慢性鼻-鼻窦炎伴鼻息肉患者鼻阻力与肺功能检测及临床分析

Clinical analysis of nasal resistance and pulmonary function testing in patients with chronic nasal-sinusitis and nasal polyps

目的:研究慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)患者鼻阻力及肺功能特点,探讨鼻阻力对CRSwNP患者鼻腔通气功能的评价作用,以及鼻内镜手术对CRSwNP患者肺功能的影响。方法:选取符合研究标准的50例CRSwNP患者为研究对象,均在全身麻醉下按照Messerklinger术式进行鼻内镜手术,手术范围根据术前CT显示病变范围及鼻内镜检查所见确定,围手术期行鼻内糖皮质激素、头孢类或青霉素类抗生素、鼻腔冲洗等治疗。主要观察指标包括术前及术后1周、3个月、6个月患者视觉模拟量表(VAS)、鼻内镜Lund-Kennedy评分、鼻阻力、肺通气功能即第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC比值及峰值呼气流速(PEF)。结果:CRSwNP患者VAS评分、鼻内镜Lund-Kennedy评分及鼻阻力之间存在显著正相关(P<0.05),而其VAS评分、鼻内镜Lund-Kennedy评分及鼻阻力与肺功能指标FEV1、FVC及PEF之间均存在显著负相关(P<0.05)。CRSwNP患者行以鼻内镜手术为主的综合治疗后其VAS评分、鼻内镜Lund-Kennedy评分及鼻阻力检测值均较术前显著降低,均差异有统计学意义(P<0.05);行鼻内镜手术后CRSwNP患者肺功能指标FEV1、FVC、FEV1/FVC及PEF较术前均显著升高,均差异有统计学意义(P<0.05)。结论:鼻阻力可以客观及可靠地反映CRSwNP患者鼻塞程度及其鼻内镜手术后鼻功能的恢复情况,且检测方法简便易行。鼻内镜手术可有效改善CRSwNP患者的肺通气功能,可为防治CRS相关下呼吸道疾病提供一定的临床参考。

Objective： To study the pulmonary function and nasal resistance characteristics of patients with chronic nose-sinusitis and nasal polyps （CRSwNP）, to explore the evaluation role of nasal resistance in nasal venti- lation function and the effect of endoscopic sinus surgery on pulmonary function in patients with CRSwNP. Method：Fifty CRSwNP patients that met the study criteria were selected . The patients were performed endoscopic surgeries according to Messerklinger surgical procedures under genera], anesthesia. Extent of surgery was based on preoperative CT showing the range of the lesion of disease and endoscopic findings. Perioperative treatments contained intranasal corticosteroids, cephalosporin or penicillin antibiotics, nasal irrigation and other treatments. Main outcome measures included visual analog scale （VAS）, endoscopic Lund-Kennedy scores, nasal resistence, pulmonary function in patientsone week before and after surgery, three months and six months after surgery. Pulmonary function includes forced expiratory volume in one second （FEV1）, forced vital capacity FEV1/FVC and peak expiratory flow （PEF）. Result：The study found that there were significantly positive correlations among VAS score, Lund-Kennedy score and nasal resistance （P〈 0.05）in CRSwNP patients, but there is a significantly negative correlation between VAS score, Lund-Kennedy score, nasal resistance and pulmonary function indexes of FEV1, FVC and PEF （P〈 0.05）. The VAS score, Lund-Kennedy score and nasal resistanceval ues of CRSwNP patients were decreased significantly after comprehensive treatments with nasal endoscopic operation as the major one, the difference was statistically different （P〈 0.05）. And the pulmonary function indexs （FEV1,FVC,PEF） were significantly increased after surgery in CRSwNP patients. Conclusion.. The nasal resist- ance can objectively and reliably reflect the degree of nasal congestion and the recovery of nasal function in CRSw- NP patients after endoscopic sinus surgery. The detection method of nasal resistance is simple. Functional endo- scopic sinus surgery can effectively improve the pulmonary ventilation function in CRSwNP patients, providing some clinical references about the prevention and treatment of CRS related lower respiratory disease.