鼻窦灌注液冲洗在慢性鼻窦炎鼻内镜术后的应用及其机制探讨

Mechanism for the curative effect of douching with nasal sinuses perfusate in treating chronicsinusitis after endoscopic sinus surgery

目的探讨鼻窦灌注液冲洗在慢性鼻窦炎鼻内镜术后的应用及其作用机制。方法将76例行鼻内镜手术治疗的慢性鼻窦炎患者按随机数字表法分为治疗组和对照组，每组38例。两组术后给予不同的鼻窦冲洗方法，对照组以0．9％氯化钠进行冲洗，治疗组应用鼻窦灌注液进行冲洗。术后2个月评价疗效。比铰两组临床疗效及治疗前后鼻窦黏膜炎性因子水平的变化。结果治疗组治愈21例，好转13例，无效4例，总有效率为89．5％（34／38），对照组治愈12例，好转15例，无效11例，总有效率为71．1％（27／38），两组总有效率比较差异有统计学意义（P〈0．05）。治疗组治疗后的鼻窦黏膜中干扰素（IFN）-y、白细胞介素（IL）-2、IL-4、IL-5水平分别为（13．21±1．38）、（14．59±1．43）、（34．83±5．31）、（39．93±7．98）pg／L，均较治疗前的（23．87±1．76）、（16．13±1．71）、（67．37±7．36）、（81．82±7．69）pg／L,显著下降（P〈0．05），而对照组治疗后的鼻窦黏膜中IFN-y、IL-2、IL-4、IL-5水平分别为（20．13±2．73）、（14．82±2．26）、（48．92±7．62）、（43．87±8．25）pg／L，较治疗前的（24．06±1．82）、（15．96±1．74）、（66．81±8．24）、（82．16±7．34）pg／L亦显著下降（P〈0．05），且治疗组治疗后IFN-y、IL-4、IL-5水平均较同期对照组更低（P〈0．05）。结论应用鼻窦灌注液对慢性鼻窦炎患者鼻内镜术后进行鼻腔冲洗可提高临床疗效，且鼻窦灌注液优于单纯0．9％氯化钠，而鼻腔冲洗的作用机制可能与抑制鼻窦黏膜炎性因子的释放有关。

Objective To investigate the mechanism for the curative effect of douching with nasal sinuses perfusate in treating chronic sinusitis after endoscopic sinus surgery. Methods Seventy-six chronic sinusitis patients after endoscopic sinus surgery were divided into treatment group and control group by random digits table with 38 cases each. Every group was given postoperatively sinus flush, treatment group was flushed with nasal sinuses perfusate,while contro group was flushed with 0.9% sodium chloride. Therapeutic effect was evaluated after two months. The therapeutic effects of the two groups were compared and the inflammation factor levels and changes of sinus mucosa were observed before and after treatment. Results In treatment group,there were 21 cases to be cured,13 eases to be improved,4 eases to be useless, the total effective rate was 89.5%（34/38 ）, while in control group, there were 12 cases to be cured, 15 cases to be improved, 11 cases to be useless, the total effective rate was 71.1% （27/38）, the total effective rates between two groups were statistically significant （P 〈 0.05）. The levels of interferon （IFN）-y, interleukin（IL）-2, IL-4, IL-5 after treatment in treatment group were respectively （13.21 ± 1.38）, （14.59 ± 1.43 ）, （34.83 ± 5.31 ）, （ 39.93 ± 7.98 ） pg/L, which were significantly decreased compared with those beforetreatment [ （ 23.87 ± 1.76 ）, （ 16.13 ± 1.71 ）, （67.37 ± 7.36 ）, （ 81.82 ± 7.69 ） pg/L, P 〈 0.05 ]. The levels of IFN- y, IL-2, IL-4, IL-5 after treatment in control group were respectively （20.13 ± 2.73 ）, （ 14.82 ± 2.26 ）, （48.92 ±7.62）, （43.87 ± 8.25） pg/L,which were significandy decreased compared with those before treatment [ （24.06 ± 1.82）, （ 15.96 ± 1.74）, （66.81 ± 8.24）, （82.16 ± 7.34） pg/L,P 〈 0.05 ]. And the levels of IFN-y, IL-4, IL-5 after treatment in treatment group were significantly lower than those in control group, the differences were statistically significant （P 〈0.05）. Conclusions That nasal flush with nasal sinuses perfusate for postoperative patients with chronic sinusitis after endoscopic sinus surgery may improve the therapeutic effect and nasal sinuses perfusate formula is superior to 0.9% sodium chloride alone, and the mechanism may be related to inhibition of inflammation factor release of sinus mueosa.