鼻内镜手术联合鼻用糖皮质激素治疗腺样体肥大性

doi:10.6040/j.issn.1673-3770.0.2017.404

摘要/Abstract

摘要： 目的探讨鼻用糖皮质激素辅助鼻内镜下腺样体切除术治疗腺样体肥大性小儿鼾症的临床效果及安全性。方法选取腺样体肥大性小儿鼾症患者98例为研究对象,采用随机平行对照法将其分为2个组各49例。对照组给予鼻内镜下腺样体切除术,以及口服头孢克洛颗粒、雾化吸入地塞米松等常规治疗。观察组在对照组基础上给予鼻用糖皮质激素喷鼻。比较两组治疗有效率、不良反应发生率、治疗前后鼻咽侧位片A/N值、呼吸暂停低通气指数、睡眠质量、免疫与炎症因子水平的差异。结果观察组总有效率为89.80%(44/49),对照组为73.47%(36/49),观察组显著高于对照组(χ2=4.356, P=0.037)。观察组出现鼻出血1例,鼻前庭干燥感1例,发生率为4.08%,对照组未见鼻出血及鼻前庭干燥感发生,两组不良反应发生率比较差异无统计学意义(P>0.05)。治疗前,两组鼻咽侧位片A/N值、呼吸暂停低通气指数及睡眠质量比较差异无统计学意义(P>0.05),治疗后两组鼻咽侧位片A/N值、呼吸暂停低通气指数及睡眠质量均改善,且组间比较差异有统计学意义(P<0.05)。治疗前,两组IgE、LTE4、TNF-α、IL-6、IL-8比较差异无统计学意义(P>0.05),治疗后,两组IgE、LTE4、TNF-α、IL-6、IL-8均降低,且组间比较差异有统计学意义(P<0.05)。结论对腺样体肥大性小儿鼾症患者,给予鼻用糖皮质激素辅助鼻内镜腺样体切除术治疗能够通过抑制炎症因子释放,改善打鼾、鼻塞等临床症状,且风险较小,患儿睡眠质量较高,值得推广应用。

关键词: 腺样体肥大, 小儿鼾症, 鼻用糖皮质激素, 手术治疗, 临床效果

Abstract: Objective To discuss the clinical efficacy and safety of nasal glucocorticoid-assisted endoscopic adenoidectomy in the treatment of adenoidal hypertrophic snoring in children. Methods Ninety-eight cases of children with adenoidal hypertrophic snoring were randomly divided into control and observation groups, with 49 cases in each group. While patients in the control group were treated with endoscopic adenoidectomy, Cefaclor Granules by oral administration, dexamethasone by inhalation, and other conventional treatments, patients in the observation group were treated with a nasal glucocorticoid. The treatment efficiency, incidence of adverse events, A/N of nasopharynx lateral radiograph, apnea-hypopnea index, sleep quality, and levels of immune and inflammatory factors before and after treatment were compared between the two groups. Results The total effective rate of treating adenoidal hypertrophic snoring was noted to be 89.80%(44/49)and 73.47%(36/49)for the observation and control group respectively. This rate in the observation group was significantly higher than that in the control group(χ2=4.356, P=0.037). There was 1 case of nasal bleeding and 1 case of nasal vestibule dryness sensation reported in the observation group, with a 4.08% incidence rate of adverse reactions in this group. On the contrary, no nasal bleeding and nasal vestibule dryness was reported in the control group and there was no significant difference in the incidence rate of adverse reactions between the two groups(P>0.05). Before treatment, there were no significant differences in A/N of nasopharynx lateral radiograph, apnea-hypopnea index, and sleep quality between the two groups(P>0.05). After treatment, the A/N of nasopharynx lateral radiograph, apnea-hypopnea index, and sleep quality of the two groups were all improved, and there was a significant difference between the two groups(P<0.05). Before treatment, there were no significant differences in IgE, LTE4, TNF-α, IL-6, and IL-8 levels between the two groups(P>0.05). After treatment, the levels of IgE, LTE4, TNF-α, IL-6, and IL-8 in the two groups decreased, and there was a significant difference between the two groups(P<0.05). Conclusion This study reported that nasal glucocorticoid-assisted endoscopic adenoidectomy inhibited the inflammatory factors and reduced snoring, nasal congestion, and other clinical symptoms, with little risk and improved sleep quality, in children with adenoid hypertrophy snoring and can be worth popularizing.

Key words: Clinical effect, Adenoid hypertrophy, Nasal glucocorticoid, Surgical treatment, Snoring in children

中图分类号:

R725.6

高进良,年婉清,李烁. 鼻内镜手术联合鼻用糖皮质激素治疗腺样体肥大性[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 38-42.

GAO Jinliang, NIAN Wanqing, LI Shuo. Evaluation of the clinical curative effect of nose surgery in combination with nasal corticosteroids in[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2018, 32(2): 38-42.

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