伴咽喉反流的难治性鼻窦炎术后应用质子泵抑制剂的疗效观察

Postoperative efficacy of proton pump inhibitor in the treatment of difficult-to-treat rhinosinusitis with laryngopharyngeal reflux

目的 探讨伴咽喉反流(LPR)的难治性鼻窦炎(DTRS)术后应用质子泵抑制剂(PPI)的临床疗效。方法 收集42例合并咽喉反流的难治性鼻窦炎患者案例,其中21例给予术后规范质子泵抑制剂治疗8周+常规围手术期处理(实验组),21例给予常规围手术期处理(对照组)。对比分析两组患者术前的一般资料、外周血嗜酸性粒细胞计数、视觉模拟量表(VAS)评分、外周血IgE、Lund-Kennedy鼻内镜评分、Lund-Mackay鼻窦CT评分及反流症状指数量表(RSI)、反流体征评分量表(RFS)等的差异;收集两组患者术后第1、3、6及12个月复查时的鼻内镜评分、鼻窦CT评分、VAS评分、RSI及RFS评分结果,对两组患者的咽喉症状评分及客观检查结果较基线的变化及组间差异进行分析,评估质子泵抑制剂治疗对伴咽喉反流的难治性鼻窦炎的术后临床疗效。结果 对两组患者术后1年的持续随访,最终实验组患者RFS、RSI、VAS评分、鼻内镜评分、鼻窦CT评分较对照组患者均显著降低[(2.57±1.54)分vs(3.57±1.60)分,P=0.045<0.05;(2.86±1.59)分vs(4.62±1.77)分,P=0.002<0.05;(3.43±1.93)分vs(5.43±3.11)分,P=0.017<0.05;(1.00±0.78)分vs(2.10±1.09)分,P=0.018;(0.67±0.66)分vs(1.24±0.83)分,P=0.001<0.05]。结论 伴咽喉反流的难治性鼻窦炎术后行质子泵抑制剂治疗可明显改善患者的鼻部症状、提高患者生活质量,降低咽喉反流相关症状体征,可作为该类患者的个体化治疗手段。

Objective To explore the clinical effect of proton pump inhibitor(PPI) after the operation for difficult-to-treat rhinosinusitis(DTRS) with laryngopharyngeal reflux(LPR). Methods A total of 42 patients with DTRS with LPR were collected, of which 21 patients were given standard PPI treatment for 8 weeks plus routine perioperative treatment(experimental group), and 21 patients were given routine perioperative treatment(control group). The general information, peripheral blood eosinophil count, VAS score, peripheral blood IgE, Lund-Kennedy nasal endoscopy score, Lund-Mackay CT score, reflux symptom index scale(RSI) and reflux sign score(RFS) were compared between the two groups. The nasal endoscopic score, sinus CT score, VAS score, RSI and RFS scores of both groups were collected at the 1, 3, 6and 12month after operation. Differences between the throat symptom score and objective examination results of both groups were analyzed, and the postoperative clinical effect of PPI therapy on DTRS with LPR was evaluated. Results After 1 year continuous follow-up, RFS, RSI, endoscopic score, sinus CT score and VAS scores were significantly lower compared with the control group [(2.57±1.54) points vs.(3.57±1.60) points, P=0.045<0.05;(2.86±1.59) points vs.(4.62±1.77) points, P=0.002<0.05;(3.43±1.93) points vs.(5.43±3.11) points, P=0.017;(1.00±0.78) points vs(2.10±1.09) points, P=0.018<0.05;(0.67±0.66) points vs.(1.24±0.83) points, P=0.001<0.05] Conclusion PPI after operation for DTRS with LPR can obviously improve nasal symptoms, improve quality of life and reduce the symptoms and signs related to throat reflux, which can be used as an individualized treatment for these patients.