) who were supposed to intern in the internal medicine departments were randomly divided into the PBL group (n=75) and the control group with traditional training (n=87) for having their clinical skills training. Then t test was applied to compare the two groups about the scores of intern rotation examination and graduate OSCE as well. Results About the baseline: the students in the two groups got similar scores in their internal medicine exam before clinical intern rotation (84.04±7.40 vs. 82.63±8.77, P=0.287). About the short term effectiveness: compared to the control group, the students in the PBL group got higher subjective evaluation from their supervised clinicians (P=0.006). In writing examination, the students of those two group got similar scores in knowledge part (54.17±9.26 vs. 51.67±9.56, P=0.92), while the PBL group won in case reasoning question (20.39±5.27 vs. 16.51±4.90, Plt;0.001). About the long term effectiveness: in the graduate OSCE, the two groups got similar scores in skills operation such as punctures and lab results analyses (P=0.567 and P=0.741), while the students in the PBL group had better performance at the case reasoning and standard patients treating (75.59±9.85 vs. 71.11±12.01, P=0.027). Conclusion With the great short term and long term effectiveness, the PBL applied in the clinical skill training improves the students’ ability of both synthesized analyses and the integrated clinical skills such as clinical thinking and interpersonal communication, but doesn’t aim at the basic knowledge and operation skills.
Objective To investigate the effects of exogenous pulmonary surfactant （PS） on ventilation weaning and respiratory mechanics in infants with acute lung injury（ALI） after cardiopulmonary bypass （CPB）.Methods Twelve infants underwent cardiopulmonary bypass cardiac surgery committed with ALI and difficulty in weaning from ventilation were included in this study.Exogenous PS was used in the treatment via intra-tracheal administration.The changes of blood gas，respiratory mechanics and the conditions of ventilation weaning were observed.Results After intra-tracheal PS administration，spontaneous breath remained steady；spontaneous respiratory rate significantly decreased from，tidal volume of spontaneous breath increased significantly.Three concave sign disappeared and koilosternia was alleviated.PaCO2 value decreased significantly and peak inspiratory pressure（PIP） decreased from （36.18±10.25）cm H2O to （25.11±5.14）cm H2O （Plt;0.01）.Static lung compliance （Cstat） increased from （1.49±0.65）mL·cm H2O-1·kg-1 before treatment to （1.95±0.50） mL·cm H2O-1·kg-1 6 h after treatment （Plt;0.01）；and airway resistance （Rstat）decreased from （128.17±26.34） cm H2O·L-1·s-1 before treatment to （78.56±18.22） cm H2O·L-1·s-1 6 h after treatment （Plt;0.01）.All 12 infants weaned from ventilator successfully.Conclusion Combined with PS intra-tracheal treatment，lung protective ventilation strategy can significantly improve parameters of respiratory mechanics，increase dynamic lung compliance，decrease airway resistance，which can decrease the breathing effort of the infants and make it easy to wean from ventilator.
ObjectiveTo explore the standardized index system of quality control for single disease of day surgery in Shanghai municipal hospitals.MethodsFrom April to November 2020, through literature research and comprehensive analysis of research results, the framework of quality control index system for single disease of day surgery focusing on obstructive sleep apnea hypopnea syndrome surgery and laparoscopic cholecystectomy was constructed; Delphi method was used to evaluate the quality of day surgery in terms of results, objectivity, statistics, sensitivity, accessibility, quantifiability, importance, and guidance. Finally, the final indicators were screened out.ResultsAfter three rounds of Delphi investigation, 18 experts finally formed 14 general indexes and 14 personalized indexes (6 for obstructive sleep apnea hypopnea syndrome and 8 for laparoscopic cholecystectomy) in the single disease of day surgery quality control index system.ConclusionsThe general indexes and personalized indexes quantifying the quality control index for single disease of day surgery are conducive to the standardization and standardized management of day surgery, and can provide a reference for improving the medical quality and safety, and sustainable development of day surgery.
