咽喉反流症状或体征评分阳性的慢性鼻窦炎患者鼻内镜术后碱性等渗盐水冲洗的疗效观察

doi:10.6040/j.issn.1673-3770.0.2021.529

摘要/Abstract

摘要： 目的探讨碱性等渗盐水鼻腔冲洗对于伴有咽喉反流症状或体征评分阳性的慢性鼻窦炎患者鼻内镜术后的临床疗效。方法 80例咽喉反流症状或体征评分阳性的慢性鼻窦炎患者使用随机数字生成器分为2组,其中鼻内镜手术后接受碱性等渗盐水冲洗患者40例为研究组,鼻内镜术后接受生理盐水冲洗患者40例为对照组。根据外周血嗜酸粒细胞占白细胞百分比是否超过4.27%对研究组和对照组分层。在鼻内镜手术后2周、6周进行随访评估。评估包括反流症状指数评分量表、反流体征评分量表、鼻腔鼻窦结局20量表、视觉模拟量表、鼻阻塞症状评估量表、Lund-Kennedy评分以及不良反应记录。结果在2周时,研究组视觉模拟量表评分的变化量［3.0(2.0,4.0)分］>对照组［1.5(0.0,3.0)分］(P=0.016<0.05);在6周时,研究组鼻腔鼻窦结局20评分的变化量［(13.4±10.3)分］以及视觉模拟量表评分的变化量［3.0(2.0,4.0)分］>对照组［(8.7±6.1)、1.0(0.0,2.2分)］(P=0.001<0.05)。分层后,使用碱性等渗盐水冲洗的患者中外周血嗜酸粒细胞占白细胞百分比≤4.27%的亚组在鼻内镜手术后2周的鼻腔鼻窦结局20和视觉模拟量表评分变化量［13.0(8.0,19.0)、(3.2±1.9)分］更大(P=0.024<0.05,P=0.030<0.05)且在术后6周的鼻腔鼻窦结局20和视觉模拟量表评分变化量［(15.7±9.5)、2.0(2.0,4.0)分］更大(P=0.002<0.05,P=0.005<0.05)。2组患者均未出现严重不良反应。结论对于伴有咽喉反流症状或体征评分阳性的慢性鼻窦炎患者,在鼻内镜手术后早期护理阶段使用碱性等渗盐水进行鼻腔冲洗具有一定的临床疗效,尤其是在外周血嗜酸粒细胞占白细胞百分比低于4.27%的患者中。

关键词: 鼻腔冲洗, 咽喉反流, 鼻窦炎, 鼻内镜, 鼻内镜手术

Abstract: Objective To study the efficacy of alkaline isotonic saline in laryngopharyngeal reflux symptom-positive or finding-positive patients with chronic rhinosinusitis(CRS)following endoscopic sinus surgery(ESS). Methods Eighty CRS patients who were reflux symptom- or finding score-positive and who had undergone ESS were randomized to receive alkaline isotonic saline(study group; n=40)or normal saline(control group; n=40). All patients were classified by phenotype(high-%EOS or low-%EOS)according to whether the eosinophil proportion in peripheral blood(%EOS)exceeded 4.27%. Follow-up evaluations were conducted at 2 and 6 weeks after surgery. Evaluations included reflux symptom index(RSI), reflux finding score(RFS), sino-nasal outcome test-20(SNOT-20), visual analogue scale(VAS), nasal obstruction symptom evaluation(NOSE), Lund-Kennedy endoscopic score, and adverse events. Results The study group showed better improvement in the VAS score ［3.0(2.0,4.0)］ than the control group ［1.5(0.0,3.0)］ at 2 weeks postoperatively(P=0.016<0.05); the variation in SNOT-20 and VAS scores ［(13.4±10.3)and 3.0(2.0,4.0), respectively］ was significantly reduced in the study group at 6 weeks(P=0.001<0.05). After stratification, patients in the low-%EOS + study subgroup showed a significant improvement in the variation of SNOT-20 and VAS scores at 2 weeks ［13.0(8.0,19.0)and(3.2±1.9), respectively］(P=0.024<0.05,P=0.030<0.05, respectively)and 6 weeks ［(15.7±9.5)and 2.0(2.0,4.0), respectively］ postoperatively(P=0.002<0.05,P=0.005<0.05, respectively). There were no severe side effects among the groups. Conclusions Alkaline isotonic saline has a better clinical efficacy in patients with CRS who are RSI-positive or RFS-positive during the early postoperative care period of CRS, particularly those with a low %EOS.

Key words: Nasal Irrigation, Laryngopharyngeal reflux, Sinusitis, Endoscopy, Endoscopic sinus surgery

中图分类号:

R765.4

秦铭,孙占伟,王卫卫,李世超,武天义,王广科. 咽喉反流症状或体征评分阳性的慢性鼻窦炎患者鼻内镜术后碱性等渗盐水冲洗的疗效观察[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 147-153.

QIN Ming, SUN Zhanwei, WANG Weiwei, LI Shichao, WU Tianyi, WANG Guangke. Efficacy of alkaline isotonic saline in laryngopharyngeal reflux symptom-positive or finding score-positive patients with chronic rhinosinusitis following endoscopic sinus surgery[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 147-153.

参考文献

[1] 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. Chinese guidelines for diagnosis and treatment of chronic rhinosinusitis(2018)[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2019, 54(2): 81-100. doi:10.3760/cma.j.issn.1673-0860.2019.02.001.
[2] 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.
[3] Ford CN. Evaluation and management of laryngopharyngeal reflux[J]. JAMA, 2005, 294(12): 1534-1540. doi:10.1001/jama.294.12.1534.
[4] 中华耳鼻咽喉头颈外科杂志编辑委员会咽喉组, 中华医学会耳鼻咽喉头颈外科学分会咽喉学组. 咽喉反流性疾病诊断与治疗专家共识(2015年)[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(5): 324-326. doi:10.3760/cma.j.issn.1673-0860.2016.05.002.
[5] 曾会勤, 侯凌云, 戴晓珊, 等. 儿童咽喉反流的诊断与治疗进展[J]. 中华实用儿科临床杂志, 2018, 33(7): 558-560. doi:10.3760/cma.j.issn.2095-428X.2018.07.020. ZENG Huiqin, HOU Lingyun, DAI Xiaoshan, et al. Progress in diagnosis and treatment of children with laryngopharyngeal reflux[J]. Chinese Journal of Applied Clinical Pediatrics, 2018, 33(7): 558-560. doi:10.3760/cma.j.issn.2095-428X.2018.07.020.
[6] 孙娜, 陈晓平. 咽喉反流与耳鼻咽喉科疾病[J]. 山东大学耳鼻喉眼学报, 2016, 30(6): 85-89. doi: 10.6040/j.issn.1673-3770.0.2016.213. SUN Na, CHEN Xiaoping. Laryngopharyngeal reflux and otorhinolaryngology diseases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2016, 30(6): 85-89. doi: 10.6040/j.issn.1673-3770.0.2016.213.
[7] 吴彦桥, 梁芳芳. 咽喉反流性鼻炎的临床初步研究[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(3): 200-202. doi:10.13201/j.issn.1001-1781.2016.03.007. WU Yanqiao, LIANG Fangfang. Clinical pilot study on the rhinitis due to laryngopharyngeal reflux[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2016, 30(3): 200-202. doi:10.13201/j.issn.1001-1781.2016.03.007.
[8] 韩德民. 正确理解难治性鼻-鼻窦炎[J]. 中华耳鼻咽喉头颈外科杂志, 2013, 48(2): 113-114. doi:10.3760/cma.j.issn.1673-0860.2013.02.012.
[9] 赵传亮, 余少卿. 难治性慢性鼻窦炎的临床研究进展[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(1): 19-22, 27. doi:10.13201/j.issn.1001-1781.2020.01.005. ZHAO Chuanliang, YU Shaoqing. Recent clinical advances in refractory chronic sinusitis[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2020, 34(1): 19-22, 27. doi:10.13201/j.issn.1001-1781.2020.01.005.
[10] Leason SR, Barham HP, Oakley G, et al. Association of gastro-oesophageal reflux and chronic rhinosinusitis: systematic review and meta-analysis[J]. Rhinology, 2017, 55(1): 3-16. doi:10.4193/Rhin16.177.
[11] 郎永耀, 杨云, 刘晴, 等. 咽喉反流性疾病的影响因素及治疗效果分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 119-123. doi: 10.6040/j.issn.1673-3770.0.2018.472. LANG Yongyao, YANG Yun, LIU Qing, et al. Analysis of influencing factors and observation of therapeutic effects in patients with laryngopharyngeal reflux disease[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 119-123. doi: 10.6040/j.issn.1673-3770.0.2018.472.
[12] Anzic SA, Turkalj M, Župan A, et al. Eight weeks of omeprazole 20 Mg significantly reduces both laryngopharyngeal reflux and comorbid chronic rhinosinusitis signs and symptoms: Randomised, double-blind, placebo-controlled trial[J]. Clin Otolaryngol, 2018, 43(2): 496-501. doi:10.1111/coa.13005.
[13] Sella GCP, Tamashiro E, Anselmo-Lima WT, et al. Relation between chronic rhinosinusitis and gastroesophageal reflux in adults: systematic review[J]. Braz J Otorhinolaryngol, 2017, 83(3): 356-363. doi:10.1016/j.bjorl.2016.05.012.
[14] Wang J, Yu Z, Ren JJ, et al. Effects of pepsin A on heat shock protein 70 response in laryngopharyngeal reflux patients with chronic rhinosinusitis[J]. Acta Otolaryngol, 2017, 137(12): 1253-1259. doi:10.1080/00016489.2017.1360515.
[15] Lee JS, Jung AR, Park JM, et al. Comparison of characteristics according to reflux type in patients with laryngopharyngeal reflux[J]. Clin Exp Otorhinolaryngol, 2018, 11(2): 141-145. doi:10.21053/ceo.2017.00577.
[16] Lechien JR, Bobin F, Muls V, et al. Validity and reliability of the reflux symptom score[J]. Laryngoscope, 2020, 130(3): E98-E107. doi:10.1002/lary.28017.
[17] Washington N, Steele RJ, Jackson SJ, et al. Determination of baseline human nasal pH and the effect of intranasally administered buffers[J]. Int J Pharm, 2000, 198(2): 139-146. doi:10.1016/s0378-5173(99)00442-1.
[18] Siu J, Johnston JJ, Pontre B, et al. Magnetic resonance imaging evaluation of the distribution of spray and irrigation devices within the sinonasal cavities[J]. Int Forum Allergy Rhinol, 2019, 9(9): 958-970. doi:10.1002/alr.22376.
[19] Succar EF, Turner JH, Chandra RK. Nasal saline irrigation: a clinical update[J]. Int Forum Allergy Rhinol, 2019, 9(S1): S4-S8. doi:10.1002/alr.22330.
[20] Wang J, Shen L, Huang ZQ, et al. Efficacy of buffered hypertonic seawater in different phenotypes of chronic rhinosinusitis with nasal polyps after endoscopic sinus surgery: a randomized double-blind study[J]. Am J Otolaryngol, 2020, 41(5): 102554. doi:10.1016/j.amjoto.2020.102554.
[21] Jiang RS, Liang KL, Wu SH, et al. Electrolyzed acid water nasal irrigation after functional endoscopic sinus surgery[J]. Am J Rhinol Allergy, 2014, 28(2): 176-181. doi:10.2500/ajra.2014.28.4015.
[22] Min HJ, Hong SC, Yang HS, et al. Expression of CAIII and Hsp70 is increased the mucous membrane of the posterior commissure in laryngopharyngeal reflux disease[J]. Yonsei Med J, 2016, 57(2): 469-474. doi:10.3349/ymj.2016.57.2.469.
[23] Kim TH, Lee HM, Lee SH, et al. Down-regulation of carbonic anhydrase isoenzymes in nasal polyps[J]. Laryngoscope, 2008, 118(10): 1856-1861. doi:10.1097/MLG.0b013e31817f4d0e.
[24] Ho J, Hamizan AW, Alvarado R, et al. Systemic predictors of eosinophilic chronic rhinosinusitis[J]. Am J Rhinol Allergy, 2018, 32(4): 252-257. doi:10.1177/1945892418779451.
[25] Hait EJ, McDonald DR. Impact of gastroesophageal reflux disease on mucosal immunity and atopic disorders[J]. Clin Rev Allergy Immunol, 2019, 57(2): 213-225. doi:10.1007/s12016-018-8701-4.
[26] Wallwork B, Coman W, Mackay-Sim A, et al. A double-blind, randomized, placebo-controlled trial of macrolide in the treatment of chronic rhinosinusitis[J]. Laryngoscope, 2006, 116(2): 189-193. doi:10.1097/01.mlg.0000191560.53555.08.
[27] Sereg-Bahar M, Jerin A, Jansa R, et al. Pepsin and bile acids in saliva in patients with laryngopharyngeal reflux - a prospective comparative study[J]. Clin Otolaryngol, 2015, 40(3): 234-239. doi:10.1111/coa.12358.
[28] 陈桂, 廖雯静, 张孝文. 咽喉反流的认识在困惑中探索[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(8): 634-636. doi:10.3760/cma.j.issn.1673-0860.2017.08.020. CHEN Gui, LIAO Wenjing, ZHANG Xiaowen. Understanding of laryngopharyngeal reflux is in confusion[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2017, 52(8): 634-636. doi:10.3760/cma.j.issn.1673-0860.2017.08.020.

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