关键词: 鼻-鼻窦炎伴鼻息肉, 哮喘, 肺功能, 药物干预

Abstract: Objective To analyze the pulmonary function of patients who developed chronic rhinosinusitis with nasal polyps(CRSwNP). Methods The pulmonary function of 74 patients who underwent functional endoscopic sinus surgery(FESS)was measured and analyzed. The patients were divided into comparable groups under different criteria: male(49 patients)and female(25 patients)groups, smoking(32 patients)and non-smoking(42 patients)groups, serum-specific immunoglobulin E(IgE)-positive(27 patients)and serum-specific IgE-negative(47 patients)groups, elevated eosinophils in peripheral blood(27 patients)and non-elevated eosinophils in peripheral blood(47 patients)groups, and elevated eosinophils in nasal polyps(31 patients)and non-elevated eosinophils in nasal polyps(43 patients)groups. The pulmonary function of all the patients were completed under guidance of a professional allergist with qualifications; test data were collected using the German GANSHORN Pulmonary Function Instrument(PowerCube-Body). Analyzed indices of pulmonary function included the percentage of forced expiratory volume in the first second(FEV₁%pre), percentage of predicted value of the ratio of FEV₁ to forced vital capacity(FVC)(FEV₁/FVC% pre), percentage of maximum ventilatory volume estimated(MVV% pre),forced expiratory flow at 50% of FVC(FEF_50%), forced expiratory flow at 75% of FVC(FEF_75%), and maximal mid-expiratory flow(MMEF). After pulmonary function was evaluated, all 74 patients accepted individualized specific aerosol inhalation twice or thrice a day, combined with one inhalation of salmeterol xinafoate and fluticasone propionate powder twice a day. In addition, 10 mg of oral montelukast sodium and loratadine were administered once a day separately, along with a nasal spray of azelastine hydrochloride and budesonide twice a day. The medical therapy persisted for 1-14 days from admission to preoperation, and the patients were administered another aerosol inhalation 30 min before surgery and one inhalation of salmeterol xinafoate and fluticasone propionate powder before general anesthesia. The improvement in pulmonary function after medical treatment was also evaluated. Results All 74 patients underwent FESS unremarkably. On admission, FEF_50%, FEF_75%, and MMEF in the female group were lower than in the male group(t=3.213, 2.829, and 3.644, respectively; P=0.002 0, 0.006, and 0.000 5, respectively); FEV₁/FVC% pre was lower in the smoking group than in the non-smoking group(t=2.032, P=0.045 8), in the elevated eosinophils in peripheral blood group than in the non-elevated eosinophils in peripheral blood group(t=2.259, P=0.029 2), and in the elevated eosinophils in nasal polyps group than in the non-elevated eosinophils in nasal polyps group(t=2.634, P=0.010 3); and MVV% pre decreased significantly in the elevated eosinophils in nasal polyps group compared to in the non-elevated eosinophils in nasal polyps group(t=2.453, P=0.016 6). Pulmonary function indices including FEV₁%pre, FEV₁/FVC% pre, MVV% pre, FEF_50%, FEF_75%, and MMEF improved significantly after standardized medical treatment(P=0.000 0). Conclusion Female patients are more likely to develop small airway dysfunction compared to male patients among those who develop CRSwNP and asthma. Smoking and elevated eosinophils in peripheral blood and in nasal polyps may also influence pulmonary function. Standardized preoperative medical treatment is efficient in improving the pulmonary function of patients with CRSwNP and asthma and in decreasing the potential of acute attacks of asthma. Therefore, unremarkable surgeries are guaranteed.

Key words: Chronic rhinosinusitis with nasal polyps, Asthma, Pulmonary function, Medical treatment