断层扫描在儿童鼻窦炎性慢性咳嗽精准治疗中的价值

THE CLINICAL VALUE OF TOMOGRAPHY IN THE TREATMENT OF CHRONIC COUGH IN CHILDREN WITH SINUSITIS

目的探讨断层扫描(CT和/或MR)在儿童鼻窦炎性慢性咳嗽精准治疗应用。方法选取2011年2月至2015年3月临沂市妇女儿童医院鼻窦炎性慢性咳嗽患儿169名,随机分为治疗组83例、对照组86例,两组均行抗水肿、抗感染和促排黏液治疗。治疗组根据鼻窦断层扫描获取(黏液粘滞度标准为本研究组拟定)黏液粘滞度、窦口不畅、厌氧菌生长、鼻窦腔病变部位及窦口位置等信息。布地奈德盐水冲洗液流至或冲至咽部,窦口不畅加强抗厌氧菌,黏液粘滞度Ⅱ度用氨溴索,Ⅲ度用氨溴索和吉诺通。对照组无上述要求。记录两组患儿咳嗽、头咽部不适消失的时间,治疗4周后第二次鼻窦断层扫描,1年内鼻窦炎所致咳嗽再次发作等指标。结果两组患者的咳嗽、头咽部不适缓解时间无明显统计学差异(P>0.05);第二次断层扫描炎症部位的变化及1年内症状再次发作情况差异均明显有统计学意义(P<0.01)。结论断层扫描在儿童鼻窦炎性慢性咳嗽诊疗中,可以帮助制定个体化治疗,提高疗效,缩短治疗时间,减少药物不良反应。

Objective To explore the clinical value of tomography in the treatment of chronic cough in children with sinusitis.Methods 169 children with chronic cough and sinusitis treated in our hospital from February,2011 to March,2015 were randomly divided into the treatment group of 83 cases and the control group of 86 cases.Both groups were treated with the therapy of anti-edema,anti-infection and promoting the dischage of mucus.Tomography scans were used to collect the information about the mucus viscosity,obstructed ostium,anaerobic bacteria growth,the position of sinus lesions and sinus position.In the treatment group,budesonide saline flushing fluid was used up to the pharynx,the use of anti-anaerobes was strengthened,ambroxol was used when the mucus viscosity was at the 2nd degree and ambroxol and myrtol were used when the mucus viscosity was at the 3rd degree.The control group received no special treatments.The frequency of cough and the disappearance time of pharyngeal discomfort were recorded.The sinus tomography was conducted again after four weeks of treatments,and the recurrence of cough caused by sinusitis within one year was also recorded.Results There were no significant difference in the remission time of cough and throat discomfort（P 〉0.05）.There were significant differences in the changes of the inflammatory sites according to the second scan and in the recurrence of symptoms within one year（P 〈0.01）.Conclusion For children with chronic cough asthe main symptoms of the chronic sinusitis,the use of tomography can aid in designing individualized therapy to improve treatment efficacy,reduce treatment time and the side effects of drugs.