山东大学耳鼻喉眼学报 ›› 2022, Vol. 36 ›› Issue (3): 195-201.doi: 10.6040/j.issn.1673-3770.0. 2020.477

• 临床研究 • 上一篇    下一篇

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

陈世琴,卫平存,胡云龙,胡金旺   

  1. 安徽省第二人民医院 耳鼻咽喉头颈外科, 安徽 合肥 230041
  • 发布日期:2022-06-15
  • 通讯作者: 胡金旺. E-mail:enthjw@163.com

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

CHEN Shiqin, WEI Pingcun, HU Yunlong, HU Jinwang   

  1. Department of Otorhinolaryngology & Head and Neck Surgery, Anhui No.2 Provincial People's Hospital, Hefei 230041, Anhui, China
  • Published:2022-06-15

PDF (PC)

84

摘要： 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。

关键词: 糖皮质激素, 慢性鼻窦炎, 鼻内镜外科手术, 黏膜, 视觉模拟量表, 鼻内镜Lund-Kennedy评分

Abstract: 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.

Key words: Glucocorticoid, Chronic rhinosinusitis, Endoscopic sinus surgery, Mucous membrane, Visual analogue scale, Nasal endoscopic Lund-Kennedy scale

中图分类号: 

  • R765.4
[1] Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020[J]. Rhinology, 2020, 58(Suppl S29): 1-464. doi:10.4193/Rhin20.600.
[2] 杨钦泰, 孙悦奇, 吴庆武, 等. 2020年欧洲鼻窦炎和鼻息肉意见书解读[J]. 中华耳鼻咽喉头颈外科杂志, 2020, 55(3): 304-308. doi:10.3760/cma.j.issn.1673-0860.2020.03.024. YANG Qintai, SUN Yueqi, WU Qingwu, et al. Interpretation of 2020 European position paper on rhinosinusitis and nasal polyps[J]. Chin J Otorhinolaryngol Head Neck Surg, 2020, 55(3): 304-308. doi:10.3760/cma.j.issn.1673-0860.2020.03.024.
[3] 付清玲, 史剑波. 我国慢性鼻-鼻窦炎的流行病学特征及其伴随疾病和危险因素解析[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(5): 321-324. doi:10.13201/j.issn.1001-1781.2018.05.001. FU Qingling, SHI Jianbo. Epidemiology, occupational and environmental risk factors of chronic rhinosinusitis in China[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(5): 321-324.doi:10.13201/j.issn.1001-1781.2018.05.001.
[4] 李晓华, 詹志荣, 孙建设, 等. 布地奈德对不伴鼻息肉的慢性鼻-鼻窦炎术后鼻黏膜细胞外基质的影响[J]. 中国耳鼻咽喉头颈外科, 2014,21(10): 546-549. doi:10.16066/j.1672-7002.2014.10.029. LI Xiaohua, ZHAN Zhirong, SUN Jianshe, et al. Effects of budesonide on extracellular matrix in nasal mucosa of chronic rhinosinusitis without nasal polyps after endoscopic sinus surgery[J]. Chin Arch Otolaryngol-Head Neck Surg, 2014,21(10): 546-549. doi:10.16066/j.1672-7002.2014.10.029.
[5] 徐翔, 葛亮, 刘蓓, 等. 鼻内镜术后鱼腥草滴鼻液与糠酸莫米松鼻喷雾剂联合局部应用对鼻黏膜组织重塑的影响研究[J]. 中国耳鼻咽喉头颈外科, 2020, 27(1): 43-46. doi:10.16066/j.1672-7002.2020.01.012.
[6] Snidvongs K, Pratt E, Chin D, et al. Corticosteroid nasal irrigations after endoscopic sinus surgery in the management of chronic rhinosinusitis[J]. Int Forum Allergy Rhinol, 2012, 2(5): 415-421. doi:10.1002/alr.21047.
[7] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 中国慢性鼻窦炎诊断和治疗指南(2018)[J]. 中华耳鼻咽喉头颈外科杂志, 2019, 54(2): 81-100. doi:10.3760/cma.j.issn.1673-0860.2019.02.001.
[8] 陈晓栋, 王海婷, 石照辉, 等. 慢性鼻-鼻窦炎内镜手术应用布地奈德混悬液中鼻道浸润的长期疗效观察[J]. 临床耳鼻咽喉头颈外科杂志, 2016,30(3): 203-205,208. doi:10.13201/j.issn.1001-1781.2016.03.008. CHEN Xiaodong, WANG Haiting, SHI Zhaohui, et al. Long-term outcome of budesonide middle meatus treatment for chronic rhinosinusitis patients following endoscopic sinus surgery[J]. J Clin Otorhinolaryngol Head Neck Surg, 2016, 30(3): 203-205,208. doi:10.13201/j.issn.1001-1781.2016.03.008.
[9] 李华斌, 赖玉婷. 慢性鼻-鼻窦炎的发病机制及诊疗进展[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 4-9. doi: 10.6040/j.issn.1673-3770.1.2018.004. LI Huabin, LAI Yuting. Pathogenesis, diagnosis, and treatment of chronic rhinosinusitis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(3): 4-9. doi: 10.6040/j.issn.1673-3770.1.2018.004.
[10] 谭国林. 从慢性鼻-鼻窦炎鼻息肉的发病机制认识鼻内镜手术后的高复发率[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(5): 324-327. doi:10.13201/j.issn.1001-1781.2018.05.002. TAN Guolin. Mechanism of chronic rhinosinusitis with polyps and its association with high recurrence rate of polyps after sinus surgery[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(5): 324-327.doi:10.13201/j.issn.1001-1781.2018.05.002.
[11] Rezaeian A. Outcome of spray cryotherapy plus functional endoscopic sinus surgery on management of healing in nasal polyposis[J]. Am J Otolaryngol, 2018, 39(1): 10-13.doi:10.1016/j.amjoto.2017.10.007.
[12] Hwang CS, Al Sharhan SS, Kim BR, et al. Randomized controlled trial of steroid-soaked absorbable calcium alginate nasal packing following endoscopic sinus surgery[J]. Laryngoscope, 2018, 128(2): 311-316. doi:10.1002/lary.26871.
[13] Xu JJ, Busato GM, McKnight C, et al. Absorbable steroid-impregnated spacer after endoscopic sinus surgery to reduce synechiae formation[J]. Ann Otol Rhinol Laryngol, 2016, 125(3): 195-198. doi:10.1177/0003489415606446.
[14] Levy JM, Mace JC, DeConde AS, et al. Improvements in psychological dysfunction after endoscopic sinus surgery for patients with chronic rhinosinusitis[J]. Int Forum Allergy Rhinol, 2016, 6(9): 906-913. doi:10.1002/alr.21776.
[15] 王建强, 白东风, 田春艳, 等. 三种填塞材料在鼻内镜术后填塞中的临床效果分析[J]. 中国耳鼻咽喉头颈外科, 2019, 26(11): 624-625. doi:10.16066/j.1672-7002.2019.11.013.
[16] 许海波, 洪燕丽, 李兆生, 等. 鼻内镜术后不同填塞材料对术后黏膜转归的影响[J]. 山东大学耳鼻喉眼学报, 2016, 30(5): 85-87,91. XU Haibo, HONG Yanli, LI Zhaosheng, et al. Packing material on outcomes of sinus mucosa with chronic rhinosinusitis after endoscopic sinus surgery[J]. J Otolaryngol Ophthalmol Shandong Univ, 2016, 30(5): 85-87,91.
[17] Chandra RK, Conley DB, Haines GK, et al. Long-term effects of FloSealTM packing after endoscopic sinus surgery[J]. Am J Rhinol, 2005, 19(3): 240-243. doi:10.1177/194589240501900304.
[18] Tajudeen BA, Ganti A, Kuhar HN, et al. The presence of eosinophil aggregates correlates with increased postoperative prednisone requirement[J]. Laryngoscope, 2019, 129(4): 794-799. doi:10.1002/lary.27693.
[19] Poetker DM, Jakubowski LA, Lal D, et al. Oral corticosteroids in the management of adult chronic rhinosinusitis with and without nasal polyps: an evidence-based review with recommendations[J]. Int Forum Allergy Rhinol, 2013, 3(2): 104-120. doi:10.1002/alr.21072.
[20] Marple BF, Smith TL, Han JK, et al. Advance II: a prospective, randomized study assessing safety and efficacy of bioabsorbable steroid-releasing sinus implants[J]. Otolaryngol Head Neck Surg, 2012, 146(6): 1004-1011. doi:10.1177/0194599811435968.
[21] Hox V, Lourijsen E, Jordens A, et al. Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: an EAACI position paper[J]. Clin Transl Allergy, 2020, 10: 1.doi:10.1186/s13601-019-0303-6.
[22] 岑瑞祥, 许昱, 万浪, 等. 纳吸棉联合布地奈德混悬液在内镜鼻窦术后填塞中的应用[J]. 临床耳鼻咽喉头颈外科杂志, 2014, 28(23): 1835-1838. doi:10.13201/j.issn.1001-1781.2014.23.005. CEN Ruixiang, XU Yu, WAN Lang, et al. Application of nasopore and budesonide suspension on tamping after endoscopic sinus surgery[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2014, 28(23): 1835-1838. doi:10.13201/j.issn.1001-1781.2014.23.005.
[23] 许庚, 李源, 谢民强, 等. 功能性内窥镜鼻窦手术后术腔粘膜转归阶段的划分及处理原则[J]. 中华耳鼻咽喉科杂志, 1999,34(5):302-305. XU Geng, LI Yuan, XIE Minqiang, et al. Staging of mucous membrane outcome in operative cavity after functional endoscopic sinus surgery[J]. Chin J Otorhinolaryngol, 1999, 34(5):302-305.
[1] 敖天, 程雷. 慢性鼻窦炎伴鼻息肉的内型研究及其指导下的精准控制与治疗[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 7-14.
[2] 熊攀辉,沈暘,杨玉成. 基于表型和内在型的慢性鼻窦炎诊治进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 15-19.
[3] 姚爽,娄鸿飞. 慢性鼻窦炎的内在型研究进展及精准医疗[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 20-29.
[4] 石帅,郑泉,程雷. 度普利尤单抗在慢性鼻窦炎伴鼻息肉治疗中的研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 36-42.
[5] 王欢,胡俐,余洪猛. 慢性鼻窦炎相关嗅觉功能障碍研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 43-49.
[6] 宜若男,陈福权. 嗜酸性粒细胞与嗅觉功能障碍[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 50-55.
[7] 谷钰,万鑫,肖自安. 中性粒细胞和嗜酸性粒细胞在慢性鼻窦炎中的相互影响及临床治疗思考[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 56-63.
[8] 林海,朱莹,张维天. 慢性鼻窦炎发病中离子通道作用研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 64-70.
[9] 乔新杰,赵玉林. 慢性鼻窦炎中上皮间质转化信号转导通路及其他相关因子的研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 71-77.
[10] 黄丹怡,张婷,陈静,张薇. 上皮屏障在慢性鼻窦炎伴鼻息肉中的研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 78-83.
[11] 李佳倪,朱冬冬,孟粹达. 表观遗传学在慢性鼻窦炎伴鼻息肉发病机制中的作用[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 84-91.
[12] 资昊坤,肖旭平,李云秋. 口服糖皮质激素在慢性鼻窦炎伴鼻息肉围手术期的应用现状[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 98-103.
[13] 曹轩,肖旭平,李云秋. 透明质酸在慢性鼻窦炎中的研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 104-109.
[14] 刘一潼,周穗子,邱前辉. NLRP3炎症小体在慢性鼻窦炎和变应性鼻炎中的研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 142-146.
[15] 刘厚军,张倩,程友,薛飞,许莉,吴明海. 慢性鼻窦炎伴双侧鼻息肉的发病与RANTES基因多态性的关系分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 165-170.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 马宝峰,党光福 . 折叠式人工晶状体经巩膜缝线固定术16例[J]. 山东大学耳鼻喉眼学报, 2008, 22(4): 376 -378 .
[2] 封新荣,张红霞,许贞姬,曲君君 . 射频消融术治疗慢性肥厚性鼻炎[J]. 山东大学耳鼻喉眼学报, 2006, 20(3): 225 -226 .
[3] 张秋贵,何海燕 . 青岛地区变应性鼻炎常见变应原调查分析[J]. 山东大学耳鼻喉眼学报, 2006, 20(6): 520 -521 .
[4] 李海燕,赵秋良,韩晓攀,于丽 . 阻塞性睡眠呼吸暂停综合征患者自由基损伤与高血压的关系[J]. 山东大学耳鼻喉眼学报, 2006, 20(6): 527 -529 .
[5] 宋西成,张华,张庆泉 . 血循环DNA的检测与头颈部肿瘤的诊断[J]. 山东大学耳鼻喉眼学报, 2006, 20(5): 385 -387 .
[6] 詹善强,孔凡俐,操文娟,汤杰,沈菊,詹文波 . 电刀切除扁桃体236例[J]. 山东大学耳鼻喉眼学报, 2006, 20(6): 559 -560 .
[7] 张 虎,艾 琴 . 甲状腺癌再手术15例[J]. 山东大学耳鼻喉眼学报, 2007, 21(2): 166 -167 .
[8] 胡 明,李招娜,李云杰,陶祥臣 . 硬性透气性角膜接触镜对圆锥角膜的塑形作用[J]. 山东大学耳鼻喉眼学报, 2007, 21(2): 171 -173 .
[9] 娄 锋 . 喉上神经阻滞预防喉显微手术心血管反应[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 173 -175 .
[10] 陈伟雄 王跃建 曾勇 何发尧 张剑利 郑立岗 汤苏成. 胸骨上小切口无注气内镜甲状腺手术的临床体会[J]. 山东大学耳鼻喉眼学报, 2009, 23(4): 24 -26 .
网站版权所有 © 2018 《山东大学耳鼻喉眼学报》编辑部　
地址：山东省济南市山大南路27号（250100）电话：+86-0531-88366912 E-mail: ebhxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发