基于《欧州鼻窦炎和鼻息肉指南2007版》的儿童慢性鼻窦炎治疗的临床研究

Clinical research of treatment about childhood patient with chronic sinusitis based on the ＂European Position Paper on rhinosinusitis and nasal polyps 2007＂

目的 探讨《欧洲鼻窦炎和鼻息肉指南2007版》（《EPOS 2007》）中关于儿童慢性鼻-鼻窦炎（CRS）治疗建议的临床应用.方法 采用多中心前瞻性病例自身前后对照研究方法,选取临床和CT确诊为CRS忠儿60例,全部应用小剂量阿奇霉素和孟鲁司特钠12周以上,19例延长阿奇霉素或/和孟鲁司特钠疗程,其中9例加用短程（5 ～7 d）头孢克洛,3例加用鼻用糖皮质激素.治疗12周后,应用视觉模拟量表（VAS）主观评价和Lund-Mackay CT评分法进行客观评价.结果 60例患儿应用阿奇霉素和孟鲁司特钠12周后,VAS评分由7.92±2.66降至2.13±1.11,差异有统计学意义（t=4.01,P=0.001）;Lund-Mackay CT评分由14.12±3.30降至2.53±1.71,差异有统计学意义（t=2.83,P=0.005）.其中41例12周后完全停药,至今随访（18.12±6.25）个月,末见CRS复发症状;余19例分别有延长阿奇霉素或/和孟鲁司特钠疗程,其中9例加用短程头孢克洛、3例加用鼻用皮质激素等,总疗程延长至24周后均能停药,从停药随访至今（6.23 ±2.13）个月,末见CRS复发症状.结论 根据《EPOS 2007》,对儿章CRS应用小剂量阿奇霉素和孟鲁司特钠治疗3个月可获显著疗效.

Objective To explore the clinical application of treatment on childhood patient with chronic sinusitis （CRS） based on＂European Position Paper on rhinosinusitis and nasal polyps 2007＂ （EPOS 2007） under the background of real world research.Methods A multi-center prospective crossover study was performed,and 60 cases of CRS diagnosed base on clinical features and CT imaging who were applied of small doses of azithromycin and montelukast for 12 weeks or more were selected.Nineteen cases prolonged azithromycin and/or montelukast treatment,and 9 cases of them were added a short course （5-7 days） of cefaclor and 3 cases of them added loratadine and nasal corticosteroids.Visual analog scale （VAS） was used for subjective evaluation and Lund-Mackay CT was used for objective evaluation after 12 weeks of treatment.Results After 12 weeks of treatment,the average VAS score was decreased from （7.92 ± 2.66） to （2.13 ± 1.11）,and there was a significant difference （t =4.01,P =0.001） ; Lund-Mackay CT score was decreased from （14.12 ± 3.30） to （2.53 ± 1.71）,and there was significant difference （t =2.83,P =0.005）.Forty-one cases were followed up for （18.12 ± 6.25）months after 12 weeks treatment,and the drug withdrawal showed no recurrence of CRS symptoms.The other 19 cases were received with azithromycin and/or montelukast treatmem longer or combined with a short course of cefaclor,or nasal corticosteroids respectively,and were followed up for （6.23 ± 2.13） months after extend to 24 weeks of total course could withdrawal,and there was no recurrence of CRS symptoms after drug withdrawal.Conclusions There is a significant effect after application of azithromycin and montelukast on treatrment of CRS base on EPOS 2007.