伴上呼吸道疾病的儿童慢性鼻-鼻窦炎治疗探讨

The management for pediatric chronic rhinosinusitis with upper respiratory tract concomitant diseases

目的:探讨上呼吸道伴随疾病对儿童慢性鼻-鼻窦炎(CRS)疗效的影响以及针对伴随疾病的治疗方法、疗效和时机。方法:回顾性分析2013-03-2015-03期间在我科确诊的267例CRS患儿,将未查及伴随疾病的66例分为A组,查及伴随疾病的201例分为B组;再根据治疗方案将B组分为B1组97例,B2组104例。A组和B1组采用基本治疗,B2组采用基本治疗联合针对性治疗,疗程均为3个月。A组和B1组及B1组和B2组均于治疗后第3、6、15个月行综合疗效评定和比较。结果:A组第3个月综合疗效大于B1组(P<0.05),第6个月和第15个月A组均轻微下降,而B1组均明显下降(均P<0.05);B2组第3个月综合疗效大于B1组(P<0.05),第6个月和第15个月B2组均无下降(Z=-1.265、-1.941、-1.342,均P>0.05),B1组均明显下降(P<0.05)。结论:反复上呼吸道感染、变应性鼻炎、腺样体肥大和慢性扁桃体炎是儿童CRS常见的上呼吸道伴随疾病,会影响儿童CRS的疗效和复发,采用基本治疗联合针对性治疗,可提高疗效减少复发。

Objective：To analyze the clinical impact of upper respiratory tract concomitant diseases in pediatrics chronic rhinosinusitis（CRS）and treatment methods,efficacy and timing of the concomitant diseases.Method：Two hundred and sixty-seven cases with CRS at a tertiary children＇s medical center from March 2013 to March2015were included in this study.The cases were divided into two groups according to the concomitant diseases.66 cases without concomitant diseases were allocated into group A;201cases with concomitant diseases were classified into group B.Group B was further divided into two subgroups according to treatment methods：subgroup B1（97cases）and subgroup B2（104cases）.Group A and B1 were given the same basic treatment for 3months,while Group B2 was given the basic plus targeted treatment for the same duration.Comprehensive evaluation was conducted at 3,6and 15-months after commencement of treatment.Result：The therapeutic effect of Group A was significantly superior to Group B1 in 3months（P〈0.05）.The clinical efficacy of Group A decreased slightly while Group B1 showed significantly reduced efficacy at 6and 15-months（all P〈0.05）.Comparing Group B1 and B2,the comprehensive effect of Group B2 was considerably better than Group B1 at 3 months（P〈0.05）.Furthermore,Group B2 showed no decrease in efficacy while Group B1 decreased significantly at 6and 15-month.Conclusion：Recurrent upper respiratory tract infections,allergic rhinitis,adenoid hypertrophy and chronic tonsillitis,were common the upper respiratory tract accompanying diseases in children with CRS,and they had significant influence on the efficacy and recurrence of CRS.The basic plus targeted treatment can improve the efficacy and reduce recurrence.