布地奈德不同给药方式对鼻-鼻窦炎患者鼻部症状及血清皮质醇水平的影响

Effects of the different administration ways of budesonide on nasal symptoms and serum cortisol levels of sinusitis patients

目的探讨布地奈德不同给药方式对鼻-鼻窦炎患者鼻部症状及血清皮质醇水平的影响。方法选取2014年2月至2015年2月在西安交通大学第二附属医院耳鼻喉科进行治疗的急性鼻-鼻窦炎患者120例,按照随机数字表法将其分为吸入组和鼻喷组,每组60例。吸入组患者接受布地奈德鼻喷剂治疗,鼻喷组患者接受布地奈德雾化吸入治疗。以7 d为一个疗程。比较两组患者一个疗程后鼻部症状改善情况、治疗前后血清皮质醇水平以及不良反应情况。结果治疗前两组患者鼻塞、流涕、嗅觉缺失、面部痛评分比较差异无统计学意义(P>0.05),治疗后鼻喷组、吸入组患者鼻塞[(5.72±1.22)分vs(3.36±1.28)分]、流涕[(5.43±1.07)分vs(2.34±0.61)分]、嗅觉缺失[(4.71±0.83)分vs(2.35±0.98)分]、面部痛症[(5.24±0.74)分vs(3.63±0.61)分]状评分均有明显改善(P<0.05),但吸入组患者改善程度明显大于鼻喷组患者,差异具有统计学意义(P<0.05)。两组患者治疗前血清皮质醇水平比较无统计学意义(P>0.05),两组患者治疗后血清皮质醇水平较治疗前均有明显降低(P<0.05),但吸入组患者血清皮质醇(15.3±1.8)μg/d L下降程度明显大于鼻喷组(17.7±2.3)μg/d L,差异具有统计学意义(P<0.05)。两组患者在恶心呕吐、头晕头痛发生率方面无明显差异(P>0.05),吸入组患者皮肤瘙痒红肿(11.67%、3.33%)、恶心呕吐的发生率明显高于鼻喷组(5.00、1.67),差异具有统计学意义(P<0.05)。结论与鼻喷治疗相比,急性鼻-鼻窦炎病患者采用布地奈德雾化吸入治疗效果更加显著,但对血清皮质醇水平影响较大,不良反应较多,临床选用应谨慎。

Objective To investigate the effects of different doses of budesonide on nasal symptoms and serumcortisol levels of sinusitis patients. Methods A total of 120 patients with acute rhinosinusitis, who admitted to Depart-ment of ENT of the Second Affiliated Hospital of Xi＇an Jiao Tong University from February 2014 to February 2015,were selected and divided into the inhalation group and the nasal spray group according to random number table method,with 60 cases in each group. The inhalation group received inhaled budesonide treatment, and the nasal spray group re-ceived budesonide nasal spray treatment. After one course of treatment for seven days, the improvement of nasal symp-toms, the levels of serum cortisol and the adverse reactions were compared between the two groups. Results Therewere no significant differences in the scores of nasal obstruction, rhinorrhea, olfactory deficit and facial pain between thetwo groups before treatment （P〉0.05）. The scores of nasal obstruction, rhinorrhea, olfactory deficit and facial pain of thenasal spray group versus the inhalation group after treatment were respectively （5.72±1.22） vs （3.36±1.28）, （5.43±1.07）vs （2.34±0.61）, （4.71±0.83） vs （2.35±0.98）, （5.24±0.74） vs （3.63±0.61） （P〈0.05）, while the degree of improvement of theinhalation group was significantly greater than the nasal spray group （P〈0.05）. There was no significant difference in se-rum cortisol level between the two groups before treatment （P〈0.05）. The levels of serum cortisol in the inhalation groupand the nasal spray group after treatment were （15.3±1.8） μg/dL and （17.7±2.3） μg/dL, which were significantly lowerthan those before treatment （P〈0.05）, and the degree of decrease in serum cortisol of the inhalation group was signifi-cantly greater that in the nasal spray group （P〈0.05）. There were no significant differences in the incidence of nauseaand vomiting and dizziness and headache between the two groups （P〉0.05）. The incidences of pruritus, nausea and vom-iting in the inhalation group were respectively 11.67% and 3.33% , which were significantly higher than 5.00% and1.67% in the nasal spray group （P〈0.05）. Conclusion Compared with the nasal spray treatment, budesonide inhalationtherapy has a more significant curative effect on the patients with acute sinusitis, but with a greater impact on the level ofserum cortisol and more adverse reactions, which should be applied cautiously.