克拉霉素治疗FESS后鼻窦黏膜迁延性炎症的临床研究

Clinical Effect of Clairschach on Rhinosinus Mucouse Membrane Deferment Inflammation after FESS

目的研究长期(>12周)小剂量的克拉霉素(250 mg/d)对功能性内窥镜鼻窦术后迁延不愈的鼻窦黏膜炎症的临床疗效.方法 2009年9月至2010年4月在头颈外科经鼻窦内窥镜手术治疗后1 a以上长期迁延性鼻窦黏膜炎症、疗效评估未愈者9人.在原有的药物治疗(局部糖皮质类固醇激素,黏膜除排剂,中成药)基础上,口服克拉霉素,每天250 mg,连续口服超过12周.采用慢性鼻-鼻窦炎视觉模拟量表(VAS)及鼻内镜检查量化评估(Lund-Kennedy评分法),对治疗前后的疗效采用相关样本作参数检验,Wilcomon Ranks TestSigneel统计学分析.结果治疗前后的VAS和Lund-Kennedy评分皆有统计学意义(P<0.05);停药后半年以上未复发;9例患者无明显的副作用,肝肾功能在正常范围.结论长期低剂量的克拉霉素对顽固的持续存在的鼻窦黏膜炎症有较为明显的临床治疗效果,且效果稳定;克拉霉素有较好临床安全性及患者的良好的依从性,适合长期服用.

Objective To investgate the clinical effect of long-term(>12 weeks)low dose administration of clarithromycin(250 mg,per day orally,) on rhinosinus mucouse membrane deferment inflammation after functional endoscopic sinus surgery(FESS).Methods Nine patients underwent functional endoscopic sinus surgery in the Department of Head and Neck Surgery between 2009 and 2010,the period of the rhinosinu mucous membrane deferment inflammation in these patients lasted more than one year,postoperatively.Clinical efficacy of postoperative treatment including intranasal steroid,endonasal irrigation,Chinese medicine and mucolytics was bad after FESS.At the same time,clarithromycin(250 mg,per day)was used for these patients orally for more than 12 weeks.The efficacy was evaluated using methods of Visual analogue scale(VAS)and Lund-kennedy.Results All nine patients met the requirement of drug withdrawal.The period of treatment with clarithromycin was 16 weeks for 5 patients,20 weeks for 2 patients and 30 weeks for 2 patients,respectively.Curative effect of clarithromycin was excellent for five patients,good for three pationts and bad for one pationt,the total effective rate was 88.9%(8/9).There was significant difference in the evaluation of VAS and lund-kennedy between before and after treatment(P<0.05).There was no relapse after stoping treatment of clarithromycin over six months.No side effects of clarithromycin were found in all patients.Conclusion Long-term low dose administration of Clarithromycin has asignificant and stable clinical effect for rhinosinus mucouse membrane deferment inflammation after functional endoscopic sinus surgery,and has good clinical safety and adherence for patients.