败丹黄灌洗液鼻腔灌洗对慢性鼻窦炎伴鼻息肉患者术后的临床疗效影响

作者	单位	E-mail
陈新野	中山大学附属第五医院耳鼻咽喉科（广东珠海519000）	zsufivehos@163.com
张春林,洪海裕,张勤修,廖伟,陈默

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中文摘要:

目的观察败丹黄灌洗液在围手术期鼻腔灌洗对慢性鼻窦炎伴鼻息肉（chronic rhinosinusitis with nasal polyps，CRwNP）患者的手术愈后影响。方法选择90例2008年10月—2010年2月中山大学附属第五医院住院接受手术治疗的CRwNP患者，随机分为治疗组（60例）和对照组（30例）。鼻内镜手术后，对患者进行常规治疗，同时采用鼻腔灌注抽吸装置进行鼻腔灌洗，治疗组采用败丹黄灌洗液，对照组给予庆大霉素加地塞米松盐水，将药液在鼻腔保留15 min。14天为1个疗程，第1个疗程，1次/3天；第2个疗程，1次/5天；第3个疗程及以后，1次/7天，随着时间推移，灌洗次数逐渐减少。分别对鼻塞、鼻漏、嗅觉障碍、头面部不适或疼痛4种临床症状进行VAS评分；鼻内镜检查采用Lund Kenenedy量化评分法，评价息肉大小、黏膜水肿、瘢痕及鼻腔结痂情况，填写SNOT 20量表，进行生活质量调查。上述评估分别在术前及术后1.5、3、6个月进行，并在1年后对患者进行综合疗效评价。结果治疗组和对照组1年后治愈率分别为79.25%和 76.92%，总有效率为90.57%和 84.62%，两组比较差异无统计学意义（P>0.05）；治疗组鼻腔清洁时间及上皮化时间分别为（2.15±0.13）周、（9.17±1.67）周，早于对照组（2.65±0.15）周、（10.71±3.12）周，差异有统计学意义（P<0.05）；在第8周时治疗组治愈而结束灌洗22例，对照组5例，差异有统计学意义（P<0.05）；治疗组术后1.5、3个月VAS总分，及术后3个月单项评分，术后6个月、1年鼻漏评分均优于于对照组（P<0.05）；治疗组术后1.5个月鼻内镜总分和鼻黏膜水肿及鼻分泌物等单项评分，较对照组低（P<0.05）；治疗组术后1.5、3个月SNOT 20量表质量总分及五大指标积分较对照组积分减少（P<0.05）。结论败丹黄灌洗液鼻腔灌洗在鼻窦炎围手术期运用，能减轻术腔炎症反应，缩短术腔清洁时间，加快上皮化进程，改善患者生活质量，提高手术疗效，尤其在围手术期1.5～3个月，其治疗作用更为突出。

英文摘要:

Objective To observe the clinical efficacy of Baidanhuang lavage fluid nasal irrigation （BLFNI） on postoperative patients with chronic sinusitis with nasal polyps （CRwNP）. Methods Ninety postoperative patients with CRwNP were randomly assigned to two groups， the treatment group （60 cases） and the control group （30 cases）. After nasal endoscopic surgery， all patients received routine therapies， while the nasal cavity perfusion device was used to irrigate. Patients in the treatment group were treated with BLFNI， while those in the control group were irrigated with physiologic saline with dexamethasone and gentamycin. The physic liquor was maintained in the nasal cavity for 15 min， 14 days as one therapeutic course： once per 3 days in first treatment course； once per 5 days in the second treatment course； once per 7 days in the third treatment course. The irrigation times gradually reduced as time went by. The VAS scoring was performed in four clinical symptoms， such as nasal obstruction， rhinorrhea， olfaction disorders， discomforts or pain in the face or head. The Lund Kenenedy quantification scoring method was used for nasal endoscopy to assess the polyps size， mucous membrane， scar， surface scab， and quality of life （QOL）. The SNOT 20 rating scales were filled to investigate the QOL. All the assessments were carried out before surgery， 1.5， 3， and 6 months， respectively. The comprehensive efficacy assessment was conducted 1 year later. Results The 1 year cure rate was 79.25% in the treatment group and 76.92% in the control group， and the total effective rate was 90.57% in the treatment group and 84.62% in the control group. There was no statistical difference between the two groups （P>0.05）. The nasal cavity cleaning time and the epithelization time was （2.15±0.13） weeks and （9.17±1.67） weeks respectively in the treatment group， earlier than those in the control group ［（2.65±0.15） weeks and （10.71±3.12） weeks， P<0.05］. At week eight 22 patients in the treatment group ended the lavage due to recovery， while 5 patients in the control group ended the lavage， showing statistical difference （P<0.05）. Compared with the control group， better results were obtained in the treatment group in relieving the total VAS score at postoperative 6 weeks and 3 months， in the single score of symptoms at 3 months after operation， the rhinorrhea at postoperative 6 months and 1 year （P<0.05）. The total endoscopic score， and the single score for nasal mucous membrane edema， and nasal secretion at postoperative 1.5 month were lower in the treatment group than in the control group （P<0.05）. The total score of SNOT 20 questionnaire， and the integrals for five major indicators at postoperative 1.5 and 3 months were lower in the treatment group than in the control group （P<0.05）. Conclusions The perioperative application of BLFNI could alleviate postoperative mucosal inflammation， shorten the cavity cleaning time， speed up the process of epithelization， improve the QOL， and elevate the operative efficacy. Its therapeutic roles were more prominent within perioperative 1.5－3 months.

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