慢性鼻-鼻窦炎手术预后的临床影响因素分析

Analysis of clinical risk factors on the postoperative prognosis of chronic rhinosinusitis

目的分析慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)手术预后影响因素,为CRS的治愈提供有效借鉴。方法随机选取90例2014年5月至2015年11月收治的CRS患者,均行鼻窦冠状位CT扫描与鼻内镜检查确诊。行连续糖皮质激素喷鼻(每日200μg)与抗炎治疗3 d后,实施鼻内镜手术治疗,对影响手术治疗效果的相关因素进行分析。结果术前患者头部胀痛、鼻塞以及鼻后滴漏症状非常严重,术后患者以上症状获得有效改善,但全身不适感与嗅觉减退症状改善并不显著。患者术后24周、48周的视觉模拟量表(visual analog scale,VAS)评分相比于术前存在明显差异(P<0.05)。患者并发鼻息肉与否、长期使用鼻减充血剂与否、有鼻窦手术治疗史与否、手术治疗后坚持实施综合治疗与否是对手术预后产生影响的相关因素。结论 CRS行鼻内镜手术治疗治疗效果较为确切,可有效改善患者临床症状。术前认真询问患者以往病史,强化对患者变应原检测,术后行后续综合治疗,对患者术后治疗效果的提升具有重要意义。

Objective To analyze the related factors affecting the postoperative prognosis of chronic rhinosinusitis（ CRS） patients,and to provide effective reference for the treatment of patients with CRS. Methods Ninety CRS patients in our hospital from May 2014 to November 2015 were randomly selected and confirmed by sinus coronal CT scan and nasal endoscopic examine. All patients underw ent endoscopic sinus surgery after continuous glucocorticoid nasal spray（ 200 μg per diem） and anti-inflammation therapy for 3 days. The related factors affecting the surgical treatment effect were analyzed. Results Before surgery,patients had very serious symptoms of head pain,rhinobyon and postnasal drip,which were effectively improved after treatment. But there is no significant improvement in general discomfort and hyposmia symptom. There were marked differences betw een the postoperative visual analog scale（ VAS） score and 24 weeks and 48 weeks after surgery. Patients with nasal polyps or not,the long-term use of nasal congestion or not,has the history of sinus surgery or not,adhere to the implementation of the comprehensive treatment after surgery or not were related factors affecting the postoperative prognosis. Conclusion Nasal endoscopic surgery is effective in the treatment of patients with CRS,and can effectively improve the clinical symptoms. Acquaintance with patients＇ past history,detection of allergens and implementation of comprehensive therapy after surgery is very important to improve the surgical effect.