慈莪散结方联合糠酸莫米松鼻喷雾剂治疗儿童腺样体肥大临床疗效观察

Observation on the Clinical Efficacy of Ci’e Sanjie Formula Combined with Mometasone Furoate Aqueous Nasal Spray in the Treatment of Pediatric Adenoid Hypertrophy

【目的】观察慈莪散结方联合糠酸莫米松鼻喷雾剂治疗痰瘀互结型儿童腺样体肥大的临床疗效。【方法】将82例痰瘀互结型腺样体肥大患儿随机分为西药组与中西药组,每组各41例。西药组给予糠酸莫米松鼻喷雾剂喷鼻治疗,中西药组给予慈莪散结方联合糠酸莫米松鼻喷雾剂喷鼻治疗,疗程为4周。观察2组患儿治疗前后主症评分、症状总积分、阻塞性睡眠呼吸暂停低通气综合征(OSAHS)疾病特异性生活质量调查量表(OSA-18)评分和腺样体体积的变化情况,并评价2组患儿的临床疗效。【结果】(1)研究过程中,西药组脱落3例,中西药组脱落2例,最终西药组38例、中西药组39例患儿完成试验。(2)治疗4周后,中西药组的总有效率为92.3%(36/39),西药组为76.3%(29/38);组间比较(秩和检验),中西药组的疗效明显优于西药组(P<0.01)。(3)治疗4周后,2组患儿的主症评分和症状总积分均较治疗前明显改善(P<0.05),且中西药组的改善作用均明显优于西药组(P<0.01)。(4)治疗4周后,2组患儿的OSA-18评分均较治疗前明显降低(P<0.01),且中西药组的降低作用明显优于西药组(P<0.05)。(5)治疗4周后,2组大部分患儿的腺样体体积均较治疗前缩小,腺样体体积分级情况均较治疗前改善(P<0.01),且中西药组的改善作用明显优于西药组(P<0.05)。(6)治疗结束4周后,中西药组的复发率为8.3%(3/36),明显低于西药组的34.5%(10/29),差异有统计学意义(P<0.01)。【结论】慈莪散结方联合糠酸莫米松鼻喷雾剂治疗痰瘀互结型儿童腺样体肥大疗效显著,可有效减轻鼻塞、打鼾、呼吸困难等症状,缩小腺样体体积,改善患儿低通气,提高患儿生活质量,降低复发率。

Objective To observe the clinical efficacy of Ci’e Sanjie Formula combined with mometasone furoate aqueous nasal spray in the treatment of pediatric adenoid hypertrophy(PAH)with phlegm blended with blood stasis syndrome.Methods Eighty-two cases of PAH with phlegm blended with blood stasis syndrome were randomly divided into western medicine group and Chinese and western medicine group,with 41 cases in each group.The western medicine group was given mometasone furoate aqueous nasal spray,and Chinese and western medicine group was given Ci’e Sanjie Formula orally combined with mometasone furoate aqueous nasal spray,the course of treatment covered 4 weeks.The main symptom scores,total symptom scores,the scores of obstructive sleep apnea18-item survey(OSA-18)for specific quality of life of children with obstructive sleep apnea hypopnea syndrome(OSAHS)and the adenoid volume of the patients were observed before and after treatment,and the clinical efficacy of the two groups was evaluated.Results(1)During the study,there were 3 cases in the western medicine group and 2 cases in the Chinese and western medicine group fell off.Finally,38 cases in the western medicine group and 39 cases in the Chinese and western medicine group completed the trial.(2)After 4 weeks of treatment,the total effective rate in the Chinese and western medicine group was 92.3%(36/39)and that in the western medicine group was 76.3%(29/38).The intergroup comparison by rank sum test showed that the curative effect of Chinese and western medicine group was significantly superior to that of the western medicine group(P<0.01).(3)After 4 weeks of treatment,the main symptom scores and total symptom scores of the two groups were significantly improved compared with those before treatment(P<0.05),and the effect on improving the scores in the Chinese and western medicine group was significantly superior to that in the western medicine group(P<0.01).(4)After 4 weeks of treatment,the scores of OSA-18 in both groups were significantly decreased compared with those before treatment(P<0.01),and the effect on lowering the scores in the Chinese and western medicine group was significantly superior to that in the western medicine group(P<0.05).(5)After 4 weeks of treatment,the adenoid volume of most of the children in both groups was reduced compared with that before treatment,and the grading of adenoid volume was improved compared with that before treatment(P<0.01).The intergroup comparison showed that the effect on improving the adenoid volume and its grading in the Chinese and western medicine group was significantly superior to that in the western medicine group(P<0.05).(6)Four weeks after the end of treatment,the recurrence rate of the Chinese and western medicine group was 8.3%(3/36),which was significantly lower than that of the western medicine group[34.5%(10/29)],and the difference was statistically significant(P<0.01).Conclusion Ci’e Sanjie Formula combined with mometasone furoate aqueous nasal spray exert certain effect in the treatment of PAH with phlegm blended with blood stasis syndrome,which can effectively relieve nasal congestion,snoring,dyspnea and other symptoms,reduce adenoid volume,improve hypoventilation and quality of life of the children,and reduce recurrence rate.