山东大学耳鼻喉眼学报 ›› 2022, Vol. 36 ›› Issue (5): 11-17.doi: 10.6040/j.issn.1673-3770.0.2021.395

• 论著 • 上一篇    

低温等离子射频消融术治疗药物性鼻炎27例

李定波1,唐志元1,邓智毅1,曾宪海1,张秋航1,2,王再兴1   

  1. 1.深圳市龙岗区耳鼻咽喉医院/深圳市耳鼻咽喉研究所 耳鼻咽喉头颈外科, 广东 深圳 518172;
    2.首都医科大学附属北京宣武医院 耳鼻咽喉头颈外科, 北京 100730
  • 发布日期:2022-09-20
  • 通讯作者: 王再兴. E-mail:entzxwang@outlook.com
  • 基金资助:
    深圳市龙岗区科技发展专项资金医疗卫生科技计划项目(LGKCYLWS2020097)

Curative effect analysis of low-temperature plasma radiofrequency ablation in 27 cases of drug-related rhinitis

LI Dingbo1, TANG Zhiyuan1, DENG Zhiyi1, ZENG Xianhai1, ZHANG Qiuhang1,2, WANG Zaixing1   

  1. 1. Department of Otorhinolaryngology & Head and Neck Surgery, Institute of ENT and Shenzhen Key Laboratory of ENT/Longgang ENT Hospital, Shenzhen 518172, Guangdong, China;
    2. Department of Otorhinolaryngology & Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100730, China
  • Published:2022-09-20

摘要: 目的 探讨低温等离子射频消融术(LPRFA)治疗药物性鼻炎的疗效。 方法 对27例药物性鼻炎患者实施双侧下鼻甲LPRFA,统计并分析患者术前、术后3个月、术后6个月视觉模拟评分(VAS)和Lund-Kennedy鼻内镜评分及鼻阻力测量值。 结果 VAS鼻内镜评分术前评分为(7.82±0.92)、术后3个月评分为(2.15±0.99),术后6个月评分为(2.26±1.06);Lund-Kennedy鼻内镜评分:术前评分为(3.22±0.58)、术后3个月评分为(1.15±0.86),术后6个月评分为(0.63±0.56);与术前相比,进行了LPRFA的患者术后3个月、6个月的VAS和Lund-Kennedy鼻内镜评分明显降低,差异有统计学意义(P<0.05);鼻窦CT和鼻内镜检查示鼻黏膜恢复良好,总鼻道较术前通畅,患者自述鼻塞症状明显改善,术前吸气总鼻阻力值为(0.97±0.50)kPa/L·s,呼气总鼻阻力值为(0.35±0.23)kPa/L·s,术后3个月的吸气总鼻阻力值为(1.01±0.84)kPa/L·s,呼气总鼻阻力值为(0.35±0.19)kPa/L·s,术后3个月患者吸气和呼气总鼻阻力值明显降低,差异有统计学意义(P<0.05)。 结论 采用LPRFA治疗药物性鼻炎后,患者鼻塞等鼻部症状明显缓解,生活质量得到提高,并在随访期(6个月)中,患者疗效稳定,LPRFA治疗药物性鼻炎值得临床推广应用。

关键词: 低温等离子射频消融术, 药物性鼻炎, 鼻阻力, 视觉模拟评分, Lund-Kennedy鼻内镜评分

Abstract: Objective To analyze the therapeutic effect of low-temperature plasma radiofrequency ablation(LPRFA)on rhinitis medicamentosa. Methods Twenty-six patients with rhinitis medicamentosa were treated using LPRFA in the bilateral inferior turbinates. The visual analog scale(VAS)score, Lund-Kennedy endoscopic nasal score, and nasal resistance measurements were collected and analyzed statistically at 3 months after surgery. Results The preoperative, 3-month postoperative, and 6-month postoperative VAS endoscopic scores were 7.82±0.92, 2.15±0.99, and 2.26±1.06, respectively. The preoperative, 3-month postoperative, and 6-month postoperative Lund-Kennedy nasal endoscopic scores were 3.22±0.58, 1.15±0.86, and 0.63±0.56, respectively. Patients who underwent LPRFA had significantly lower VAS and Lund-Kennedy endoscopic scores at 3 and 6 months postoperatively than the preoperative scores(P<0.05). Sinus CT and nasal endoscopy showed that the nasal mucosa had recovered well. The total nasal tract was unobstructed postoperatively compared with that before surgery. Furthermore, the patient-reported symptoms of nasal obstruction were significantly improved. The preoperative total nasal inspiratory resistance value was 0.97±0.50 kPa/L·s. The total nasal expiratory resistance value was 0.35±0.23 kPa/L·s. The total nasal inspiratory resistance value 3 months postoperatively was 1.01±0.84 kPa/L·s. The total expiratory nasal resistance was 0.35±0.19 kPa/L·s. The total inspiratory and expiratory nasal resistance significantly decreased at 3 months after surgery(P<0.05). Conclusion After treating rhinitis medicamentosa using LPRFA, the nasal symptoms such as nasal congestion were relieved, and the patient's quality of life improved. During the follow-up period(6 months), nasal obstruction and other nasal symptoms were gradually relieved. Hence, LPRFA should be recommended for the clinical treatment of rhinitis medicamentosa.

Key words: Low-temperature plasma radiofrequency ablation, Rhinitis medicamentosa, Nasal resistance, Visual analog scale, Lund-Kennedy nasal endoscopic score

中图分类号: 

  • R765
[1] Settipane RA. Rhinitis: a dose of epidemiological reality[J]. Allergy Asthma Proc, 2003, 24(3): 147-154.
[2] 王忠义. 布地奈德联合鼻内镜手术治疗慢性鼻炎鼻窦炎伴鼻息肉的疗效观察[J]. 华夏医学, 2018, 31(5): 114-116. doi:10.19296/j.cnki.1008-2409.2018-05-038. WANG Zhongyi. Efficacy of budesonide combined with endoscopic sinus surgery forchronic rhinosinusitis with nasal polyps[J]. Acta Medicinae Sinica, 2018, 31(5): 114-116. doi:10.19296/j.cnki.1008-2409.2018-05-038.
[3] Lockey RF. Rhinitis medicamentosa and the stuffy nose[J]. J Allergy Clin Immunol, 2006, 118(5): 1017-1018. doi:10.1016/j.jaci.2006.06.018.
[4] Ramey JT, Bailen E, Lockey RF. Rhinitis medicamentosa[J]. J Investig Allergol Clin Immunol, 2006, 16(3):148-155.
[5] 盛健峰. 鼻内镜下低温等离子射频消融术治疗慢性肥厚性鼻炎的临床研究[J]. 四川医学, 2014, 35(8): 1008-1010. doi:10.16252/j.cnki.issn1004-0501-2014.08.059. SHENG Jianfeng. Clinical study on the nasal endoscopic plasma radiofrequency ablation at low temperature for chronic hypertrophic rhinitis[J]. Sichuan Medical Journal, 2014, 35(8): 1008-1010. doi:10.16252/j.cnki.issn1004-0501-2014.08.059.
[6] 王雨农, 栾兆磊, 王洪田. 药物性鼻炎的研究进展[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(11): 872-875. doi:10.3760/cma.j.issn.1673-0860.2017.11.019. WANG Yunong, LUAN Zhaolei, WANG Hongtian. Research progress on rhinitis medicamentosa[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2017, 52(11): 872-875. doi:10.3760/cma.j.issn.1673-0860.2017.11.019.
[7] Bousquet PJ, Combescure C, Neukirch F, et al. Visual analog scales can assess the severity of rhinitis graded according to ARIA guidelines[J]. Allergy, 2007, 62(4): 367-372. doi:10.1111/j.1398-9995.2006.01276.x.
[8] Psaltis AJ, Li G, Vaezeafshar R, et al. Modification of the Lund-Kennedy endoscopic scoring system improves its reliability and correlation with patient-reported outcome measures[J]. Laryngoscope, 2014, 124(10): 2216-2223. doi:10.1002/lary.24654.
[9] 许庚, 顾之燕, 韩德民, 等. 关于限制滥用麻黄素类鼻腔减充血剂的建议[J]. 耳鼻咽喉头颈外科, 2003, 10(3): 186-188. doi:10.3969/j.issn.1672-7002.2003.03.040.
[10] Yukselen A, Kendirli SG, Yilmaz M, et al. Effect of one-year subcutaneous and sublingual immunotherapy on clinical and laboratory parameters in children with rhinitis and asthma: a randomized, placebo-controlled, double-blind, double-dummy study[J]. Int Arch Allergy Immunol, 2012, 157(3): 288-298. doi:10.1159/000327566.
[11] Eifan AO, Akkoc T, Yildiz A, et al. Clinical efficacy and immunological mechanisms of sublingual and subcutaneous immunotherapy in asthmatic/rhinitis children sensitized to house dust mite: an open randomized controlled trial[J]. Clin Exp Allergy, 2010, 40(6): 922-932. doi:10.1111/j.1365-2222.2009.03448.x.
[12] 郝玉梅, 张咏梅. 氦-氖激光治疗药物性鼻炎临床分析[J]. 山东大学基础医学院学报, 2003, 17(2): 124.
[13] 裴鹏. ATP治疗药物性鼻炎60例[J]. 山东大学基础医学院学报, 2004, 18(4): 196. doi:10.3969/j.issn.1673-3770.2004.04.029.
[14] 陈瑜萍, 李其兴. 药物性鼻炎应用糠酸莫米松鼻喷雾剂治疗效果分析[J]. 中外医学研究, 2019, 17(25): 148-150. doi:10.14033/j.cnki.cfmr.2019.25.063. CHEN Yuping, LI Qixing. Therapeutic effect of mometasone furoate nasal spray on drug-induced rhinitis[J]. Chinese and Foreign Medical Research, 2019, 17(25): 148-150. doi:10.14033/j.cnki.cfmr.2019.25.063.
[15] 李巧玉, 郑国玺. 布地奈德鼻喷雾剂对过敏性鼻炎患者Th1/Th2细胞因子的影响及疗效观察[J]. 河北医学, 2016, 22(4): 538-540. doi:10.3969/j.issn.1006-6233.2016.04.004. LI Qiaoyu, ZHENG Guoxi. Efficacy of budesonide nasal spray and the influence on Th1/Th2 cytokines in patients with allergic rhinitis[J]. Hebei Medicine, 2016, 22(4): 538-540. doi:10.3969/j.issn.1006-6233.2016.04.004.
[16] Ostroumova OD, Shikh EV, Rebrova EV, et al. Rhinitis medicamentosa. Vestn Otorinolaringol, 2020, 85(3): 75-82. doi: 10.17116/otorino20208503175.
[17] 曾宪平, 郭雪雪, 李芊颖, 等. 药物性鼻炎阶梯治疗的临床分析[J]. 中国耳鼻咽喉颅底外科杂志, 2021, 27(3): 333-336. doi:10.11798/j.issn.1007-1520.202103055. ZENG Xianping, GUO Xuexue, LI Qianying, et al. Clinical analysis of rhinitis medicamentosa treated with stage therapy[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2021, 27(3): 333-336. doi:10.11798/j.issn.1007-1520.202103055.
[18] 刘青山, 王定胜. 高渗盐水替代麻黄素配伍克林霉素滴鼻佐治小儿鼻窦炎临床效果观察[J]. 中国实用医药, 2014, 9(32): 121-122. doi:10.14163/j.cnki.11-5547/r.2014.32.095.
[19] 田淑琴. 低温等离子射频消融术治疗慢性肥厚性鼻炎疗效分析[J]. 中国临床医生杂志, 2020, 48(5): 618-619. doi:10.3969/j.issn.2095-8552.2020.05.035.
[20] 盛健峰. 鼻内镜下低温等离子射频消融术治疗慢性肥厚性鼻炎的临床研究[J]. 四川医学, 2014, 35(8): 1008-1010. doi:10.16252/j.cnki.issn1004-0501-2014.08.059. SHENG Jianfeng. Clinical study on the nasal endoscopic plasma radiofrequency ablation at low temperature for chronic hypertrophic rhinitis[J]. Sichuan Medical Journal, 2014, 35(8): 1008-1010. doi:10.16252/j.cnki.issn1004-0501-2014.08.059.
[21] 蔡国遇. 等离子低温治疗慢性肥厚性鼻炎的疗效观察[J]. 中国医药指南, 2014, 12(35): 27. doi:10.15912/j.cnki.gocm.2014.35.017. CAI Guoyu. Observation of the effect in treatment of chronic hypertrophic rhinitis by low-temperature plasma[J]. Guide of China Medicine, 2014, 12(35): 27. doi:10.15912/j.cnki.gocm.2014.35.017.
[22] 彭洪, 尹金淑, 王佳, 等. 低温等离子消融治疗药物治疗效果不理想的常年性变应性鼻炎[J]. 山东大学耳鼻喉眼学报, 2014, 28(6): 29-31. doi:10.6040/j.issn.1673-3770.0.2014.131. PENG Hong, YIN Jinshu, WANG Jia, et al. Hypothermal radiofrequency ablation in perennial allergic rhinitis with unsatisfactory effect by drugs[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2014, 28(6): 29-31. doi:10.6040/j.issn.1673-3770.0.2014.131.
[23] 李佩忠, 邱明玲, 薛亚琼. 正常和病理状态下鼻气道阻力在鼻腔中的分布[J]. 中国耳鼻咽喉头颈外科, 2009, 16(7): 349-351. LI Peizhong, QIU Mingling, XUE Yaqiong. Distribution of nasal airway resistance in normal and pathologic nasal cavity[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2009, 16(7): 349-351.
[24] Back LJ, Hytonen mL, Malmberg HO, et al. Submucosal bipolar radiofrequency thermal ablation of inferior turbinates: a long-term follow-up with subjective and objective assessment[J]. Laryngoscope, 2002, 112(10): 1806-1812. doi:10.1097/00005537-200210000-00019.
[25] 苏小磊, 廖剑绚, 唐洪波. 鼻内镜下低温等离子射频消融与双极电凝治疗慢性肥厚性鼻炎的疗效比较[J]. 华夏医学, 2011, 24(4): 455-457. doi:10.3969/j.issn.1008-2409.2011.04.020. SU Xiaolei, LIAO Jianxuan, TANG Hongbo. Curative effect comparison of nasal endoscopic radiofrequency ablation and bipolar coagulaxion in treatment of chronic hypertrophic rhinitis[J]. Chinese Journal of Hematology, 2011, 24(4): 455-457. doi:10.3969/j.issn.1008-2409.2011.04.020.
[26] 艾文彬, 肖霞, 罗志强, 等. 鼻内镜下等离子消融联合下鼻甲骨折外移治疗慢性肥厚性鼻炎105例[J]. 山东大学耳鼻喉眼学报, 2011, 25(2): 51-53. AI Wenbin, XIAO Xia, LUO Zhiqiang, et al. Radio-frequency ablation with lateral fracture for 105 cases of chronic hypertrophic rhinitis after ESS[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2011, 25(2): 51-53.
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