中山醫學大學2010-07-282026-04-012010-07-282010-07-28https://scholars.csmu.edu.tw/handle/123456789/8784背景：縱使在抗生素發展迅速的近代，正確用藥來治療鼻竇炎卻不是件容易的事；除了菌株的抗藥性外，檢體也是不易取得。藉鼻竇X光片的影像診斷，實施上顎竇穿刺沖洗術，是一種治療合併診斷的方式。方法：收集1999年1月至2001年12月共195名門診病患，以回溯性方式進行研究；病人在症狀上自述臉頰腫脹感、鼻塞、鼻涕倒流、喉嚨有異物感等，視診上見鼻口、咽部有黃色膿性分泌物，症狀期一周至兩年，安排鼻竇X光片檢查。如果上顎竇於water's view上呈現黏膜增厚，液氣相面，均勻或不均勻混濁，則施予上顎竇穿刺術。選擇穿刺一週前未服用抗生素者為統計對象。依症狀期分為急性、亞急性及慢性鼻竇炎，統計菌種及洗出液外觀與培養率之關聯。並與鼻竇X 光片作對照。結果：本研究檢體的陽性培養率(指所有檢體培養出菌株的比例)為75.3%。急性鼻竇炎患者常見菌種依次為嗜血性流性感冒桿菌、溶血性鏈球菌、肺炎鏈球菌。亞急性鼻竇炎患者常見菌種依次為嗜血性流性感冒桿菌、肺炎鏈球菌、鼻內常駐菌。慢性鼻竇炎患者常見菌種依次為嗜血性流性感冒桿菌、肺炎鏈球菌、PRSA (penici-llin -resistant Staphylococcus aureus) 。鼻竇X光片上顎竇呈現不透光的嚴重程度與洗出液的外觀具有統計上意義。結論：確實無菌的步驟，上顎竇穿刺術可正確建立鼻竇內菌株。此項技術執行與否，鼻竇X光片的water's view 提供了重要資訊。 Background: As specimen collection is difficult and bacteria develop resistance to the action of drugs, it is not easy, even as antibiotics are increasingly faster to develop, to apply correct medicine to treat paranasal sinusitis. However, the using antral puncture and sinus X-ray can be used as both treatment and diagnosis of this disease. Method: In a retrospective study of 195 outpatients with paranasal sinusitis from January 1999 to December 2001, the patients gave accounts of such symptoms as swollen cheeks, stuffy nose, post nasal drip, and a lump sensation in the throat. On inspection, the patients were found to have a purulent yellowish discharge from the naso-oropharynx. These symptoms lasted from one week to two years. Sinus X-rays were taken. If thickened mucosa, air-fluid level, and diffuse cloudiness were spotted by water s view, antral puncture was performed. When doing our statistical analysis, we excluded patients who had taken antibiotics before antral puncture. Based on the duration of symptoms, their diseases were divided into acute, subacute and chronic paranasal sinusitis. The correlations among types of bacteria, appearance of washout liquid and culture rates were analyzed. In addition, we compared sinus X-ray findings. Results: The positive bacterial culture rate was 75.3%. The most common organisms found in acute case of sinusitis were haemophilus species, hemolytic streptococcus, and Streptococcus pneumonia. The most common organisms of subacute paranasal sinusitis were Haemophilus species, Streptococcus pneumonia, and normal flora. Patients with chronic paranasal sinusitis were found to have Haemophilus species, Streptococcus pneumonia, and PRSA (penicillin-resistant staphylococcus aureus). The correlation between the opaque order of severity on the maxillary sinus and the appearance of washouts were statistically significant. Conclusions: Using a sinus puncture of maxillary sinus, samples can be collected and cultured and the pathogens can be determined. The water s view of sinus X-rays provides important information on whether to sinus puncture.zh-TW