3种鼻腔冲洗方法对慢性鼻窦炎患者鼻内镜术后疗效的影响观察

The efficacy observation of the nasal irrigation after endoscopic surgery in chronic sinusitis

目的探讨不同鼻腔冲洗方法对鼻窦炎患者鼻内镜术后疗效的影响和应用价值。方法选择120例行鼻内镜手术的慢性鼻窦炎患者,术后给予激素抗感染治疗,根据随机原则分为洗鼻剂(无碘海盐+碳酸氢钠)组、高渗盐水组、未冲洗组(对照组),分别于出院时及术后2 w、6 w、6个月时记录患者鼻塞、鼻分泌物、头痛等症状改善情况,依据视觉模拟评分法(Visual Analogue Scale/Score,简称VAS)及1997海口会议鼻内镜手术疗效标准评估对术后6个月疗效进行评价。观察3组术后6 w黏膜病变情况。采用糖精试验评价3组鼻黏毛传输速率。结果120例患者经鼻内镜手术后,有112例(93.3%)术后2 w至医院随访,术后6 w时有99例(82.5%),至第6个月最后一次随访时,有92例(76.7%)完成。3组患者均未发生不良反应。3组疗效比较差异有统计学意义(χ2=10.392,P=0.034),洗鼻剂组和高渗盐水组总有效率均高于对照组,差异有统计学意义(χ2分别为6.826、7.281,P值分别为0.033、0.026)。洗鼻剂组和高渗盐水组疗效差异无统计学意义(P>0.05)。出院时3组VAS评分差异无统计学意义(P>0.05),术后2 w、6 w、6个月时洗鼻剂组及高渗盐水组VAS评分低于对照组,差异有统计学意义(P<0.05)。术后6 w随访时,3组囊泡形成及积脓情况差异有统计学意义(P<0.05),洗鼻剂组囊泡形成较对照组及高渗盐水组少,洗鼻剂组及高渗盐水组术腔积脓较对照组轻。3组患者术前及术后2 w鼻黏膜纤毛输送速率差异无统计学意义(P>0.05)。术后6 w及6个月时,洗鼻剂组及高渗盐水组鼻黏膜纤毛输送速率高于对照组,差异有统计学意义(P<0.05),且洗鼻剂组鼻黏膜纤毛输送速率高于高渗盐水组,差异有统计学意义。结论慢性鼻窦炎患者术后应用鼻腔洗器冲洗鼻腔可改善患者的主观症状,提高治愈率。洗鼻剂在恢复纤毛运动功能以及抑制囊泡形成、使用方便程度方面优于高渗盐水。应根据患者的实际情况选择鼻腔冲洗方法。

Objective To explore the efficacy of the nasal irragation after nasal endoscopic surgery. Methods 120 cases of chronic sinusitis with nasal endoscopic surgery were included in our study. According to the principle of random selection, the patients were divided into nasal irrigation （No iodine salt＋ sodium Bicar- bonate, hypertonic saline group and non-irrigation group control group）. The improved status was recorded at 2 weeks, 6 weeks and 6 months after surgery. Visual Analogue Scale （Visual Analogue Scale/ Score, VAS） and 1997 nasal endoscopic surgical standard assessment established in Haikou meeting were used to evaluate the improvement of symptoms and curative effect at 6 months after surgery. The mucosal lesions in 3 groups were observed after 6 w. Saccharin test was carried to evaluate the transmission rate of saccharin nose sticking hair in three groups. Results After nasal endoscopic surgery, 112 （93.3%） cases were followed up after 2 weeks of operation, 99 cases after 6 weeks, which accounted for 82.5~, and 92 cases completed follow-up after 6 months （76.7~）. There were no adverse reactions in three groups of pa- tients. The differences of curative effect between three groups was statistically significant （chi-square= 10.392, P = 0.034）. The total effective rate of nasal irrigation and hypertonic saline group was higher than the control group, and the difference was statistically significant （chi-square were 6.826, 7.281, P values were 0.033, 0.026）. Curative effect in nasal irrigation group and hypertonic saline group has no statistical significant differences （P 〉0.05）. VAS score in 3 groups had no statistically significant difference When out of the hospital （P 〉0.05）. Postoperative after the nasal irrigation, VAS score in nasal irrigation （No iodine salt-t-sodium bicarbonate） group and in hypertonic saline group was lower than the control group at 2w, 6w, 6 months after the surgery. The difference was statistically significant （P 〈0.05）. The difference in vesicle formation and empyema was statistically significant （P 〈0.05） in postoperative follow-up at 6 w. 3 groups of. There was less vesicle formation in nasal irrigation group than the control group and hyperton- ic saline group. The transport rate of nasal mucociliary in 3 groups of patients before and after 2 w of oper- ation showed no significant difference （P 〉0.05）. After 6w and 6 months, the transport rate of nasal mu- cociliary in collunarium group and hypertonic saline is higher than the control group, the difference was statistically significant （P 〈0.05）, and collunarium nasal mucociliary transport rate is higher than that of saline group, the difference was statistically significant. Conclusion The nasal irrigation after endoscopic sinus surgery can improve the subjective symptoms of patients, the curative rate was significantly higher than non-irrigation nasal group. Nasal irrigation （No iodine salt＋sodium bicarbonate） group had better effect on restoring the cilia movement function and inhibition of vesicle formation. We should choose the proper method according to the actual situation of patients.