苍芷消渊散辅助鼻内窥镜手术治疗放射性鼻窦炎临床研究

Clinical study of Changzhi-Xiaoyuan Decoction combined auxiliary nasal endoscopic surgery treating radioactive sinusitis

目的评价苍芷消渊散辅助鼻内窥镜手术治疗放射性鼻窦炎的疗效。方法将本院2016年5月-2018年6月符合入选标准的90例放射性鼻窦炎患者采用随机数字表法分为2组,每组45例。全部患者均行鼻内窥镜手术以消除病灶,对照组术后给予鼻咽冲洗,同时口服克拉霉素;观察组在对照组基础上配合服用苍芷消渊散。2组均连续治疗2个月,随访12个月。分别于治疗前后进行临床症状评分,采用改良Lund-Mackay内镜评分量表(Modified Lund Mackay Postoperative Endoscopic Score,MLMES)分别从双侧上颌窦、筛窦、额窦、蝶窦、嗅裂的黏膜炎症状态、黏液性分泌物和脓性分泌物进行评分,采用糖精试验进行纤毛传输速率的检测,评价临床疗效。结果观察组总有效率为91.1%(41/45)、对照组为64.4%(29/45),2组比较差异有统计学意义(χ^2=7.779,P=0.005)。治疗后,观察组鼻塞、鼻甲肿大、鼻腔分泌物、嗅觉减退、头痛评分均低于对照组(t值分别为3.558、5.582、5.367、7.442、7.115,P值均<0.01),MLMES评分低于对照组(t=4.762,P<0.01),纤毛传输速率[(4.42±0.51)mm/min比(3.87±0.38)mm/min,t=5.801]高于对照组(P<0.01)。结论苍芷消渊散辅助鼻内窥镜手术可减轻放射性鼻窦炎患者的鼻窦症状,恢复鼻黏膜功能,提高临床疗效。

Objective To evaluate the clinical effect of Changzhi-Xiaoyuan Decoction auxiliary nasal endoscopic surgery for radioactive sinusitis.Methods A total of 90 patients with radioactive sinusitis included inour hospital from May 2016 to June 2018 were divided into two group according to the random number table method,45 in each group.The control group was treated with nasal endoscopic surgery,nasopharyngeal flushing after the surgery andoral clarithromycin.The observation group was treated with Changzhi-Xiaoyuan Decoction on the basis of the control group.Both groups were treated for 2 months,following up for 12 months.Before and after the treatment,for clinical symptom scores,using the modified Lund Mackay Postoperative Endoscopic Score(MLMES)respectively from bilateral maxillary sinus,Ethmoid sinus,frontalsinus,sphenoidsinus,olfactory cleft state of mucous membrane inflammation and mucus secretion and purulent secretion evaluation;tested the cilia transmission rateand clinical efficacy were evaluated.Results The total effective rate of observation group was 91.1%(41/45),and the control group was 64.4%(29/45).There was statistically significant difference between two groups(χ^2=7.779,P=0.005).After the treatment,stuffy nose,turbinate swelling,nasal secretions,hyposmia,headaches scores of the observation group were significantly lower than those of the control group(t value were 3.558,5.582,5.367,7.442,7.115,respectively,all Ps<0.01),the MLMES score was significantly lower than that of the control group(t=4.762,P<0.01).After the treatment,cilia transmission rate(4.42±0.51 mm/min vs.3.87±0.38 mm/min,t=5.801)of the observation group was significantly higher than that of the control group(P<0.01).Conclusions The Changzhi-Xiaoyuan Decoction combined with auxiliary nasal endoscopic surgery can reduce symptoms of radioactive sinusitis patients with sinus,restore the function of nasal mucosa,and enhance the clinical curative effect.