慢性鼻-鼻窦炎鼻息肉患者围手术期口服糖皮质激素时长对鼻内镜手术近期疗效的影响

The short-term curative effects of endoscopic sinus surgery influenced by different duration of oral glucocorticoidtreatment in patients with chronic rhinosinusitis and nasal polyps

目的观察慢性鼻-鼻窦炎鼻息肉患者围手术期应用不同时长的口服糖皮质激素对手术近期疗效的影响以及不良反应。探讨应该使用糖皮质激素多长时间可以取得比较满意的治疗效果。方法将150例慢性鼻-鼻窦炎鼻息肉患者随机分为3组各50例,在其围手术期正规治疗中分别采取不应用糖皮质激素以及口服2周、4周糖皮质激素等处理方式,对近期治疗效果进行评价,并比较术中出血和并发症发生情况,评估口服糖皮质激素的全身不良反应。结果 A组总有效率78.0%,B组总有效率94.0%,C组总有效率92.0%,B组和C组总有效率均高于A组(P<0.05),而B组与C组间差异无统计学意义(P>0.05)。3组术中出血量,B组和C组均少于A组,B组少于C组(P<0.05)。术后出血>50mL例数B组和C组均少于A组(P<0.05)。3组间眶周淤血例数差异无统计学意义(P>0.05)。3组均未发现脑脊液鼻漏者和明显的糖皮质激素全身应用不良反应。结论围手术期口服糖皮质激素对于慢性鼻-鼻窦炎鼻息肉患者近期疗效有明显促进作用,推荐使用。口服2周与4周糖皮质激素相比差异并无统计学意义,但出于减少不良反应发生率、降低医疗成本的考虑,建议围手术期口服糖皮质激素2周。

Objective To observe the effect of perioperative corticosteroid on the short-term efficacy and adverse reactions in patients with chronic rhinosinusitis and nasal polyps.Methods One hundred and fifty chronic rhinosinusitis with nasal polyps patients were randomly divided into 3 groups,each group with 50 patients.In the perioperative period,the 3 groups were respectively taken none oral glucocorticoids,2 weeks oral glucocorticoids,and 4 weeks oral glucocorticoids therapy.We evaluate the efficacy of recent treatment,compare the occurrence of intraoperative bleeding and complications,and assess the incidence of systemic adverse reactions with oral corticosteroids.Results Total effective rate of group A was 78.0%.Total effective rate of group B was 94.0%.Total effective rate of group C was 92.0%.Group B and group C were both more efficient than group A（P〈0.05）,and the difference between group B and group C was not statistically significant（P〉0.05）.The amount of bleeding in group B and group C were less than that in group C,and the difference between the two groups was statistically significant.Postoperative bleeding〉50mL in group B and group C were less than group A（P〈0.05）,there was no significant difference in the number of patients with orbital congestion in the 3 groups（P〉0.05）.Conclusion Perioperative oral glucocorticoids have obvious promoting effect for endosopic sinus surgery treatment in patients with chronic rhinosinusitis and nasal polyps.There was no statistically significant difference between 2 weeks of oral corticosteroids and 4 weeks.To reduce the incidence of adverse events and to reduce the cost of care,perioperative corticosteroids are recommended for 2 weeks.