咽喉反流症状或体征评分阳性的慢性鼻窦炎患者鼻内镜术后碱性等渗盐水冲洗的疗效观察

Efficacy of alkaline isotonic saline in laryngopharyngeal reflux symptom-positive or finding score-positive patients with chronic rhinosinusitis following endoscopic sinus surgery

目的探讨碱性等渗盐水鼻腔冲洗对于伴有咽喉反流症状或体征评分阳性的慢性鼻窦炎患者鼻内镜术后的临床疗效。方法80例咽喉反流症状或体征评分阳性的慢性鼻窦炎患者使用随机数字生成器分为2组,其中鼻内镜手术后接受碱性等渗盐水冲洗患者40例为研究组,鼻内镜术后接受生理盐水冲洗患者40例为对照组。根据外周血嗜酸粒细胞占白细胞百分比是否超过4.27%对研究组和对照组分层。在鼻内镜手术后2周、6周进行随访评估。评估包括反流症状指数评分量表、反流体征评分量表、鼻腔鼻窦结局20量表、视觉模拟量表、鼻阻塞症状评估量表、Lund-Kennedy评分以及不良反应记录。结果在2周时,研究组视觉模拟量表评分的变化量[3.0(2.0,4.0)分]>对照组[1.5(0.0,3.0)分](P=0.016<0.05);在6周时,研究组鼻腔鼻窦结局20评分的变化量[(13.4±10.3)分]以及视觉模拟量表评分的变化量[3.0(2.0,4.0)分]>对照组[(8.7±6.1)、1.0(0.0,2.2分)](P=0.001<0.05)。分层后,使用碱性等渗盐水冲洗的患者中外周血嗜酸粒细胞占白细胞百分比≤4.27%的亚组在鼻内镜手术后2周的鼻腔鼻窦结局20和视觉模拟量表评分变化量[13.0(8.0,19.0)、(3.2±1.9)分]更大(P=0.024<0.05,P=0.030<0.05)且在术后6周的鼻腔鼻窦结局20和视觉模拟量表评分变化量[(15.7±9.5)、2.0(2.0,4.0)分]更大(P=0.002<0.05,P=0.005<0.05)。2组患者均未出现严重不良反应。结论对于伴有咽喉反流症状或体征评分阳性的慢性鼻窦炎患者,在鼻内镜手术后早期护理阶段使用碱性等渗盐水进行鼻腔冲洗具有一定的临床疗效,尤其是在外周血嗜酸粒细胞占白细胞百分比低于4.27%的患者中。

Objective To study the efficacy of alkaline isotonic saline in laryngopharyngeal reflux symptom-positive or finding-positive patients with chronic rhinosinusitis(CRS)following endoscopic sinus surgery(ESS).Methods Eighty CRS patients who were reflux symptom-or finding score-positive and who had undergone ESS were randomized to receive alkaline isotonic saline(study group;n=40)or normal saline(control group;n=40).All patients were classified by phenotype(high-%EOS or low-%EOS)according to whether the eosinophil proportion in peripheral blood(%EOS)exceeded 4.27%.Follow-up evaluations were conducted at 2 and 6 weeks after surgery.Evaluations included reflux symptom index(RSI),reflux finding score(RFS),sino-nasal outcome test-20(SNOT-20),visual analogue scale(VAS),nasal obstruction symptom evaluation(NOSE),Lund-Kennedy endoscopic score,and adverse events.Results The study group showed better improvement in the VAS score[3.0(2.0,4.0)]than the control group[1.5(0.0,3.0)]at 2 weeks postoperatively(P=0.016<0.05);the variation in SNOT-20 and VAS scores[(13.4±10.3)and 3.0(2.0,4.0),respectively]was significantly reduced in the study group at 6 weeks(P=0.001<0.05).After stratification,patients in the low-%EOS+study subgroup showed a significant improvement in the variation of SNOT-20 and VAS scores at 2 weeks[13.0(8.0,19.0)and(3.2±1.9),respectively](P=0.024<0.05,P=0.030<0.05,respectively)and 6 weeks[(15.7±9.5)and 2.0(2.0,4.0),respectively]postoperatively(P=0.002<0.05,P=0.005<0.05,respectively).There were no severe side effects among the groups.Conclusions Alkaline isotonic saline has a better clinical efficacy in patients with CRS who are RSI-positive or RFS-positive during the early postoperative care period of CRS,particularly those with a low%EOS.