鼻窦冲洗对慢性鼻窦炎鼻内镜手术效果的影响

摘要

Objective To investigate the effects of nasal endoscopic surgery combined with sinus perfusion and flushing on chronic sinusitis and its cytokines.Methods One hundred patients with chronic sinusitis were divided into two groups according to the random number table.The patients in the two groups received nasal endoscopic surgery.Fifty cases in the observation group were given sinus perfusion and flushing with self-made sinus perfusion fluid one week after operation,twice a day for four weeks.Fifty cases in the control group were given routine treatment without sinus perfusion and flushing after operation.The therapeutic effects of the two groups were observed,the transmission velocity of nasal mucosa cilia,serum interferon-γ(INF-γ),interleukin(IL)-2,IL-4,IL-5 and eosinophili count in nasal mucosa tissues were determined as well.Results The therapeutic effect in the observation group was superior to that in the control group(P<0.05).After treatment,the transmission velocity of nasal mucosa cilia increased significantly in the two groups,which was faster in the observation in contrast with that in the control group(P<0.05);the eosinophili count,and the levels of IFN-γ,IL-2,IL-4 and IL-5 decreased significantly in the two groups in contrast with those before treatment(P<0.05),and the decrease of the indexes mentioned above was more significant in the observation group(P<0.05).Conclusion Nasal endoscopic surgery combined with sinus perfusion and flushing achieves favorable effects on chronic sinusitis,which can effectively increase the transmission velocity of nasal mucosa cilia,release the local inflammatory responses,regulate the Th1/Th2 immunologic balance,and improve the therapeutic effect.%目的：观察鼻内镜手术联合鼻窦灌注冲洗治疗慢性鼻窦炎的疗效及其对细胞因子的影响。方法慢性鼻窦炎患者100例，按随机数字表法分为两组，两组患者均行鼻内镜手术治疗，观察组50例于术后1周采用自制的鼻窦灌注液进行鼻窦灌洗，2次／d，共4周，对照组50例手术后按常规治疗，未行鼻窦灌注冲洗。观察两组治疗效果及两组治疗前后鼻黏膜纤毛传输速度、血清干扰素γ（ IFN-γ）、白细胞介素（ IL）-2、IL-4、IL-5及鼻窦黏膜组织中嗜酸性粒细胞数。结果观察组疗效优于对照组（P＜0．05）。治疗后两组患者鼻黏膜纤毛传输速度均提高，而且观察组速度快于对照组（P＜0．05）；与治疗前比较，治疗后两组嗜酸性粒细胞数、IFN-γ、IL-2、IL-4、IL-5水平均明显降低（P＜0．05），且观察组上述指标降低更明显（ P＜0．05）。结论鼻内镜手术联合鼻窦灌注冲洗治疗慢性鼻窦炎效果好，可有效提高鼻黏膜纤毛传输速度，减轻局部炎症反应，调节Th1／Th2免疫平衡，提高临床疗效。