慢性鼻-鼻窦炎120例药物治疗评估

Evaluation of drug therapy of 120 cases with chronic rhinosinusitis

目的评估药物治疗慢性鼻-鼻窦炎疗效。方法根据症状、鼻内镜检查及CT表现，12周岁以上120例（216侧）不伴鼻息肉慢性鼻-鼻窦炎患者列入治疗对象。给予大环内酯类抗生素（克拉霉素缓释片）、黏液溶解剂（标准桃金娘胶囊）和一种中成药（鼻渊通窍颗粒）3种药物口服，糖皮质激素鼻内局部应用。最少用药4～6周复查，若患者主观感觉症状缓解或消失，复查cT，cT提示鼻窦炎症完全消失者，停用除克拉霉素缓释片外的其他药物，将克拉霉素减半继续服用达12周。若仅有主观症状改善继续合并用药，治疗过程中根据症状与cT表现确定是否调整用药方法，最长用药12周，所有患者在停药后4周，根据治疗前后症状及CT表现，分别采用视觉模拟量表（VAS）和Lund—Mackey鼻窦cT扫描病变范围评分系统对临床疗效进行主观与客观评估。结果120例CRS患者治疗前VAS得分为（7．88±1．58）分，治疗后为（2．74±1．56）分，治疗前后得分比较t=27．01，P〈0．01。Lund-Mackey鼻窦cT量化评分治疗前为（8．10±1．g1）分，治疗后为（2．98±1．56）分，治疗前后得分比较t=26．67，P〈0．01。治疗前后按侧进行Lund—Mackey鼻窦CT量化评分判为正常（轻微）、轻度、中度和重度的构成比变化比较，x2=197．77，P〈0．01。结论合适的药物治疗对慢性鼻-鼻窦炎疗效明显，12岁以上不伴鼻息肉慢性鼻-鼻窦炎应首选药物治疗。

Objective To evaluate the effect of drug therapy on chronic rhinosinusitis （CRS）. Methods Based on symptoms and endoscopic and CT findings, 120 CRS patients （216 sides） without nasal polyps older than 12 years of age patients were enrolled in the study. They were treated with clarithromycin, mucolytic agent and ready patent drug, as well as steroid nasal spray, for at least 4 - 6 weeks. If the patients felt well and CT findings were negative, the drugs were stopped except clarithromycin that continued to be used at half dosage up to a total length of 12 weeks. If not, all the drugs continued to be used depending on symptoms and CT findings and not exceeding 12 weeks. Finally, the therapeutic effects were evaluated using visual analogue scale （VAS） and Lund- Mackey scale 4 weeks later after the drugs were stopped. Results There were significant differences in VAS and Lund-Maekey scores between before and after therapy （7.88 ± 1.58 vs 2.74 ± 1.36, t =27.01, P 〈0.01 ; 8.10 ± 1.41 vs 2.98 ± 1.56, t = 26.67, P 〈0.01 ）. There was also a significant difference in the proportions of the different severities of the 216 sides with CRS （ based on Lund-Mackey score） between before and after therapy （ X2 = 197.77, P 〈 0.01 ）. Conclusion Systemic drug therapy has a significant and stable effect on CRS without nasal polyps, and it should be the first choice for the patients older than 12 years of age.