影响鼻中隔偏曲患者手术效果的预测因素分析

Analysis of predictive factors of surgical outcomes in patients with nasal septum deviation

目的 分析鼻中隔偏曲患者手术治疗前的特征及术后症状的改善情况,探讨可以预测手术效果的相关因素。方法 对53例以鼻塞为主诉的鼻中隔偏曲患者进行前瞻性研究,每例患者在术前经过病史询问、体格检查、鼻内镜检查、鼻腔鼻窦CT、鼻阻力测量、鼻声反射测量、鼻腔峰值吸气流量测量(peak nasal inspiratory flow, PNIF)测量并填写焦虑自评量表(self-assessment scale, SAS)与抑郁自评量表(depression self-assessment scale, SDS)、白天与夜间鼻塞症状的视觉模拟量表(visual analogue scale, VAS)。在术后1个月和6个月分别评估患者的鼻塞症状评价(nasal obstruction symptom evaluation NOSE)评分、鼻腔鼻窦结局测试-22(sino-nasal outcome test 22, SNOT-22)评分的改善程度及患者术后的满意度。结果 NOSE评分改善程度和PNIF相关(r=-0.33),SNOT-22评分改善程度与SAS评分相关(r=-0.31)。夜间鼻塞的VAS评分与NOSE改善程度(r=-0.36)、SNOT-22评分改善程度(r=-0.37)都相关。在多因素回归分析中,患者的手术满意度仅与夜间鼻塞的VAS评分相关(OR=1.65,95%CI=1.09~2.48,P=0.02)。结论 对患者术前鼻塞特点以及心理状态的评价有助于临床医师判断患者的预后,从而进一步为患者选择合理治疗方式,优化鼻中隔偏曲诊治的流程。

Objective To analyze the preoperative characteristics of patients with nasal septum deviation and the improvement of postoperative symptoms to determine the relevant factors that could predict the surgical outcome.Methods A prospective study was conducted on 53 patients with nasal septal deviation and whose main complaint was nasal congestion.Each patient underwent preoperative history taking,physical examination,auxiliary examination induding nasal endoscopy,paranasal sinus CT,acoustic rhinometry,rhinomanometry,and peak nasal inspiratory flow(PNIF).They also completed an anxiety self-assessment scale(SAS),depression self-assessment scale(SDS),and nasal obstruction visual analogue scale(VAS)at day and night respectively.The improvement of the nasal obstruction symptom evaluation(NOSE)scale score,sino-nasal outcome test 22(SNOT-22)score,and patient's postoperative satisfaction were assessed at one month and six months after surgery.Results The degree of improvement in NOSE scores was correlated with PNIF(r=-0.33),and the degree of improvement in SNOT-22 scores was correlated with SAS scores(r=-0.31).VAS scores for nocturnal nasal congestion were correlated with the degree of improvement in NOSE(r=-0.36)and SNOT-22 scores(r=-0.37).In a multifactorial regression analysis,patient satisfaction with the operation was only associated with the VAS scores for nocturnal nasal congestion(OR=1.65,95%CI=1.09-2.48,P=0.02).Conclusion The evaluation of patients'preoperative nasal congestion characteristics as well as their psychological status can help clinicians to evaluate patients'prognosis,in order to further select reasonable treatment for patients and optimize the procedure of diagnosis and care for nasal septal deviation.