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鼻窦炎冲洗液鼻腔冲洗在鼻窦炎围手术期的疗效观察

发布时间:2019-05-18 10:07
【摘要】:背景 围手术期综合治疗作为提高临床疗效的手段,已经被广泛应用于各种手术领域,怎样利用围手术期处理提高慢性鼻-鼻窦炎手术的疗效,备受到耳鼻喉科临床医生的关注。围手术期综合治疗应该包括术前消肿抗炎、术中保护正常粘膜及术后随访治疗,包括术后抗炎消肿、促排、抗细菌生物膜等药物治疗,清理术腔、密切随访病情等综合治疗。鼻腔冲洗作为局部治疗的一种措施,已逐渐被应用于鼻腔及鼻窦各种疾病的治疗中,包括急性和慢性鼻窦炎、变应性和非变应性鼻炎、鼻腔术后、鼻咽癌放疗后等情况,甚至哮喘、病毒性感冒等上呼吸道疾病,它借助一定的装置,通过物理冲刷、局部给药等作用机制,清除鼻腔炎性分泌物、提高粘膜纤毛运输功能,减轻局部炎症反应,疗效肯定;鼻腔冲洗配合围手术期药物治疗,势必能促进鼻窦炎患者病情的恢复。 目的 旨在观察脾胃湿热证慢性鼻窦炎患者在围手术期应用鼻窦炎冲洗液的疗效,对比单纯生理盐水冲洗,通过综合疗效评价,了解中药冲洗在围手术期治疗中的优势。 方法 1根据病例纳入标准,收集符合条件病例120例,随机分组为治疗组(中药冲洗)、对照组(生理盐水冲洗),除常规围手术期药物治疗外,术后24-48h后开始行鼻腔冲洗治疗,治疗1个月,随访6个月,分别于术前、术后3个月、6个月,采集相关研究数据; 2疗效评定内容分为主、客观两方面,①客观疗效:进行鼻内镜复查,利用Lund-Kennedy评分法对术腔进行计分;②主观疗效:进行症状和生活质量问卷调查(VAS评分、SNOT20评分)。 结果 客观疗效:术后所有患者(3个月、6个月)Lund-Kennedy评分都较术前有明显改善;不同组别之间的术腔上皮化情况具有差异性,中药冲洗组优于盐水冲洗组疗效(P0.05)。 主观疗效:术后(3个月、6个月)VAS、SNOT-20总评分都较术前有明显改善,其中SNOT-20不同维度的比较中,鼻部症状的改善最明显。对比治疗组与对照组的主观疗效指标,中药冲洗组的VAS评分、SNOT-20在不同维度的改善程度均有较大的优势,在改善生活质量方面作用突出,差异有统计学意义(P0.05)。 结论 鼻窦炎冲洗液中药鼻腔冲洗能够提高临床治疗效果,改善生活质量,减轻鼻流涕、头痛、睡眠障碍及疲倦、焦虑等局部和全身症状,减轻术后鼻腔粘膜炎症,促进粘膜上皮化,减少鼻腔分泌物,疗效优于单纯生理盐水冲洗。
[Abstract]:Background as a means to improve the clinical efficacy, perioperative comprehensive treatment has been widely used in various surgical fields. How to use perioperative management to improve the curative effect of chronic rhinosinusitis surgery. It has attracted the attention of clinicians in otolaryngology. Perioperative comprehensive treatment should include preoperative detumescence and anti-inflammation, intraoperative protection of normal mucous membrane and postoperative follow-up treatment, including postoperative anti-inflammatory and detumescence, promoting excretion, anti-bacterial biofilm and other drugs, cleaning the cavity, closely following up the condition and so on. As a measure of local treatment, nasal lavage has been gradually used in the treatment of various diseases of nasal cavity and paranasal sinuses, including acute and chronic sinusitis, allergic and non-allergic rhinitis, nasal cavity surgery, nasopharyngeal carcinoma after radiotherapy and so on. Even asthma, viral colds and other upper respiratory diseases, with the help of certain devices, through physical scour, local administration and other mechanisms, clear nasal inflammatory secretions, improve mucous ciliated transport function, reduce local inflammatory reactions. The curative effect was positive; Nasal lavage combined with perioperative drug treatment is bound to promote the recovery of sinusitis patients. Objective to observe the curative effect of washing liquid of sinusitis in patients with chronic sinusitis of spleen and stomach dampness-heat syndrome during perioperative period, and to compare with saline washing alone, and to understand the advantages of traditional Chinese medicine washing in perioperative treatment through comprehensive evaluation of curative effect. Methods 1 according to the inclusion criteria of the cases, 120 eligible cases were randomly divided into treatment group (traditional Chinese medicine flushing) and control group (saline flushing), in addition to routine perioperative drug treatment. 24 hours after operation, nasal lavage was performed for 1 month and followed up for 6 months. The relevant research data were collected before operation, 3 months and 6 months after operation. (2) the content of curative effect evaluation was mainly divided into two aspects: (1) objective curative effect: nasal endoscopic reexamination was carried out, and Lund-Kennedy score method was used to score the operative cavity; Subjective efficacy: symptom and quality of life questionnaire (VAS score, SNOT20 score). Results objective curative effect: the Lund-Kennedy score of all patients (3 months, 6 months) was significantly improved compared with that before operation. The effect of traditional Chinese medicine flushing group was better than that of saline flushing group (P 0.05), and the effect of traditional Chinese medicine flushing group was better than that of saline flushing group (P 0.05). Subjective efficacy: the total score of VAS,SNOT-20 was significantly improved after operation (3 months, 6 months), and the improvement of nasal symptoms was the most obvious in the comparison of different dimensions of SNOT-20. Compared with the subjective curative effect index of the treatment group and the control group, the VAS score and SNOT-20 of the traditional Chinese medicine flushing group had great advantages in the improvement of different dimensions, and played a prominent role in improving the quality of life, the difference was statistically significant (P 0.05). Conclusion nasal lavage can improve the clinical treatment effect, improve the quality of life, reduce the local and systemic symptoms such as runny nose, headache, sleep disorder, fatigue, anxiety and so on, and reduce the inflammation of nasal cavity after operation. The effect of promoting mucous epithelial transformation and reducing nasal secretions is better than that of saline alone.
【学位授予单位】:广州中医药大学
【学位级别】:硕士
【学位授予年份】:2012
【分类号】:R765.9

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