Effect of nursing intervention on rehabilitation of patients with chronic sinusitis and nasal polyps after nasal endoscopy

BACKGROUND Chronic sinusitis is a kind of chronic suppurative inflammation of the sinus mucosa.Nasal endoscopy is a good method to treat nasal polyps.However postoperative rehabilitation and care should not be neglected.AIM To investigate the Effect of nursing intervention on the rehabilitation of patients with chronic sinusitis and nasal polyps(CSNPS)after nasal endoscopy.METHODS A total of 129 patients with CSNPS hospitalized from February 2017 to February 2019 were studied.Using the digital parity method,we investigated nursing cooperation strategies for endoscopic surgery.The comparison group(64 cases):Surgical nursing was carried out with traditional nursing measures;experimental group(65 cases):Surgical nursing was carried out by traditional nursing countermeasures+comprehensive nursing measures.We compared postoperative recovery rates,nursing satisfaction rates,and nasal cavity ratings between the two groups.RESULTS Experimental group patients with CSNPS had a significantly higher recovery rate(98.46%)compared to the control group(79.69%).This difference was statistically significant(χ2=11.748,P<0.05).Additionally,the satisfaction rate with treatment was also significantly higher in the experimental group(98.46%)compared to the control group(79.69%),with a statistically significant difference(χ2=11.748,P<0.05).Before nursing,there was no significant difference in sinus nasal cavity scores between the experimental group(20.29±7.25 points)and the control group(20.30±7.27 points)(t=0.008,P>0.05).However,after nursing,the sinus nasal cavity score in the experimental group(8.85±3.22 points)was significantly lower than that in the control group(14.99±5.02 points)(t=8.282,P<0.05).CONCLUSION Comprehensive nursing intervention in patients with CSNPS can significantly improve the total recovery rate after endoscopic surgery.

Association of Comorbid Asthma and the Efficacy of Bioabsorbable Steroid-eluting Sinus Stents Implanted After Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis with Nasal Polyps

Objective To identify factors affecting the efficacy of steroid-eluting sinus stents implanted after endoscopic sinus surgery(ESS)in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods We performed a post-hoc analysis of a randomized self-controlled clinical trial on post-operative implantation of bioabsorbable steroid-eluting stents in patients with CRSwNP.Univariate logistic regression analysis was conducted to identify which of the following factors affect the response to post-operative stent implantation:sex,serum eosinophil levels,history of prior surgery,endoscopic scores,and comorbid conditions(asthma and allergic rhinitis).The primary outcome was the rate of post-operative intervention on day 30,and the secondary outcome was the rate of polypoid tissue formation(grades 2–3)on days 14,30,and 90.Results A total of 151 patients with CRSwNP were included in the post-hoc analysis.Asthma was identified as the only risk factor for a poor response to steroid-eluting sinus stents on post-operative day 30,with an odds ratio of 23.71(95%CI,2.81,200.16;P=0.004)for the need for post-operative intervention and 19(95%CI,2.20,164.16;P=0.003)for moderate-to-severe polypoid tissue formation.In addition,the asthmatic group showed higher rates of post-operative intervention and polypoid tissue formation than the non-asthmatic group on post-operative day 30.Blood eosinophil levels were not identified as a risk factor for poor outcomes after stent implantation.Conclusion Comorbid asthma,but not blood eosinophil level,impairs the efficacy of steroid-eluting sinus stents in the short term after ESS in patients with CRSwNP.

Expression of IL-17 and Syndecan-1 in Nasal Polyps and Their Correlation with Nasal Polyps

Nasal polyp(NP) is a common chronic inflammatory disease of the nasal cavity and sinuses. Although some authors have suggested that NP is related to inflammatory factors such as interleukin(IL)-1β, IL-5, IL-8, granulocyte-macrophage colony-stimulating factor(GM-CSF), tumor necrosis factor(TNF)-α, and IL-17, the mechanisms underlying the pathogenesis and progression of NP remain obscure. This study investigated the expression and distribution of IL-17 and syndecan-1 in NP, and explored the roles of these two molecules in the pathogenesis of eosinophilic chronic rhinosinusitis with nasal polyps(Eos CRSwNP) and non-Eos CRSwNP. Real-time PCR and immunohistochemistry were used to detect the expression of IL-17 and syndecan-1 in samples [NP, unciform process(UP) from patients with CRS, and middle turbinate(MT) from healthy controls undergoing pituitary tumor surgery]. The results showed that the expression levels of IL-17 and syndecan-1 were upregulated in both NP and UP tissues, but both factors were higher in NP tissues than in UP tissues. There was no significant difference in IL-17 levels between the Eos CRSw NP and non-Eos CRSwNP samples, and syndecan-1 levels were increased in the non-Eos CRSwNP tissues as compared with those in Eos CRSwNP tissues. In all of the groups, there was a close correlation between the expression of IL-17 and syndecan-1 in nasal mucosa epithelial cells, glandular epithelial cells, and inflammatory cells, suggesting that IL-17 and syndecan-1 may play a role, and interact with each other, in the pathogenesis of non-Eos CRSwNP.

Effects of IL-17 on Expression of GRO-α and IL-8 in Fibroblasts from Nasal Polyps

Recent studies indicated that interleukin（IL）-17, growth-related oncogene（GRO）-α and IL-8 play an important role in the pathogenesis of nasal polyps. However, the effects of the increased amount of IL-17 and the production of GRO-α and IL-8 in human nasal polyp fibroblasts are not completely understood. This study aimed to determine the effects of the increased IL-17 on the changes of GRO-α and IL-8 expression in human nasal polyp fibroblasts and further investigate the mechanism of neutrophil infiltration in nasal polyps. Nasal polyp fibroblasts were isolated from six cases of human nasal polyps, and the cells were stimulated with five different concentrations of IL-17. Real-time fluorescence quantitative polymerase chain reaction（RT-PCR） was used to detect the mRNA expression of GRO-α and IL-8. The mRNA of GRO-α and IL-8 was expressed in unstimulated controls and remarkably increased by stimulation with IL-17. Moreover, the levels of GRO-α and IL-8 produced by fibroblasts were increased gradually with the increases in IL-17 concentrations. The present study showed that nasal fibroblasts can produce GRO-α and IL-8, and their production is remarkably enhanced by IL-17 stimulation, thereby clarifying the mechanism of the IL-17 mediated neutrophil infiltration in nasal polyps. These findings might provide a rationale for using IL-17 inhibitors as a treatment for nasal inflammatory diseases such as nasal polyps.

Expression of Tenascin and Fibronectin in Nasal Polyps

To explore the role of tenascin (TN ) and fibronectin (FN ) in the pathophysiology of nasal polyps (NP) ,the expression of TN and FN in NP from 34patients and inferior turbinates from 2 0 patients with deviation of nasal septum was imm unohistochem ically studied.In patients with NP,the relations between expression and histopathological features,eosinophils(EOS) infil- tration,clinical staging and the size of NP were analyzed.Our study showed that the gray score of TN and FN expression was16 3.10± 10 .5 4 and16 3.2 4± 11.5 2 in NP respectively,whereas itwas 175 .4 9± 9.2 9and173.93± 7.92 in inferior turbinates respectively.The difference between two groups was significant (P<0 .0 1) .The expression of TN and FN in edematous type was signifi- cantly stronger than that in cystic and glandular type and fibrous type (P<0 .0 5 ) .The association between FN expression and EOS infiltration was significant (r=- 0 .6 0 ,P <0 .0 1) .The expres- sion of TN and FN did not correlate with clinical staging and size(P>0 .0 5 ) .It was suggested that abnormal ECM m ight contribute to proliferation of epithelia,accum ulation of EOS and edem a formation,thereby causing development of NP.

Dysregulation of E-cadherin in Chronic Rhinosinusitis with Nasal Polyps

E-cadherin is a key epithelial protein and adhesive molecule. This study detected the E-cadherin expression in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and controls, and analyzed its possible role in the pathogenesis of CRSwNP. The expression of E-cadherin was detected by using Western blotting and immunohistochemistry in controls and patients with CRSwNP. Computed tomography (CT) scan findings were scored. The results showed that the E-cadherin expression was up-regulated in patients with CRSwNP as compared with controls (P=0.039) and the positive staining was predominantly localized on the epithelial cell membrane. E-cadherin level was correlated negatively with Lund-Mackay scores in patients with CRSwNP (r=–0.604, P=0.005). It is suggested that E-cadherin may be involved in the pathogenesis of CRSwNP and correlated with disease severity.

Ethmoidal Polyposis, Adenoid Hypertrophy and Tympanic Membrane Perforation—A Case Report

Background: Ethmoidal polyposis coexisting with adenoid enlargement and tympanic membrane perforation is a rare condition in otolaryngological practice. Evidences have shown that antrochoanal polyp often times coexists with adenoid enlargement especially in the young which was in sharp contrast to ethmoidal polyposis occurring in the presence of adenoid enlargement. Moreover, the hidden location of nasopharynx housing the adenoids, coupled with the masking effect of bilateral sinonasal polyps, leads to inadvertent misdiagnosis of this complex pathology with subsequent difficulty in providing effective management. Case Presentation: A 24 year-old lady presented with recurrent bilateral nasal obstruction that became persistent associated with nasal discharge and anosmia. She also had recurrent right otorrhoea with associated hearing loss. Diagnostic rigid nasal endoscopy revealed mucoid discharge with bilateral polypoid masses filling both nasal cavities. Otoendoscopic finding revealed a small (about 5%) central tympanic membrane perforation. A clinical assessment of chronic rhinosinusitis with nasal polyposis complicated by chronic suppurative otitis media (CSOM) was made. A non-contrast CT scan of the paranasal sinuses showed isodense lesions in the nasal cavities, all paranasal sinuses and the entire nasopharynx. She had endoscopic sinus surgery and a nasopharyngeal clearance biopsy. The nasal, paranasal and nasopharyngeal masses had histologic confirmation of inflammatory nasal polyps and lymphoid (adenoid) hyperplasia respectively. Her condition improved remarkably with subsequent medical treatment. She was followed up for 8 months and no recurrence was observed. Conclusion: Sinonasal polyposis can coexist with adenoid hypertrophy and middle ear disease as a single pathological condition. Hence, a high index of suspicion and thorough evaluation become necessary for making timely diagnoses and instituting effective management.

Utilization of RNA sequencing to investigate olfactory dysfunction in chronic rhinosinusitis without nasal polyps:A pilot study

Objectives:Prior research on olfactory dysfunction in chronic rhinosinusitis(CRS)has focused on patients with polyps and suggests that direct inflammation of the olfactory cleft mucosa plays a contributory role.The purpose of this study was to evaluate gene expression in superior turbinate mucosal specimens,comparing normosmic and dysosmic CRS patients without polyps(CRSsNP).Methods:Tissue samples were obtained from the superior turbinates of patients with CRSsNP at the time of endoscopic sinus surgery.Samples subsequently underwent RNA sequencing and functional analysis to investigate biological pathways associated with differentially expressed genes between dysosmic(n=7)and normosmic(n=4)patients.Results:Differential gene expression analysis comparing dysosmic and normosmic CRSsNP patients showed upregulation of 563 genes and downregulation of 327 genes.Using stringent criteria for multiple comparisons,one upregulated gene(Immediate Early Response 3[IER3])had an false discovery rate(FDR)correction adjustedP value considered statistically significant(P<0.001,fold change 2.69).Reactome functional analysis revealed eight biological pathways significantly different between dysosmic and normosmic patients(P<0.05,FDR correction)including IL-4 and IL-13 signaling,IL-10 signaling,and rhodopsin-like receptors.Conclusions:RNA sequencing of the superior turbinates in patients with CRSsNP can provide valuable information regarding biological pathways and genes involved in olfactory dysfunction.This study supports literature suggesting that Type 2 inflammation may play a role in olfactory dysfunction in at least some patients with CRSsNP.This study also prompts questions regarding the role of IL-10,rhodopsin-like receptors,andIER3 in the pathogenesis of olfactory dysfunction.

A Rare Case of Nasal Glial Heterotopia Presenting as Sphenochoanal Polyp

Objective: This paper reports a rare case of nasal glial heterotopia presenting as sphenochoanal polyp. So far, literature has revealed only few cases. Case Report: A 55-year-old woman presented with a 2-month history of left sided nasal obstruction. Rigid endoscopy showed greyish left nasal polyp and anterior discharge. Subsequently, CT scan of the sinuses revealed sphenochoanal polyp filling the left nasal cavity, without signs of expansion, or destruction and no obvious connection with intracranial tissue. Mass was removed endoscopically and histology confirmed glial nature of the mass. Conclusion: Any mass arising from sphenoid sinus should be carefully evaluated on CT scan for existence of fibrous stalk, or connection with brain tissue and needs to be considered in the differential diagnosis of the sphenochoanal mass. Complete surgical excision is the treatment of choice, which is curative.

Role of Allergy in Sinonasal Polyposis

Objectives: The exact role of allergy in sinonasal polyposis is not yet clearly elucidated and is undoubtedly a contro-versial subject. The study focussed on the association of allergy in nasal polyposis. We aim to determine whether there was a correlation between Serum IgE, absolute eosinophil count, eosinophilic inflammation, and nasal polyps. Methods: A study group of fifty two consecutive patients of nasal polyposis were evaluated prospectively and compared with 26 controls who underwent septoplasty and mimimal FESS or Endoscopic Sphenopalatine artery ligation. Patients were evaluated for presence of allergy with regard to absolute eosinophil count, total serum IGE and tissue eosinophilia and correlations were established. All patients were categorized based on histological evidence of tissue eosinophilia. Re-sults: The incidence of asthma was 5.8% and positive history of allergy was obtained in 40.4% of patients in study group and 7.7% of patients in control group. The statistically significant association was not seen with absolute eosino-phil count, Serum IgE and tissue eosinophilia. Tissue eosinophilia was observed in more number of patients with nasal polyposis compared to controls. So clinical significance might be established. Conclusions: Allergy is parameter that is frequently associated with this disease, irrespective of the type of polyp and the age at presentation. Unrecognized and untreated allergy adds to the morbidity of the disease and generally results in poor treatment outcome.

鼻腔局部类固醇药物治疗慢性鼻窦炎息肉和变应性鼻炎患者的临床效果

目的:分析鼻腔局部应用类固醇类药物在治疗鼻窦炎息肉、变应性鼻炎方面的有效性与安全性情况,为临床提供参考。方法:选择2021年3月—2022年3月河南科技大学第二附属医院收治的145例变应性鼻炎和慢性鼻窦炎鼻息肉患者作为研究对象。根据用药差异性划分为参照组与研究组。参照组予以安慰治疗,研究组予以鼻腔局部类固醇药物治疗。比较两组患者的治疗情况与使用安全性情况。结果:参照组采安慰剂治疗无法获得较好效果,仅可对患者的心理状态产生一定安慰作用。研究组各组患者治疗总有效率均明显高于参照组,差异有统计学意义(χ^(2)=50.516、54.133、54.133、50.516,P<0.05)。研究组各组间治疗总有效率比较,差异无统计学意义(χ^(2)=0.352、0.000、0.352、0.352、0.000、0.352,P>0.05)。研究组各组患者的不良反应发生率均较低,但各组间比较,差异无统计学意义(χ^(2)=1.681、1.097、0.420、0.090、0.892、0.132,P>0.05)。结论:将鼻腔局部类固醇药物应用于慢性鼻窦炎息肉和变应性鼻炎患者的治疗工作当中,不仅可以有效提升治疗有效率,同时可以保证患者的用药安全性。

鼻黏膜不同炎症的临床表现及客观炎症指标的异同性研究

目的比较慢性鼻炎(CR)、慢性鼻窦炎伴鼻息肉(CRSwNP)和慢性鼻窦炎不伴鼻息肉(CRSsNP)患者在鼻部症状、生活质量评估和临床炎症指标表达方面异同。方法研究共纳入2017年1月~2018年12月在北京同仁医院鼻科就诊的154例连续患者,年龄18~70岁,其中男性106例,女性48例。根据入选标准,纳入患者分为CR组、CRSsNP组和CRSwNP组。患者于就诊当天进行鼻内镜、鼻呼出NO(nasal exhaled nitric oxide,nNO)、皮肤点刺试验、鼻窦CT和血常规检查,并在医师指导下对自身鼻部症状进行视觉模拟量表(VAS)评分,填写鼻腔鼻窦结局测试22条(SNOT-22)问卷。共43例CR患者,58例CRSsNP患者及53例CRSwNP患者入选本研究。结果CRSsNP组SNOT-22总分显著低于CR和CRSwNP组(30.0±19.4 vs.41.1±21.9,30.0±19.4 vs.40.9±18.7,P<0.05),CR组和CRSwNP组的SNOT-22总评分无统计学差异。CRSwNP组鼻部症状及鼻外症状平均得分最高;CRSsNP组得分较低;CR患者对睡眠的损害影响显著高于CRSsNP患者(9.9±6.2 vs.5.1±5.3,P<0.05),与CRSwNP组睡眠评分无显著差异(9.9±6.2 vs.7.1±5.7,P>0.05)。当患者合并过敏原阳性时,CR、CRSsNP和CRSwNP之间症状评分及SNOT-22评分之间无统计学差异;当过敏原阴性时,无论症状评分还是SNOT-22评分,三者之间均表现出明显的统计学差异。结论CR、CRSsNP和CRSwNP三种鼻黏膜炎症类型都对患者生活质量产生明显影响。就症状评分及生活质量评分而言,CR组和CRSwNP组相近且较CRSsNP组损害更明显。客观评价指标与症状和生活质量评分的变化趋势并不一致。

短期口服糖皮质激素对慢性鼻窦炎伴鼻息肉上皮紧密连接的影响

目的观察短疗程口服糖皮质激素(glucocorticoids,GCs)对慢性鼻窦炎伴鼻息肉(CRSwNP)上皮中紧密连接(tight junctions,TJs)表达水平的影响。方法招募拟行鼻内镜手术治疗的CRSwNP患者,术前给予GCs口服连续7 d,分别留取治疗前、后的鼻息肉组织。选取因非炎性疾病而拟行相关鼻内镜手术的成年患者,留取术中所得到的钩突黏膜、中鼻甲黏膜或下鼻甲黏膜作为对照。应用实时荧光定量PCR和免疫荧光共聚焦显微镜检测TJs的表达情况。结果短疗程口服GCs治疗前,鼻息肉标本中claudin-3、claudin-4和occludin mRNA的表达水平显著低于正常鼻黏膜;治疗后,鼻息肉组织中TJs mRNA和蛋白的表达水平较治疗前显著升高。结论鼻息肉组织中多种TJs表达下降,短期口服GCs治疗可以显著上调TJs的表达。

嗅裂区呼吸道上皮腺瘤样错构瘤与鼻息肉患者临床表现及鼻窦CT特征的对比分析研究

目的比较病变位于双侧嗅裂区的呼吸道上皮腺瘤样错构瘤(respiratory epithelial adenomatoid hamartoma,REAH)与鼻息肉(nasalpolyps,NP)患者的临床和影像学特征,为二者的鉴别诊断提供证据。方法纳入2006年6月~2023年8月于北京同仁医院行鼻内镜手术治疗且病理证实为双侧嗅裂区REAH的患者,设为REAH组;纳入2023年1~10月于北京同仁医院行鼻内镜手术治疗且病理证实为双侧嗅裂区NP的患者,设为NP组。对两组患者的人口学特征、临床特征和影像学资料进行比较分析。结果研究纳入REAH组和NP组患者各155例。REAH组以老年男性居多,合并哮喘的患病率低于NP组(P<0.05)。鼻窦CT测量结果显示REAH组的双侧中鼻甲头端距离、双侧上鼻甲头端距离、中鼻甲与鼻中隔最大角度均大于NP组(P<0.05)。结论鼻窦CT有助于术前鉴别REAH并制定相应的治疗方案。

慢性鼻窦炎伴鼻息肉鼻黏膜中纤维蛋白交联和降解相关调控基因表达异常

目的研究慢性鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps,CRSwNP)患者以及合并哮喘(asthma,AS)患者(CRSwNP+AS)鼻黏膜中纤维蛋白沉积及其相关调控基因的表达情况。方法利用免疫荧光染色评估鼻黏膜中纤维蛋白的沉积情况;利用实时荧光定量聚合酶链式反应检测纤维蛋白交联和降解相关调控基因的表达,以及糖皮质激素治疗后的基因表达变化。结果与对照组相比,CRSwNP鼻黏膜中有显著的纤维蛋白沉积,且呈交联状态,CRSwNP+AS组有更明显的纤维蛋白沉积。基因表达检测显示,促进纤维蛋白交联的基因-凝血因子ⅩⅢA1(factorⅩⅢA chain 1,F13A 1)和抑制纤维蛋白降解的基因-纤溶酶原激活物抑制物1(plasminogen activator inhibitor 1,PAI-1)在CRSwNP和CRSwNP+AS组的表达均升高,并且F13A1在CRSwNP+AS组的表达较CRSwNP显著更高;促进纤维蛋白降解的基因-组织型纤溶酶原激活因子(plasminogen activator tissue type,PLAT)在CRSwNP+AS组的表达显著低于CRSwNP和对照组;尿激酶型纤溶酶原激活因子(plasminogen activator urokinase,PLAU)的表达在两种类型的CRSwNP中均上调。CRSwNP+AS患者经糖皮质激素治疗,可显著下调F13A1、上调PLAT的表达。结论CRSwNP患者鼻黏膜中存在大量纤维蛋白沉积,可能与纤维蛋白交联和降解相关基因的表达失调有关,合并AS患者鼻黏膜中F13A1和PLAT的表达失调更为明显。

内镜下中鼻道上颌窦自然开口入路与泪前隐窝入路治疗上颌窦后鼻孔息肉的临床效果和术后复发情况

目的观察内镜下中鼻道上颌窦自然开口入路与泪前隐窝入路治疗上颌窦后鼻孔息肉(ACP)的临床效果和术后复发情况。方法回顾性分析2019年3月-2023年3月该院收治的64例ACP患者的临床资料,根据手术入路不同,分为对照组(n=32)与研究组(n=32),对照组采用内镜下中鼻道上颌窦自然开口入路治疗,研究组采用内镜下泪前隐窝入路治疗,比较两组患者临床疗效、手术指标、手术前后Lund-Mackay鼻内镜评分和鼻窦CT Lund-Mackay评分,以及术后5个月并发症和复发情况。结果研究组总有效率为93.75%,高于对照组的75.00%,且研究组术中出血量少于对照组,住院时间短于对照组,差异均有统计学意义(P<0.05);术后3个月,两组患者Lund-Mackay鼻内镜评分和鼻窦CT Lund-Mackay评分较术前低,且研究组低于对照组,差异均有统计学意义(P<0.05);研究组复发率为3.13%,低于对照组的18.75%,差异有统计学意义(P<0.05),两组患者术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论内镜下泪前隐窝入路治疗ACP的临床疗效好,能全面地清理病灶,且术中出血少,住院时间短,术后复发率较低,较内镜下中鼻道上颌窦自然开口入路更具优势。

鼻后神经切断术在复发性鼻窦炎伴息肉临床治疗中的应用

目的分析功能性鼻内镜手术联合鼻后神经切断术治疗复发性鼻窦炎伴息肉的临床疗效,以及对重要炎症指标的影响,探讨其临床作用机制。方法选择2021年1月-2021年12月该院复发性鼻窦炎伴息肉患者54例,采用随机抽签法,分为试验组(27例)和对照组(27例),对照组采用功能性鼻内镜手术,试验组采用功能性鼻内镜手术联合鼻后神经切断术,观察两组患者术前、术后6和12个月总有效率、鼻腔鼻窦结局测试22(SNOT-22)评分、Lund-Kennedy鼻内镜评分和炎症因子[外周血嗜酸性粒细胞(EOS)、免疫球蛋白E(IgE)、血清白细胞介素-4(IL-4)和血清白细胞介素-5(IL-5)]变化情况。结果术前两组患者各指标比较,差异均无统计学意义;试验组术后6和12个月随访人数分别为25和23例,对照组术后6和12个月随访人数分别为26和25例;术后6和12个月试验组总有效率、SNOT-22评分、Lund-Kennedy鼻内镜评分明显优于对照组,且术后12个月试验组EOS、IgE、IL-4和IL-5水平较对照组明显降低,差异均有统计学意义(P<0.05)。结论对于复发性鼻窦炎伴息肉患者,联合鼻后神经切断术的功能性鼻内镜手术,更能抑制机体IgE分泌和黏膜炎症反应,提高术后治疗效果。

分析优质护理对慢性鼻窦炎伴鼻息肉行鼻内镜术后患者睡眠质量的影响

目的:分析优质护理对慢性鼻窦炎伴鼻息肉行鼻内镜术后患者睡眠质量的影响。方法:选取2021年11月至2022年11月中国人民解放军联勤保障部队第九一〇医院收治的慢性鼻窦炎伴鼻息肉患者70例作为研究对象,按照随机数字表法分为对照组和观察组,每组35例。对照组给予常规护理干预,观察组实施优质护理干预。采用我院自制的睡眠质量量表比较干预前后2组患者睡眠质量的差异,采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评估2组患者干预前后的心理状态,采用SF-36生命质量量表比较2组患者干预前后生命质量的变化,并比较2组患者的护理满意度及并发症发生率。结果:干预后,观察组入睡时间、睡眠障碍、催眠药物评分显著低于对照组,观察组睡眠时间显著高于对照组,观察组SAS评分、SDS评分显著低于对照组,观察组护理满意度显著高于对照组,观察组并发症发生率显著低于对照组,观察组SF-36评分显著高于对照组,差异均有统计学意义(均P<0.05)。结论:优质护理可以减少患者鼻内镜术后并发症的发生率,改善患者睡眠质量,缓解焦虑、抑郁情绪,提高患者的生命质量,具有较好的临床推广应用价值。

外周血指标对鼻息肉患者黏膜中IL-5和金黄色葡萄球菌肠毒素特异性免疫球蛋白E阳性表达的预测价值

目的借助外周血指标预测慢性鼻窦炎伴鼻息肉(CRSwNP)2型生物标志物。方法收集2020年6月~2022年5月在北京同仁医院鼻科住院的CRSwNP患者临床资料,检测外周血中嗜酸粒细胞百分比(Eos%)、Eos计数、骨膜蛋白和总IgE以及CRSwNP黏膜中白细胞介素5(IL-5)和金黄色葡萄球菌肠毒素特异性免疫球蛋白E(Staphylococcus aureus enterotoxinimmunoglobulin E,SE-IgE)。应用受试者工作特征(ROC)曲线评估每个外周血指标对黏膜IL-5/SE-IgE阳性表达预测价值,利用Logistic回归筛选对黏膜IL-5/SE-IgE阳性有预测价值的外周血指标,构建诺模图模型。结果CRSwNP患者哮喘比例、血中Eos%、骨膜蛋白和总IgE在IL-5/SE-IgE阳性和阴性两组之间,均具有统计学差异。ROC曲线单因素分析显示血Eos%、Eos计数、骨膜蛋白和总IgE对黏膜IL-5和SE-IgE阳性预测的AUC分别波动在0.655~0.784和0.721~0.802,Logistic回归确认血中Eos%、总IgE和血中骨膜蛋白、总IgE可分别作为IL-5和SE-IgE阳性的独立预测因素。构建预测CRSwNP黏膜IL-5/SE-IgE阳性的诺模图模型,一致性指数(C-index)为0.804和0.81,提示具有很好的预测准确性。结论血中Eos%、总IgE和血中骨膜蛋白、总IgE分别构建的诺模图,对CRSwNP黏膜IL-5和SE-IgE阳性表达具有很好的预测价值,可以预判CRSwNP内型和表型严重性。

Cyclin D1、VEGF联合NLR、PLR水平预测慢性鼻窦炎-鼻息肉术后复发的临床研究

目的探究Cyclin D1、血管内皮生长因子(Vascular Endothelial Growth Factor,VEGF)表达含量联合中性粒细胞/淋巴细胞比值(Neutrophil-lymphocyte Ratio,NLR)和血小板/淋巴细胞比值(Platelet-lymphocyte Ratio,PLR)水平预测慢性鼻窦炎伴鼻息肉(Chronic Rhinosinusitis with Nasal Polyps,CRSwNP)复发的临床加价值。方法选取广东省韶关市粤北人民医院耳鼻喉科于2021年1月—2022年6月收治的333例CRSwNP患者为研究对象,均行慢性鼻窦炎-鼻息肉术治疗,根据术后复发情况分为复发组(138例)和未复发组(195例),比较两组患者一般资料、Cyclin D1、VEG、NLR、PLR水平,采用受试者工作特征(Receiver Operating Characteristic,ROC)曲线分析Cyclin D1、VEGF联合NLR、PLR水平对CRSwNP者术后1年复发的预测效能。结果两组Cyclin D1、VEGF、NLR、PLR水平对比,差异有统计学意义(P均<0.05)。Logistic回归分析结果显示,CRSwNP患者复发的影响因素包括Cyclin D1、VEGF、NLR、PLR水平(OR=1.521、1.483、1.365、1.403,P均<0.05)。ROC曲线结果显示Cyclin D1、VEGF、NLR、PLR四者联合检测的灵敏度、特异度及曲线下面积均高于单独检测(P均<0.05)。结论Cyclin D1、VEGF、NLR、PLR水平是诱发CRSwNP患者术后复发的相关因素,也是预测CRSwNP患者术后复发的可靠性指标。