鼻内窥镜联合糠酸莫米松治疗慢性鼻-鼻窦炎伴鼻息肉的疗效及其对患者远期预后的影响

Efficacy of nasal endoscopy combined with mometasone furoate on chronic rhinosinusitis with nasal polyps and its effects on long-term prognosis of patients

目的探讨鼻内窥镜联合糠酸莫米松治疗慢性鼻-鼻窦炎(CRS)伴鼻息肉的疗效及其对患者远期预后的影响。方法选取2018年8月至2019年8月榆林市中医医院耳鼻喉科收治的88例CRS伴鼻息肉患者,按照随机数字表以1∶1比例随机分为常规组和药物组各44例,所有患者均采用鼻内窥镜下Messerk1inger术式治疗,药物组患者于手术前后1周采用糠酸莫米松喷鼻治疗+生理盐水灌洗,常规组仅术后1周定期采用生理盐水灌洗,比较两组患者的临床疗效,术前1周及术后1周、6个月的鼻功能变化和鼻黏膜组织炎症指标水平,同时比较两组患者术前及术后6个月的生活质量[鼻腔鼻窦结局测试20条(SNOT-20)]和随访1年后的复发率。结果药物组患者的临床治疗总有效率为93.18%,明显高于常规组的77.27%,差异有统计学意义(P<0.05);术后1周和6个月,药物组和常规组患者的鼻黏膜纤毛输送速率分别为(5.21±0.57)mm/min、(7.23±0.89)mm/min和(5.36±0.61)mm/min、(6.35±0.45)mm/min,明显高于两组干预前的(4.71±0.68)mm/min和(4.69±0.62)mm/min,鼻气道阻力分别为(1.42±0.21)k Pa/(s·L)、(0.25±0.05)kPa/(s·L)和(1.96±0.26)kPa/(s·L)、(1.48±0.15)kPa/(s·L),明显低于两组干预前的(2.82±0.35)kPa/(s·L)和(2.86±0.38)kPa/(s·L),内镜Lund-Kennedy分别为(4.02±0.66)分、(3.55±0.52)分和(4.58±0.89)分、(4.11±0.62)分,明显低于两组干预前的(4.98±0.99)分和(5.02±1.01)分,嗅觉功能评分分别为(2.51±0.27)分、(1.24±0.11)分和(3.22±0.31)分、(2.51±0.28)分,明显低于两组干预前的(4.49±0.71)分和(4.51±0.75)分,差异均有统计学意义(P<0.05);上述指标组间交互、时间点交互和组间与时间点交互比较差异均有统计学意义(P<0.05);药物组和常规组患者的鼻黏膜组织中黏蛋白-5AC(MUC5AC)蛋白表达分别为(1.65±0.87)%、(0.58±0.21)%和(1.32±0.61)%、(0.79±0.32)%,明显低于两组干预前的(1.62±0.89)%和(1.65±0.87)%,白介素-6(IL-6)分别为(25.74±5.61)ng/m L、(13.54±1.25)ng/m L和(22.01±5.38)ng/mL、(15.21±3.65)ng/mL,明显低于两组干预前的(25.52±5.57)ng/mL和(25.74±5.61)ng/mL,差异均有统计学意义(P<0.05);上述指标组间交互、时间点交互比较差异均有统计学意义(P<0.05);药物组和常规组患者术前1周的SNOT-20评分分别为(24.58±8.45)分和(24.19±8.62)分(P>0.05),较组内术后6个月的(13.12±6.45)分和(19.28±7.23)分呈明显下降趋势,且药物组变化幅度明显大于常规组,差异均有统计学意义(P<0.05);药物组患者术后1年的复发率为4.55%,明显低于常规组的20.45%,差异有统计学意义(P<0.05)。结论鼻内窥镜联合糠酸莫米松治疗CRS伴鼻息肉可明显促进患者鼻功能恢复,减轻鼻黏膜炎症,有效降低患者复发率,提高其生活质量,临床疗效确切。

Objective To explore the efficacy of nasal endoscopy combined with mometasone furoate in the treatment of chronic rhinosinusitis(CRS)with nasal polyps and its effects on long-term prognosis of patients.Methods Eighty-eight patients with CRS and nasal polyps treated in Department of Otolaryngology,Yulin Hospital of Traditional Chinese Medicine were selected between August 2018 and August 2019,which were divided into routine group(44 cases)and drug group(44 cases)by 1:1 according to random number table method.All patients were treated with Messerk1inger under nasal endoscope.The patients in drug group was given mometasone furoate nasal spray+saline lavage at 1 week before and after operation,and those in routine group were periodically given saline lavage only at 1 week after operation.The clinical efficacy,nasal function changes,and nasal mucosal tissue inflammation indexes at 1 week before operation and at 1 week and 6 months after operation,quality of life[Sinonasal Outcome Test-22(SNOT-22)]before operation and at 6 months after operation,and recurrence rate after 1 year of follow-up were compared between the two groups.Results The total effective rate of clinical treatment in drug group was significantly higher than that in routine group(93.18%vs 77.27%,P<0.05).At 1 week and 6 months after operation,the nasal mucociliary delivery rates were(5.21±0.57)mm/min and(7.23±0.89)mm/min in drug group and(5.36±0.61)mm/min and(6.35±0.45)mm/min in routine group,which were significantly higher than(4.71±0.68)mm/min in drug group and(4.69±0.62)mm/min in routine group before intervention;the airway resistance values were(1.42±0.21)k Pa/(s·L),(0.25±0.05)kPa/(s·L)in drug group and(1.96±0.26)k Pa/(s·L),(1.48±0.15)k Pa/(s·L)in routine group,which were significantly lower than(2.82±0.35)k Pa/(s·L)in drug group and(2.86±0.38)k Pa/(s·L)in routine group before intervention;the endoscopic Lund-Kennedy scores were(4.02±0.66)points,(3.55±0.52)points in drug group and(4.58±0.89)points,(4.11±0.62)points in routine group,which were significantly lower than(4.98±0.99)points and(5.02±1.01)points before intervention;the olfactory function scores were(2.51±0.27)points,(1.24±0.11)points in drug group and(3.22±0.31)points,(2.51±0.28)points in routine group,which were significantly lower than(4.49±0.71)points and(4.51±0.75)points before intervention(P<0.05).There were statistically significant differences in the between-group interaction,time-point interaction,and interaction of time-point and between-group of the above indicators(P<0.05).At 1 week and 6 months after operation,the Myxin-5AC(MUC5AC)protein expression rate were(1.65±0.87)% and(0.58±0.21)%in drug group and(1.32±0.61)% and(0.79±0.32)% in routine group,which were significantly lower than(1.62±0.89)% and(1.65±0.87)% in the two groups before intervention;the levels of interleukin-6(IL-6)were(25.74±5.61)ng/mL,(13.54±1.25)ng/mL in drug group and(22.01±5.38)ng/mL,(15.21±3.65)ng/mL in routine group,which were significantly lower than(25.52±5.57)ng/mL,(25.74±5.61)ng/mL in the two groups before intervention;the differences were statistically significant(P<0.05).The differences in the between-group interaction and time-point interaction of the above indicators were statistically significant(P<0.05).The SNOT-20 scores of drug group and routine group were(24.58±8.45)points and(24.19±8.62)points at 1 week after operation(P>0.05),which were significantly lower than(13.12±6.45)points and(19.28±7.23)points at 6 months after operation,and the change of drug group was significantly greater than that of routine group(P<0.05).The recurrence rate at 1 year after operation in drug group was significantly lower than that in routine group(4.55%vs 20.45%,P<0.05).Conclusion Nasal endoscopy combined with mometasone furoate in the treatment of CRS with nasal polyps can significantly promote the recovery of nasal function,relieve the nasal mucosal inflammation,effectively reduce the recurrence rate and improve the quality of life,with exact clinical efficacy.