鼻腔冲洗在变应性鼻炎防治中的应用

doi:10.6040/j.issn.1673-3770.0.2017.151

摘要/Abstract

摘要： 变应性鼻炎(AR)治疗药物在临床实践中会因为患者个体化差异、药物不良反应、治疗长期化导致其使用依从性下降,AR防治需要辅助或替代手段。鼻腔冲洗可以改善黏液流变学特性,通过去除变应原和炎性黏蛋白改善黏膜纤毛功能,进而开放鼻腔通道。鼻腔冲洗常见装置包括喷雾器、雾化器和挤压瓶;冲洗液所含钠、镁、锌、钙、钾和碳酸氢根各种离子, 对上皮细胞起着重要作用;冲洗液pH<7或pH>10会抑制纤毛摆动频率;糖精试验证实3%~5%高张冲洗液能增强健康受试者的鼻黏膜纤毛清除能力;40 ℃冲洗液能更加显著减轻AR视觉模拟量表评分并降低组胺释放;海水在促进细胞生长作用上明显优于生理盐水或稀释海水;丙酮酸钠具有抗氧化、抗炎作用,含丙酮酸钠的鼻腔喷雾剂能减轻季节性AR鼻眼结膜炎的症状评分并减少鼻用糖皮质激素用量;鼻腔冲洗有助于减少AR治疗药物使用量。作为一种局部物理治疗,鼻腔冲洗安全、方便、耐受性好、患者易于接受,可作为AR安全、有效的补充治疗手段。

关键词: 变应性鼻炎, 鼻腔冲洗, 防治

Abstract: Nasal irrigation is a safe, convenient, well-tolerated, and easy-to-accept local physical therapy for the supplementary treatment of allergic rhinitis(AR). It improves the rheological properties of mucus, and opens the nasal passage by removing allergens and inflammatory mucins to improve mucociliary function. Common nasal irrigation devices comprise a sprayer, an atomizer, and a squeeze-bottle. Washing liquid contains sodium, magnesium, zinc, calcium, potassium, and bicarbonate ions, all of which play an important role in the epithelial cells. At a pH<7 or pH>10, washing liquid inhibits ciliary beat-frequency, and saccharin tests have confirmed that 3%-5% washing liquid enhances nasal mucociliary clearance in healthy subjects, whilst washing liquid heated to 40 ℃ significantly reduces AR visual analog scale scores as well as histamine release. Seawater, in particular, significantly increases cell growth, more than saline or diluted seawater. Sodium pyruvate has both antioxidant and anti-inflammatory effects, thus nasal spray containing sodium pyruvate serves to both alleviate the symptoms of conjunctivitis in seasonal AR patients as well as reduce the requirement for nasal corticosteroids. Therefore, nasal irrigation can help reduce the amount of AR drugs needed.

Key words: Preventive treatment, Nasal irrigation, Allergic rhinitis

中图分类号:

R765.21

关凯,李丽莎. 鼻腔冲洗在变应性鼻炎防治中的应用[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 22-27.

GUAN Kai, LI Lisha. Nasal irrigation and its role in the treatment of allergic rhinitis.[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2017, 31(3): 22-27.

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