鼻内镜术后布地奈德鼻腔灌洗与鼻腔喷剂治疗慢性鼻-鼻窦炎合并哮喘的比较研究

摘要

目的 比较鼻内镜术后采用布地奈德鼻腔灌洗与鼻腔喷剂治疗对慢性鼻-鼻窦炎(CRS)合并哮喘患者的影响.方法对符合条件的48例CRS合并哮喘患者随机分为灌洗组和喷雾组(n=24),灌洗组鼻内镜手术(ESS)后采用0.5 mg布地奈德溶于250 ml生理盐水鼻腔灌洗,喷雾组ESS后采用布地奈德喷雾剂喷鼻.随访1、3及6个月,比较两组治疗前后汉化版鼻腔鼻窦结局测试22条(SNOT-22)、Lund-Kennedy(LK)内镜评分、口服类固醇和吸入类固醇的使用量.结果不同时间SNOT-22和LK内镜评分差异有统计学意义(P=0.000),灌洗组与喷雾组的SNOT-22和LK内镜评分差异有统计学意义(P=0.004和0.009),与喷雾组比较,灌洗组的SNOT-22和LK内镜评分较低,相对效果较好.灌洗组与喷雾组的SNOT-22和LK内镜评分变化趋势差异有统计学意义(P=0.000).两组间入组后治疗6个月期间口服激素总量比较,差异有统计学意义(P=0.000);两组治疗前后6个月口服激素总量比较,差异有统计学意义(P<0.05);两组间及组内术前6个月及治疗后6个月期间使用吸入激素量,差异均无统计学意义(P>0.05).结论CRS伴哮喘患者ESS后,布地奈德鼻腔灌洗是一种有效的方法,可以改善生活质量,防止复发和减少使用口服类固醇,效果优于鼻腔喷剂.但灌洗后吸入激素量没有减少.%Objective To compare the efficacy of postoperative steroid irrigation and nasal spray in patients with chronic rhinosinusitis and asthma. Methods All 48 patients with CRS complicated with asthma were randomly divided into irrigation group and spray group (n=24). Patients in the irrigation group were treated with budesonide nasal irrigating after ESS, and the spray group was treated with budesonide spray after ESS. The 22-item sinonasal outcomes test (SNOT-22) and Lund-Kennedy endoscopy scores were checked before nasal budesonide irrigation or spray, and 1, 3, and 6 months after treatment. The total number of oral steroids and inhaled steroids 6 months before and after study were calculated. Results The differences of SNOT-22 and LK endoscopic score between all the different time points were statistically significant (P=0.000). The difference of SNOT-22 and LK endoscopic score between the irrigation group and the spray group was statistically significant (P= 0.004 and 0.009 respectively). Compared with the spray group, the irrigation group had lower SNOT-22 and LK endoscopy scores, and the relative effect was better. The difference of SNOT-22 and LK endoscopic score between the irrigation group and the spray group was statistically significant (P=0.000). The total amount of oral steroid was decreased over the 6 months before irrigation compared with over the 6 months after irrigation (P= 0.000). Conclusions Nasal irrigation with budesonide is an effective postoperative treatment for chronic rhinosinusitis with asthma, which reduces the oral steroid intake, the effect is superior to nasal spray.