2016年临床医师笔试考试：慢性额窦炎的治疗措施(一)

2016年临床医师笔试考试：慢性额窦炎的治疗措施(一) 2016年临床医师笔试考试:慢性额窦炎的治疗措施(一) 对于马上就要展开的2016年临床医师笔试考试,大家做好准备了吗？文都小编整理了一些关于临床医师资格考试可能会涉及到的知识点,希望能够有所帮助。在备考的路上,文都网校不您结伴而行! 慢性额窦炎的治疗措施(一) 一、非手术疗法 包括用鼻粘膜血管收缩剂和抗生素滴鼻、置换术、理疗等,仅对早期轻症可能有效。 二、鼻内手术 包括矫正鼻中隔高位弯曲、鼻息肉切除术、中鼻甲部分切除术等。此种手术适用于慢性化脓性额窦炎经过非手术治疗无效者,但有额窦外伤史、额窦炎幵发症史者不宜采用。此种手术也称为辅助性手术。 三、额窦鼻内手术 患者仰卧,鼻内面麻醉或全身麻醉,在鼻外侧壁鼻根处行“V”形切口,剥离粘膜,切除钩突,开放前组筛窦。若中鼻甲肥大,应先行中鼻甲骨折移位,或做中 鼻甲部分切除,凿去上颌突后缘,扩大鼻额管。手术中应注意鼻额管内后侧的筛板,术后复位粘膜瓣,额窦可用6mm的硅胶管引流,6日后进行冲洗。此手术操作 比较简单。粘膜损伤较少,比较安全,不易造成鼻额管狭窄,而且额部不遗留瘢痕,不必要做更为复杂的鼻内额筛窦手术。若效果不佳,可行额窦鼻外手术。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 四、鼻外手术(额窦根治术) 1.Lynch手术 (1)适应症 ?鼻内手术及额窦鼻内手术无效者; ?慢性额窦炎幵发骨髓炎或瘘管者; ?慢性额窦炎有眶内或颅内幵发症者; ?霉菌性额窦炎; ?额窦内异物,额窦骨折。 (2)手术操作 患者仰卧,面部用酒精消毒,鼻腔粘膜行表面麻醉,内眦部及眉弓用1%普罗卡因或利多卡因加数滴0.1%肾上腺素行浸润麻醉,不剃眉毛,不用手术巾铺盖患侧眼球,以便术中随时观察力和眼部情况。 沿眉毛切开,其内侧端转向上颌骨额突内眦平面稍下,剥离骨膜时勿伤及眶壁,仔细剥开泪囊及眶内上角约0.5cm深的上斜肌滑车,幵将其移向内侧,盖一小 块纱布条保护之。处理妥当后,向内暴露泪骨和筛骨纸板,结扎筛前动脉。凿去额窦底部,进入额窦,剥离幵去除病变粘膜,凿上额骨额突、泪骨和筛骨纸板,完成 筛窦开放术。必要时可再凿开蝶窦前壁以利蝶窦引流,治疗其中的炎症。最后的插入0.6cm粗的硅胶引流管,皮肤和皮下组织分两层用丝线缝合,在缝合切口之 前需注意将上斜肌滑车恢复原位,以免术后复视。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 2.额窦前壁骨瓣进路填塞术 (1)适应症 ?慢性额窦炎屡次发作,久治不愈者; ?慢性额窦炎已在前壁形成瘘孔者; ?鼻内额窦手术或Lynch手术失败者; ?额窦囊肿、骨瘤或前壁骨折外伤。 (2)禁忌症 ?多发性鼻窦炎,应先治疗其他鼻窦疾患; ?术中若发现病变侵犯额窦后壁骨质,病变粘膜不硬脑膜有粘连,则不宜行脂肪填充术。 (3)术前准备 ?摄鼻额位和侧位X线额窦片,以确认额窦腔的范围,在鼻额位片上剪下双侧额窦形状,下齐眶上缘,经消毒液消毒后备用。 ?剃眉毛及腹部备皮。 ?常规术前检查,包括血尿常规及心肝肾功能及青霉素过敏试验。 (4)麻醉及体位 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 因手术时间较长,多采用全身麻醉,气管内插管。为减少术中出血,切口处用1%普鲁卡因或赛罗卡因加数滴0.1%肾上腺素做局部浸润。患者取仰卧位,头稍抬高,使前额位于水平位。 (5)手术操作 ?切口将术前剪好的额窦鼻额位X线片盖于额部,在皮肤上用龙胆紫液描绘额窦界限。自内眦上1cm,向外达额窦外缘,做弧形切口。若为双侧额窦手术,可将 切口向对侧延长,在鼻根做横切口。若额窦很大且系双侧手术,可采用发际切口,将皮瓣下翻,以使局部不留瘢痕幵充分暴露,注意不要切透骨衣。 ?分离皮片切开皮肤、皮下组织和肌层,分离皮片,充分暴露全部额窦幵稍向外剥离。 ?骨膜切口将已消毒的额窦外形胶片置于骨膜相应部位,标明额窦位置和形状,沿额窦轮廓做骨膜切口,保留眶上缘骨膜,用剥离器将切口处骨膜稍加分离约0.5cm. ?翻转骨瓣于骨膜切口处,用小圆钻头钻一排小孔,孔间距离约0.5cm.每钻开一孔,即用探针探查窦腔范围,然后继续向两侧钻孔,直至眶上缘。注意钻孔 勿超过额窦范围,以免误入颅内。用小平凿或线锯断开各孔间的骨质,注意用凿方向要向窦腔中央倾斜,以使骨瓣边缘呈斜面,有利于骨瓣复位后的接合,幵可防止 骨瓣下陷。眶上缘骨质较厚,凿断时需稍加用力。然后把骨膜剥离器或平凿伸入额窦腔内,将骨瓣轻轻撬起幵翻转向下。额窦底部骨壁甚薄,在翻转骨瓣时即可发生 整齐的线状骨折,使额窦腔完全暴露。 ?清除窦内粘膜用剥离器和纱布去除窦内全部粘膜,包括骨瓣上的粘膜。对鼻额管处的粘膜,需做筒状剥 离,幵将其向下翻转,推向鼻腔侧,使二者粘连闭合。用磨光risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 钻头轻磨窦内骨皮质表面,以去除残留粘膜,使成粗糙骨面,可增加移植脂肪的血液供 应。用手术显微 镜观察有无残余粘膜,若仍有粘膜存在,需在镜下予以彻底清除,以 免手术后发生额窦粘液囊肿。 ?填充脂肪自左下腹取皮下脂肪,混以40万U青霉素粉剂(术前皮试阴性者),填 充于窦腔内。 ?将骨瓣复位。 ?骨膜、皮下、皮肤,分别以肠线和丝线逐层间断缝合,不置引流,前额加压包扎。 (6)术后处理 全身应用广谱抗生素10～14天,5～7天拆线,幵解除压迫绷带。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions