3种方法治疗儿童慢性鼻-鼻窦炎的疗效分析

Clinical analysis of three conservative treatment options for pediatric chronic rhinosinusitis

目的探讨3种保守方法治疗儿童慢性鼻-鼻窦炎的疗效。方法回顾性分析2012年10月-2014年6月诊治的184例慢性鼻-鼻窦炎患儿的临床资料。根据治疗方法分为3组,A组（69例）采用药物治疗,包括抗生素2周、鼻用激素和黏液促排剂3个月;B组（57例）采用药物联合鼻腔冲洗;C组（58例）采用药物联合鼻腔分泌物吸引,各组总疗程均为3个月。3组患儿均以VAS评分法于治疗前、治疗后第1周、2周、1个月、2个月、3个月、6个月和15个月行主观症状评分,以Lund-Kennedy评分法于治疗前、治疗后第3、6和15个月行鼻腔鼻内镜检查评分,根据VAS和Lund-Kennedy评分于第3、6和15个月行综合疗效评定;分析3组6、15个月综合疗效下降与治疗方法、症状未控制和未完全控制的关系。结果 3组综合疗效均于第3个月达到最大,其中C组〉B组〉A组;同组第6、15个月与第3个月比较疗效均有下降,差异具有统计学意义（P值均〈0.05）,但第6个月与第15个月疗效差异无统计学意义;3组6个月疗效下降与治疗方法、病情部分控制和未控制比例相关（R值分别为0.638、0.572,P〈0.05）;15个月疗效下降仅与治疗方法相关（R=2.046,P〈0.05）,与病情部分控制和未控制比例则无相关性（P=0.170）。结论儿童慢性鼻-鼻窦炎以单纯的药物治疗疗效有限且易复发,辅以鼻腔盐水冲洗可提高疗效减少复发,而联合鼻腔分泌物吸引疗效显著复发少;治疗结束后适宜的随访时间为3个月。

Objective To assess the effectiveness of three conservative treatment options for pediatric chronic rhinosinusitis（ PCRS）. Methods Clinical data of 184 children with chronic rhinosinusitis conservatively treated in our hospital between October 2012 and June 2014 were analyzed retrospectively. They were classified into three groups according to the previous treatment options. Children in group A received drug therapy including oral antibiotics for 2weeks,mometasone furoate as a nasal spray and mucoactive medications for 3 months. Patients in group B received drug therapy plus nasal irrigation and those in group C received drug therapy plus negative pressure aspiration for nasal secretions. The total course was 3 months. Symptoms were scored by visual analogue scale（ VAS） at time-points before treatment and 1 week,2 weeks,1 month,2 months,3 months,6 months,15 months after treatment. Endoscopic examinations were assessed in terms of Lund-Kennedy score at time-points before treatment and 3 months,6 months,15 months after treatment. VAS scores and Lund-Kennedy scores were employed to comprehensively evaluate the clinical efficacy after treatment for 3,6 and 15 months. The relationship between short / long-term effect and therapeutic method,uncontrolled or partly controlled symptoms was analyzed. Results Compared with baseline scores,VAS and Lund-Kennedy scores were significantly reduced in all 3 groups at 3 months after treatment（ group C〉 group B〉 group A）. Compared with scores at 3 months,the scores were significantly increased in all 3 groups at 6 and 15 months after treatment（ P〈 0. 05）. The differences between scores at 6 and 15 months were statistically insignificant（ all P〈 0. 05）. The effect decreased at 6 months in all groups was positively related with the previous treatment and severity of uncontrolled or not fully controlled symptoms（ R1 = 0. 638,R2 = 0. 572,all P〈 0. 05）. The effect decreased at 15 months in all groups was in positive relationship with the previous treatment,but had no correlation with the severity of uncontrolled or not fully controlled symptoms（ P = 0. 170）. Conclusion For pediatric CRS,simple drug therapy tends to poor results and recurrence. As an adjunctive therapy,nasal irrigation can reduce risk of recurrence and improve therapeutic efficacy.Moreover,routine medication combined with nasal aspiration therapy can obviously improve the efficacy. Our study suggests that the patients should be followed up for 3 months after treatment.