糖皮质激素三种不同鼻用法对鼻内镜术后黏膜转归的影响

Effects of three different nasal uses of glucocorticoid on mucosal outcome after endoscopic sinus surgery

目的研究慢性鼻窦炎患者鼻内镜术后糖皮质激素三种不同给药方式对术后鼻腔黏膜转归的影响。方法将慢性鼻窦炎鼻内镜术后患者60例随机分为三组,每组20例,分别是术腔填塞纳吸棉+常规激素喷鼻(A组)、术腔填塞浸润有布地奈德混悬液的纳吸棉+常规激素喷鼻(B组)、术腔填塞纳吸棉+头后仰位激素喷鼻(C组)三组,比较各组间患者鼻腔症状改善和术腔黏膜转归的情况。结果术后2周、4周、12周B组和C组视觉模拟量表(VAS)及鼻内镜Lund-Kennedy评分均较A组低(P<0.05)。术后2周、4周和12周B组和C组鼻腔囊泡、水肿、分泌物及结痂率均较A组低(P<0.05)。术后4周和12周B组和C组鼻腔瘢痕粘连率均较A组低(P<0.05)。术后4周和12周C组VAS及Lund-Kennedy评分均较B组低(P<0.05)。术后12周C组鼻腔水肿率及分泌物发生率较B组低(P<0.05)。结论术后鼻腔填塞浸润有布地奈德混悬液纳吸棉并常规激素喷鼻法、术后头后仰位鼻喷激素法,这两种方法在慢性鼻窦炎鼻内镜术后对患者自身症状的缓解、术腔创面黏膜修复及重塑均发挥积极的作用,且术后头后仰位激素喷鼻法效果更佳。

Objective To study the effects of three different glucocorticoid administration methods on nasal mucosal outcome after endoscopic sinus surgery for chronic rhinosinusitis patients.Methods 60 patients who with chronic rhinosinusitis after endoscopic surgery were randomly divided into three groups,20 patients cavities in each group.Respectively nasopore filled in surgical cavity and conventional hormone nasal spray(Group A),nasopore with budesonide suspension liquid filled and conventional hormone nasal spray(Group B),nasopore filled and hormone nasal spray at the head back position(Group C).Comparing nasal symptoms improvement and mucous membrane outcome between groups of patients.Results Visual analogue scale(VAS)and Lund-Kennedy scores of nasal endoscopy in group B and group C were lower than those in group A at the 2,4 and 12 weeks after surgery(P<0.05).The rates of nasal vesicles,edema,secretion and scab in group B and group C were lower than those in group A at 2,4 and 12 weeks after operation(P<0.05).The nasal scar adhesion rate of group B and group C were lower than those in group A at 4 and 12 weeks after surgery(P<0.05).At 4 and 12 weeks after surgery,VAS and Lund-Kennedy scores in group C were lower than those in group B(P<0.05).The incidence of nasal edema and secretions in group C were lower than those in group B at 12 weeks after operation(P<0.05).Conclusion The two methods of nasopore with budesonide suspension liquid filled in the nasal cavity joint with conventional hormone nasal spray,and nasopore filled joint with the hormone spray at the head back position after the operation play an active role after endoscopic surgery for chronic rhinosinusitis.They can relieving patients?symptoms,repairing and remodeling the mucous membrane in the operative cavity.And the effect of the hormone spray at the head back position is better.