鼻内镜手术联合布地奈德鼻腔雾化吸入及康复新液冲洗治疗鼻息肉的临床研究

Clinical Observation on Nasal Endoscopic Surgery Combined with Budesonide for Nasal Inhalation and Kangfuxin for Nasal Irrigation in the Treatment of Nasal Polyps

目的观察鼻内镜手术联合布地奈德鼻喷雾剂及康复新液治疗鼻息肉患者的临床疗效。方法选取2019年1月—2020年1月期间衡水市第二人民医院收治的62例鼻息肉患者作为研究对象,按随机数字表法分为对照组和试验组,每组各31例。对照组接受鼻内镜手术治疗,试验组实施鼻内镜手术联合布地奈德鼻喷雾剂及康复新液治疗。治疗2周后,观察比较两组患者临床症状(鼻痒、流涕、喷嚏、鼻塞、鼻甲肿胀)消失时间,治疗前后鼻腔黏液纤毛清除功能[鼻腔黏液纤毛传输时间(Mucociliary Transport Time,MTT)及黏液纤毛清除率]、鼻黏膜组织中相关指标[血管内皮生长因子(Vascular Endothelial Growth Factor,VEGF)、粒细胞-巨噬细胞集落刺激因子(Granulocyte-Macrophage Colony Stimulating Factor,GM-CSF)、白细胞介素-1β(Interleukin-1β,IL-1β)、干扰素-γ(Interferon-γ,IFN-γ)]水平、生活质量评分[世界卫生组织生活质量测定简表(WHOQOL-100)]、不良反应及复发情况。结果治疗后试验组鼻痒、流涕、喷嚏、鼻塞、鼻甲肿胀消失时间短于对照组,差异有统计学意义(P<0.05)。治疗后两组患者MTT均较治疗前降低,黏液纤毛清除率均较治疗前升高,差异有统计学意义(P<0.05);且试验组MTT明显低于对照组,黏液纤毛清除率明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者鼻黏膜组织中VEGF、GM-CSF、IL-1β及IFN-γ水平均较治疗前降低,差异有统计学意义(P<0.05);且试验组鼻黏膜组织中VEGF、GM-CSF、IL-1β及IFN-γ水平明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者WHOQOL-100评分均较治疗前升高,差异有统计学意义(P<0.05);且试验组WHOQOL-100评分明显高于对照组,差异有统计学意义(P<0.05)。治疗期间,试验组术后不良反应总发生率3.23%明显低于对照组25.81%,差异有统计学意义(P<0.05)。且试验组随访1年复发率3.23%明显低于对照组22.58%,差异有统计学意义(P<0.05)。结论运用鼻内镜手术联合布地奈德鼻喷雾剂及康复新液治疗,可明显缩短患者临床症状消失时间,改善患者鼻腔黏液纤毛清除功能,减轻鼻黏膜组织炎性反应,改善患者生活质量,有效降低患者术后不良反应发生率及复发率。

Objective To observe the clinical effect of nasal endoscopic surgery combined with budesonide for nasal inhalation and Kangfuxin for nasal irrigation in the treatment of nasal polyps.Methods A total of 62 patients with nasal polyps diagnosed in the Second People′s Hospital of Hengshui from January 2019 to January 2020 were randomly assigned into a control group and an observation group,with 31 patients in each group.The control group received nasal endoscopic surgery,and the observation group received nasal endoscopic surgery combined with budesonide for nasal inhalation and Kangfuxin for nasal irrigation.Both groups were treated for 2 weeks.The time to disappearance of clinical symptoms(nose itching,runny nose,sneezing,nasal congestion,turbinate swelling)was recorded and compared between groups.The nasal mucociliary clearance functions[mucociliary transport time(MTT)and mucociliary clearance rate],levels ofinflammatory cytokines[vascular endothelial growth factor(VEGF),granulocyte-macrophage colony-stimulating factor(GM-CSF),interleukin-1β(IL-1β),and interferon-γ(IFN-γ)]in the nasal mucosa,quality of life score[World Health Organization Quality of Life assessment(WHOQOL-100)]before and after treatment were compared between the two groups.The postoperative adverse events were compared between the two groups,and the recurrence was followed.Results The time to disappearance of nasal itching,runny nose,sneezing,nasal congestion,and turbinate swelling in the observation group was shorter than that in the control group(P<0.05).The MTT and mucociliary clearance rate in the two groups after treatment were recovered compared with those before treatment.Further,the observation group had lower MTT and higher mucociliary clearance rate than the control group(P<0.05).The levels of VEGF,GM-CSF,IL-1β,and IFN-γin the nasal mucosa of the two groups after treatment were lower than those before treatment,and the levels were lower in the observation group than in the control group after treatment(P<0.05).The treatment in both groups elevated the score of WHOQOL-100,and the score in the observation group was higher than that in the control group after treatment(P<0.05).The total incidence of adverse reactions(3.23%)in the observation group was lower than that(25.81%)in the control group(P<0.05)during the treatment.The recurrence rate(3.23%)in the observation group was also lower than that(22.58%)in the control group(P<0.05)within 1 year.Conclusion In the treatment of nasal polyps,nasal endoscopic surgery combined with budesonide for nasal inhalation and Kangfuxin for irrigation can significantly shorten the time to disappearance of clinical symptoms,restore the mucociliary clearance function of nasal cavity,alleviate the inflammation of nasal mucosa,improve the quality of life of patients,and reduce the occurrence of postoperative complications and recurrence,demonstrating good therapeutic effect.