鼻内镜手术结合药物治疗慢性鼻-鼻窦炎并发支气管哮喘的临床效果研究

Clinical Study of Endoscopic Sinus Surgery combined with Medicine in the Treatment of Chronic Rhinosinusitis Complicated with Bronchial Asthma

目的:探讨鼻内镜手术(ESS)结合药物治疗对慢性鼻-鼻窦炎(CRS)并发支气管哮喘患者围手术期及术后近期的疗效。方法:在本院选择55例CRS合并支气管哮喘的患者,均接受ESS治疗,并予以糖皮质激素吸入和喷鼻、抗过敏等药物治疗,观察该综合治疗方案对围手术期支气管哮喘急性发作的预防效果以及术后近期的CRS疗效和支气管哮喘疗效。结果:(1)围手术期情况:52例围手术期病情平稳,3例诊断为支气管哮喘急性发作。(2)CRS疗效随访:术后12周、48周的术后视觉模拟量表(VAS)评分和鼻内镜Lund-Mackay评分明显较术前1周降低(P<0.05),且术后48周明显低于12周(P<0.05)。(3)支气管哮喘疗效随访:术后12周、48周的哮喘控制量表(ACT)评分明显较术前1周降低(P<0.05),术前后的肺功能指标无明显变化(P>0.05)。(4)支气管哮喘用药:术后以最低剂量激素维持24周以上并停药者42例(76.4%)。结论:规范的ESS结合药物治疗可有效降低围手术期支气管哮喘发作的风险,改善CRS鼻部症状,并对近期的哮喘控制有积极作用。

Objective:To investigate the efficacy of endoscopic sinus surgery(ESS)combined with medication in the treatment of chronic rhinosinusitis(CRS)complicated with bronchial asthma.Methods:The clinical data of 55 CRS patients with bronchial asthma from Oct.2014 to Oct.2016 were analyzed retrospectively,and all of them were treated with ESS,inhaled corticosteroids,nasal sprays,and anti allergy drugs.The effect of the comprehensive treatment on the acute attack of bronchial asthma during operation and the short-term curative effect of CRS and bronchial asthma were studied.Results:①The perioperative period:52 cases were in perioperative stable condition,whereas 3 cases were diagnosed as acute bronchial asthma.②CRS effective follow-up:the postoperative visual analogue scale(VAS)score and endoscopic Lund-Mackay score of postoperative 12w and 48w were significantly lower than those of preoperative 1w(P<0.05),and the postoperative 48W was significantly lower than that of 12W(P<0.05).③Bronchial asthma effective follow-up:The asthma control scale(ACT)scores of postoperative 12w and 48w were significantly lower than those of preoperative 1w(P<0.05),and there were no significant change in lung function before and after the operation(P>0.05).④Drugs for bronchial asthma:42 patients(76.4%)were treated with minimum dose of hormone for more than 24 weeks and discontinued after operation.Conclusion:The combination of standard ESS and drug therapy can effectively reduce the risk of perioperative asthma attack,improve CRS nasal symptoms,and have a positive effect on the recent asthma.