激素经鼻雾化在鼻内镜术后疗效及安全性探索

Efficacy and Safety of Nasal Pulse Nebulization with Corticosteroid after Endoscopic Sinus Surgery:Preliminary Exploration

目的探讨分析功能性内镜鼻窦手术(functional endoscopic sinus surgery,FESS)术后患者使用经鼻脉冲雾化布地奈德的疗效及安全性。方法回顾性分析2019~2020年在笔者医院行FESS术后接受相同常规术后治疗3个月仍有水疱和脓涕的60例慢性鼻窦炎患者。患者接受鼻窦脉冲雾化吸入布地奈德混悬液(A组)、鼻腔喷雾(B组)或口服激素(C组)3种不同的治疗方式进行治疗。通过鼻炎总症状评分(TNSS)及鼻内镜检查,Lund-Kennedy(LK)评分评估各治疗方法疗效,以不良事件及治疗晨起血清糖皮质激素水平来评估治疗方法安全性。结果最终3组患者TNSS评分均较治疗前降低,且两两比较差异有统计学意义。内镜下LK评分同样3组患者较用药前会有所好转,但A组和C组明显优于B组5.95±2.01。两两比较中,与B组比较,A组和C组差异有统计学意义,而A组和C组之间比较差异无统计学意义。在安全性方面,而口服组的晨起血清糖皮质激素浓度在治疗后较前显著降低。结论在FESS术后3个月恢复不佳的患者中,应用糖皮质激素脉冲雾化能明显减轻术腔黏膜水肿反应,促进黏膜良性转归,且对下丘脑-垂体-肾上腺轴无明显的抑制作用,可作为慢性鼻窦炎术后的治疗选择之一。

Objective To explore the efficacy and safety of nasal pulse nebulization with budesonide in patients after functional nasal endoscopy surgery(FESS).Methods Retrospective analysis was performed in 60 patients with chronic sinusitis who underwent functional endoscopic sinus surgery(FESS)in our hospital from 2019 to 2020,but still had blisters and purulent nasal discharge after 3 months of routine treatment.The patients were treated with three different ways of pulsed sinus inhalation of budesonide suspension(group A),nasal spray(group B)or oral hormone(group C).The total symptom score(TNSS),endoscopic examination and Lund Kennedy score were used to evaluate the efficacy of the treatment methods.The safety of the treatment methods was evaluated by adverse events and serum glucocorticoid levels in the morning.Results The TNSS scores of the three groups were lower than before treatment,and the difference was statistically significant.The Lund Kennedy score under endoscopy was the same in the three groups,but group A and group C were significantly better than group B(5.95±2.01).In pairwise comparison,the difference between group A and group C for group B was statistically significant,while the difference between group A and group C was not statistically significant.In terms of safety,the morning serum glucocorticoid concentration in the oral group decreased significantly after treatment.Conclusion In the patients with poor recovery 3 months after FESS,glucocorticoid pulse atomization can significantly reduce the mucosal edema reaction,promote the benign outcome of the mucosa,and has no obvious inhibitory effect on the hypothalamus pituitary adrenal axis,which can be used as one of the treatment options for chronic sinusitis.