慢性鼻-鼻窦炎伴哮喘患者鼻内镜手术综合治疗对肺通气功能的影响

The effect of endoscopic sinus surgery on pulmonary function of chronic rhinosinusitis patients with asthma

目的:探讨以鼻内镜手术为主的综合治疗对慢性鼻-鼻窦炎(CRS)伴哮喘患者肺通气功能的影响。方法:选取50例符合研究标准的CRS伴哮喘患者,其中35例(鼻内镜组)行鼻内镜手术治疗及常规围手术期治疗;另外15例作为对照组行保守治疗;2组均行常规哮喘治疗。主要观察指标包括各组患者VAS评分、鼻内镜Lund-Kennedy评分、哮喘症状控制情况、肺通气功能即FEV1、FVC、FEV1/FVC及PEF。结果:CRS伴哮喘患者VAS评分与FEV1和PEF存在显著负相关性(P<0.05),鼻内镜Lund-Kennedy评分则与PEF存在显著负相关性(P<0.05);鼻内镜组VAS评分和鼻内镜Lund-Kennedy评分术后1年和3年分别与术前相比均有显著下降,且与同期对照组比较均有显著改善(P<0.05)。鼻内镜组术后1年和术后3年哮喘控制率均显著高于同期随访对照组(P<0.05);鼻内镜组术前FEV1、FVC、FEV1/FVC及PEF术后1年和3年与术前相比,以上各指标均显著改善(P<0.05),且与对照组相比,除随访第3年FVC鼻内镜组与对照组无显著差异外(P>0.05),其余随访指标在试验组与对照组之间均存在显著差异(P<0.05)。结论:在CRS伴哮喘患者的病程中,CRS与哮喘可相互影响;以ESS为主的综合治疗,在改善CRS病情的同时可显著改善患者哮喘症状控制情况及肺通气功能。因此,针对防治CRS伴哮喘疾病,本研究具有一定的临床参考价值。

Objective：To explore the effection of the pulmonary function of patients of chronic rhinosinusitis（CRS）with asthma which treated with endoscopic sinus surgery（ESS）based comprehensive treatment.Method：There were 50cases of chronic rhinosinusitis with asthma whom met the study criteria.35cases enrolled in the trial group,which treated with endoscopic sinus surgery,and routine perioperative tratment.Another 15cases as control group which underwent conservative treatment.Both groups underwent the rule treatment of asthma.The main monitoring indexes,which included visual analogue scale（VAS）score,endoscopic Lund-Kennedy score,control of asthma symptoms,the pulmonary function which involved forced expiratory volume in first second（FEV1）,forced vital capacity（FVC）,the ratio of forced expiratory volume in first second and forced vital capacity（FEV1/FVC）and peak expiratory flow（PEF）,were measured in the patients of each groups before surgery,follow-up for 1year and 3-year.Result：Our study found that the VAS score of CRS with asthma was significantly negatively correlated with FEV1and PEF（P＆lt;0.05）,endoscopic Lund-Kennedy score was significantly negatively correlated with PEF（P＆lt;0.05）;After the trial group underwent ESS based comprehensive treatment,the improvement of VAS score and endoscopic Lund-Kennedy score of postoperative compared with preoperative and the same period in the control group were significantly（P＆lt;0.05）.The difference of the postoperative asthma control rate of trial group after 1year and after 3years,respectively,compared with the same period control group were statistically significant（P＆lt;0.05）.The preoperative FEV1,FVC,FEV1/FVC and PEF of trial group compared with preoperative were significantly（P＆lt;0.05）.Even the difference of them compared with the same period control group were significantly（P＆lt;0.05）,except the FVC in the follow-up 3years（P=0.088）.Conclution：The CRS may aggravate asthma symptoms and affect negatively the pulmonary function,and poor asthma control or aggravate may exacerbate the CRS in the course of CRS with asthma patient.With ESS based on combined therapy,it can improve the condition of CRS significantly and improve the control of asthma symptoms and pulmonary function else.