鼻息肉术后口服糖皮质激素的疗效观察

Clinical observation on effect of oral glucocorticoids after operation of nasal polyp

目的通过观察鼻息肉术后口服糖皮质激素的疗效,探讨鼻息肉术后糖皮质激素的应用及作用机制。方法 56例鼻息肉术后患者中随机选取28例为试验组,28例为对照组,试验组术后口服+鼻喷糖皮质激素,对照组术后口服安慰剂+鼻喷糖皮质激素,术后第2、6、12、24周对所有患者症状、鼻腔黏膜及副作用进行观察,比较试验组与对照组的差别。结果①术后第2周,试验组患者鼻腔黏膜水肿、结痂较对照组明显减轻,差异具有统计学意义(P<0.05),两组VAS评分差异具有统计学意义(P<0.05);②术后第6周及术后第12周,试验组及对照组患者VAS评分、鼻腔黏膜水肿、结痂情况差异均无统计学意义(P均>0.05);患者鼻腔黏膜出现上皮化,其中试验组多于对照组;③术后第24周,试验组上皮化时间与对照组比较差异无统计学意义(P>0.05),治疗总有效率与对照组比较差异无统计学意义(P>0.05);④仅有1例患者口服激素后第4天出现膝关节疼痛,停药后症状逐渐消失,未行特殊治疗,其余患者均未出现睡眠障碍、体重增加及关节疼痛等并发症。结论口服糖皮质激素短期内能安全有效缓解鼻内镜术后鼻息肉患者自我感觉症状及鼻腔黏膜水肿,但停药后其作用不能有效维持。

Objective To observe on clinical effect of oral glucocorticoids after operation of nasal polyp, the application and mechanism of the oral glucocorticoids were discussed.Methods Twenty-eight patients from the 56 patients with nasal polyp surgery were randomly selected in the experimental group. The experimental group received oral administration of glucocorticoids and a nasal spray containing glucocorticoids. Twenty-eight patients of the 56 patients were taken as the control group. The control group received oral placebo and a nasal spray of glucocorticoids. All patients were observed and compared the difference for symptoms, nasal mucosa and side effects at 2, 6, 12 and 24 weeks after mucosal surgery between the experimental group and the control group.Results ①There were significant reduced in the experimental group for nasal mucosa edema, formation of scab compared with the control group at the 2 th weeks after operation(P<0.05). And there was statistical difference in Visual Analogue Scale(VAS) between the two group(P<0.05);②At the 6 th and 12 th week after surgery, there was no statistical difference in VAS,nasal mucosa edema, formation of scab between the two group(all P>0.05). The nasal mucosa of the patients showed epithelialization, and he epithelializatjion in treatment group was much than that in control group;③At the 24 th weeks after operation, there were no significant differencesin for the epithelialization time between the experimental group and the control group(P>0.05);④Only one case after oral hormone had the knee pain, but symptoms disappeared gradually after drug withdrawal. The other patients did not show sleep disorders, weight gain, joint pain and other complications.Conclusion With an improvement of self-perceived symptoms, oral glucocorticoid can safely and effectively relieve nasal mucosa edema and scab in patients with nasal polyps after nasal endoscopic surgery in a short time, but its effect cannot be effectively maintained after drug withdrawal.