玉屏风颗粒联合鼻用激素治疗儿童中重度腺样体肥大的临床观察

A combined therapy with Yupinfeng Granule and nasal steroids for the treatment of moderate to severe adenoid hypertrophy among children

目的：总结玉屏风颗粒联合鼻用激素治疗儿童中重度腺样体肥大的临床体会。方法拒绝接受手术治疗的腺样体肥大患儿30例，依据鼻咽侧位片A/N比值评判腺样体大小，包括中度肥大17例，重度肥大13例，予以玉屏风颗粒口服，鼻用激素丙酸氟替卡松或曲安奈德鼻喷剂喷鼻，连续治疗3月。观察比较治疗前后患儿相关症状变化及腺样体体积改变，评价治疗效果，并结合文献复习探讨其病机特点，分析临床疗效。结果经连续3月以上治疗，中度腺样体肥大患儿显效11例（11/17，64.71%），有效3例（3/17，17.64%），总有效率（14/17，82.35%）；重度腺样体肥大患儿显效6例（6/13，46.15%），有效4例（4/13，30.76%），总有效率（10/13，76.92%）。经半年以上随访，多数患儿基本维持有效现状，但有5例因病情反复而接受手术治疗（5/24，20.83%）。结论对于中度以及拒绝手术治疗的重度腺样体肥大患儿，可以考虑采用玉屏风颗粒联合鼻用激素疗法治疗观察3~6月，仍无症状改善者，则宜积极考虑手术疗法。

Objective To observe the therapeutic effect of a combined therapy with Yupingfeng Granule （YPFG） and nasal steroids（NS） on moderate to severe adenoid hypertrophy among children. Methods Included in this study were 30 children cases with adenoid hypertrophy diagnosed on the basis of A/N ratio determination according to a lateral nasopharyngeal X-ray photograph, with 17 at moderate degree and 13 at severe degree. All these cases were given a combined therapy with YPFG orally taken and NS spraying into nasal cavity lasted for 3 months consecutively. Then, changes in symptoms and adenoidal volume of these cases were observed in a comparative way with that of pre-treatment to evaluate therapeutic effect on the lesion, supplemented with a literature review to explore associated pathogenesis with such a condition in terms of Chinese Medicine. Results As results of the consecutive therapy lasted for 3 months, the significantly effective rate was 64.71% and effective rate was 17.64% among children with their adenoids at moderate degree, with a total effective rate of 82.35%, while these rates were 46.15%and 38.46%among those with their adenoids at severe degree, with a total effective rate of 76.92%. By the end of following up period lasted for more than 6 months, most cases remained their effective status as seen at the end point of therapeutic course, other than 5 children who received surgical treatment at last because of their lesion reoccurred following the end of therapy. Conclusions This kind of combined therapy with YPFG and NS can be used for children with adenoid hypertrophy at moderate to severe degrees for 3 to 6 months to observe their lesion responding to the treatment at first. Then, surgical therapy should be considered once they are failed to respond to the therapy.