慢性鼻-鼻窦炎术前应用布地奈德联合鼻腔冲洗的临床疗效观察

The clinical effect observation of budesonide combined with nasal irrigation before surgery in chronic rhinosinusitis

目的探讨慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)患者术前短时间给予布地奈德联合鼻腔冲洗的临床疗效。方法选取2018年5月至2020年7月清华大学第一附属医院收治的拟行鼻内镜手术的CRS患者60例,采用随机数字表法分为试验组和对照组,每组30例。试验组在250 ml生理盐水中加入布地奈德1 mg,对照组使用250 ml生理盐水,鼻内镜手术前1周开始每日冲洗鼻腔2次。比较两组用药前后的视觉模拟评分(isual analogue scale,VAS)、鼻腔鼻窦结果测量22条表(sino-nasal outcome test-22,SNOT-22)评分和Lund-Kennedy内镜评分。结果研究过程中,试验组1例患者随访脱失排除。用药1周后,两组VAS、SNOT-22评分及Lund-Kennedy内镜评分均较用药前明显改善,且试验组VAS、SNOT-22评分及Lund-Kennedy内镜评分改善均优于对照组[(21.00±16.04)分比(33.97±18.59)分,(8.17±4.76)分比(15.20±9.62)分,(5.24±1.43)分比(6.83±2.72)分],差异有统计学意义(P<0.05)。59例患者中,病理结果提示21例有嗜酸性粒细胞浸润,其中试验组12例,对照组9例。试验组中,嗜酸组用药1周后VAS及Lund-Kennedy内镜评分较非嗜酸组改善更明显[(25.88±17.20)分比(14.08±11.64)分,(5.71±1.40)分比(4.58±1.38)分],差异均有统计学意义(P<0.05);对照组中,嗜酸组与非嗜酸组患者的VAS、SNOT-22评分及Lund-Kennedy内镜评分比较,差异均无统计学意义(P>0.05)。结论鼻内镜手术前短期鼻腔冲洗可以改善患者的鼻部症状及生活质量,减轻术腔水肿及息肉体积,应用布地奈德联合生理盐水溶液冲洗效果更优,尤其适用于嗜酸性粒细胞性CRS患者,可作为鼻窦炎术前治疗方法之一。

Objective To investigate the clinical effect of budesonide combined with nasal irrigation before operation in patients with chronic rhinosinusitis(CRS).Methods A total of 60 patients with CRS who underwent endoscopic nasal surgery in the First Hospital of Tsinghua University from May 2018 to July 2020 were divided into experimental group and control group by random number table method,with 30 cases in each group.The experimental group was rinsed with budesonide 1 mg in 250 ml normal saline,while the control group was rinsed with 250 ml normal saline,and the nasal cavity was rinsed twice a day from one week before nasal endoscopic surgery.Visual analogue scales(VAS)of nasal symptoms,sinonasal outcome test-22(SNOT-22)and Lund-Kennedy endoscopic scores were assessed in both groups before and after treatment.Results During the study,one patient in the experimental group was lost and excluded during follow-up.After one week of medication,VAS,SNOT-22 scores and Lund-Kennedy endoscopic scores were all significantly improved in the two groups compared with those before medication,and the improvements in the experimental group were better than those in the control group[(21.00±16.04)points vs.(33.97±18.59)points,(8.17±4.76)points vs.(15.20±9.62)points,(5.24±1.43)points vs.(6.83±2.72)points],the differences showed statistical significance(P<0.05).Of the 59 patients,the pathological results showed that 12 eosinophilia occurred in the experimental group and nine in the control group.In the experimental group,CRS patients with eosinophilic had more significant improvements in VAS and Lund-Kennedy endoscopic scores after budesonide irrigation compared with those patients without eosinophilic[(25.88±17.20)points vs.(14.08±11.64)points,(5.71±1.40)points vs.(4.58±1.38)points],and the differences showed statistical significance(P<0.05).In the control group,there were no significant differences in the VAS,SNOT-22 scores and Lund-Kennedy endoscopic scores between CRS patients with or without eosinophilic(P>0.05).Conclusions Short-term nasal irrigation before endoscopic nasal surgery can improve the nasal symptoms and the patients’quality of life,and reduce the volume of intraoperative cavity edema and polyps.The combined application of budesonide saline solution is better and can be considered as a preoperative therapy for rhinosinusitis,especially for patients with eosinophilic CRS.