Objective:To investigate the occurrence and managements of poor recovery after total endoscopic middle ear surgery. Methods:A total of 302 cases（315 ears） who underwent endoscopic middle ear surgery in our hospital from June 2020 to June 2021 were collected. Follow up by means of endoscopy, pure tone hearing threshold, tympanogram was conducted at 1 month, 3 months, 6 months and 1 year after surgery to analyze the incidence, possible causes, treatment strategies and effects of poor results tympanic membrane healing and hearing recovery. Results:Among 302 patients（315 ears） followed up, there were 28 cases with poor recovery. There were fourteen cases of poor eardrum healing, of which 10 cases achieved healing of eardrum after tympanic membrane patching in the outpatient department, with a success rate of about 71.4%. TM recurrence adhesion occurred in 4 cases after surgeries of cholesteatoma and adhesive otitis media. One case completely recovered after self eustachian tube insufflation, while 2 cases maintained the degree of eardrum subsidence, and one ineffective patient chose resurgical treatment, with an effective rate was 75.0%. Failure in hearing improvement occurred in 8 cases, all of which underwent second surgical exploration, and seven cases were improved after the second surgery, with an effective rate of 87.5%. Among the 8 patients with no improvement or aggravation of hearing loss after surgery, four cases had postoperative B-type or C-type of tympanogram, and the hearing could not improve after self eustachian tube insufflation for secondary surgical exploration. and the hearing improved after the secondary surgery. Incorrect orientation of ossicular prosthesis was accounted for another 2 cases, the hearing was improved after the ossicular orientation adjustment. One patient with lateral healing of TM and failed hearing recovery was corrected by a second operation. One case of tympanosclerosis underwent stapes release surgery, but hearing recovery still failed. One patient had recurrent postoperative cicatricial atresia of external auditory canal, and the patient was reluctant to undergo reoperation. Postoperative delayed facial paralysis occurred in 1 case, and the facial paralysis recovered recovered after conservative treatments. Conclusion:Eardrum patch and eustachian tube autoflation are simple and effective early outpatient treatment for patient with poor recovery. For those who failed with conservative treatments such as eardrum patch or eustachian tube and poor hearing recovery, the second surgical exploration is safe and effective. Regular follow up after endoscopic middle ear surgery is necessary for the managements of poor recovery.
Humans ; Ear, Middle/surgery* ; Female ; Male ; Endoscopy/methods* ; Adult ; Middle Aged ; Tympanic Membrane/surgery* ; Treatment Outcome ; Hearing Loss/surgery* ; Otologic Surgical Procedures/methods* ; Otitis Media/surgery* ; Eustachian Tube/surgery*

Objective To explore the influencing factors of the pregnant women with preeclampsia in blood pressure,glucose and lipid metabolism to hypertension after delivery.Methods One hundred patients of preeclampsias in Obstetrics and Gynecology Department of Maternal and Child Care Sservice Centre of Weinan from April 2012 to May 2014 were selected as the observation group.One hundred maternal-health at the same period were selected as the control group.All observed objects were followed up from May 2014 to May 2015.The general situation,sugar metabolism,lipid metabolism were recorded when in group and folllowed up.The general situation,sugar metabolism,lipid metabolism in prenatal were contrasted in two groups of prenatal and postpartum.Influence factors for hypertension of preeclampsia in pregnant women after childbirth were analyzed.Results Family history of hypertension,history of long-term use of contraceptives,prenatal body mass index(BMI),postpartum BMI,systolic prenatal,antenatal diastolic in the observation group were higher than that in the control group.The differences were statistically significant (P＜ 0.05).The fasting glucose (FPG),fasting insulin antenatal,prenatal insulin resistance index,total cholesterol(TC),triglycerides (TG),low-density lipoprotein cholesterol (LDL-C) of prenatal and postpartum in the observation group were (4.51 ±0.48) mmol/L and (5.21±1.08) mmol/L,(10.11±3.88) mU/L and (9.68±4.97) mU/L,(1.64±0.65) and (2.34±1.48),(6.21±0.98) mmol/L and (5.14±0.51) mmol/L,(3.51±1.35) mmol/L and (1.41 ±0.79) mmol/L,(3.31±0.97) mmol/L and (2.69±0.56) mmol/L,higher than that in the control group ((4.12±0.51) mmol/L and (4.76±0.97) mmol/L,(8.19±2.99) mU/L and (7.25±3.96) mU/L,(1.47 ±0.42) and (1.79±0.79),(5.91± 1.01) mmol/L and (4.99±0.39) mmol/L,(2.96±0.87) mmol/L and (0.86±0.78) mmol/L,(3.01 ± 1.01) mmol/L and (2.46±0.47) mmol/L),the differences were statistically significant(t=5.238,3.690,2.069,2.005,3.225,2.015,2.917,3.600,3.089,2.200,4.661,2.961;P＜0.05).Prenatal and postpartum BMI (OR =1.356,95％ CI 1.012-2.102;OR =1.378,95％ CI 1.034-2.609),fasting blood glucose level of prenatal(OR=1.753,95％CI 2.307-59.257) and postnatal fasting insulin levels(OR =1.351,95％ CI 1.810-112.267),the difference of systolic pressure of prenatal and postnatal(OR=1.247,95％CI 1.208-108.323),the difference between prenatal and postnatal triglycerides (OR =1.119,95％ CI 4.540-77.559),the difference of insulin resistance index (OR =1.529,95％ CI 1.828-92.844) and the difference between high-density lipoprotein cholesterol hypertension (OR =2.547,95％CI 1.763-110.693) were the risk factors that can cause preeclampsia occurs hypertension after childbirth (P ＜0.05).Conclusion Preeclampsia with high blood pressure,abnormal glucose metabolism and lipid metabolism are the risk factors that can cause preeclampsia occurs hypertension after childbirth.

Objective To investigate the clinical efficacy ofHejie Fenxiao Decoction on damp-heat patients with acute kidney injury (AKI).Methods Totally 68 patients were divided into the control group and the treatment group according to the patients’ willings. Both groups were given treatment, such as elimination of the incentives and symptomatic treatment. Besides, patients of the treatment group acceptedHejie Fenxiao Decoction for 30 days. The changes of renal function indexes, such as serum creatinine (SCr), blood urine nitrogen (BUN), uric acid (UA), albumin (ALB) and integral of TCM syndrome, were observed, and recovery ratio and clinical endpoints were compared.Results SCr and eGFR of both group were improved on day 14 (P<0.05). After treatment, the renal function recovery ratio and renal replacement ratio in the two groups showed obvious differences (P<0.05);although survival rate of treatment group was higher than control group, it showed no statistical significance (P>0.05);clinical endpoints analysis of the two groups showed statistical significance (P<0.05). The difference of integrals of TCM syndrome between the two groups showed statistical significance (P<0.05) on day 14.ConclusionHejie Fenxiao Decoction combined with basic regular Western medicine can better improve the clinical symptom, recover the renal function, and decrease the rate of renal replacement and death of AKI damp-heat patients.