摘要
目的观察鼻用糖皮质激素联合两性霉素B(AmB)鼻窦冲洗在真菌球型鼻窦炎功能性鼻内镜手术(FESS)术后的应用效果。方法前瞻性选取2019年2月至2022年2月在川北医学院附属医院接受FESS治疗的94例真菌球型鼻窦炎患者为研究对象,采用信封法随机分为对照组(n=44)和观察组(n=50)。对照组术后给予鼻用糖皮质激素联合0.9%氯化钠溶液冲洗治疗,观察组术后给予鼻用糖皮质激素联合AmB鼻窦冲洗治疗。统计两组治疗2、4周后鼻腔黏膜转归情况,检测两组治疗前、治疗2、4周后的炎症因子[白细胞介素(IL)-17A、IL-6]水平,比较两组治疗前、治疗4、24周后的鼻腔纤毛传输速度、鼻窦CT评分、鼻内镜下LundKennedy评分(L-K)评分、T&T嗅觉识别测试(T&T)评分的差异,统计不良反应情况。结果治疗2、4周后,观察组鼻腔囊泡发生率分别为32.00%、18.00%,鼻腔分泌物发生率分别为20.00%和0,均低于对照组[鼻腔囊泡发生率(56.82%、43.18%)、鼻腔分泌物发生率(52.72%、63.64%)],差异均有统计学意义(P<0.05)。治疗2、4周后,观察组和对照组的IL-17A、IL-6水平均较手术前下降,且观察组IL-17A、IL-6水平均低于对照组,差异均有统计学意义(P<0.05)。治疗4、24周后,两组鼻腔纤毛传输速度均较手术前升高,且观察组均高于对照组,差异均有统计学意义(P<0.05)。治疗4、24周后,观察组和对照组的鼻窦CT评分、L-K评分、T&T评分均较治疗前下降,且观察组均低于对照组,差异均有统计学意义(P<0.05)。观察组不良反应发生率为12.00%与对照组的9.09%比较,差异无统计学意义(P>0.05)。结论鼻用糖皮质激素联合AmB鼻窦冲洗可促进真菌球型鼻窦炎FESS术后鼻腔纤毛功能的恢复,抑制炎症因子的表达,促进创面黏膜修复。
Objective To observe the effect of nasal glucocorticoid combined with amphotericin B(AmB)sinus irrigation after functional endoscopic sinus surgery(FESS)for fungal bulb sinusitis.Methods Ninety-four patients with fungal bulb sinusitis who received FESS treatment in Affiliated Hospital of North Sichuan Medical College from February 2019 to February 2022 were prospectively selected as the study objects,and were randomly divided into control group(n=44)and observation group(n=50)by envelope method.The control group was given postoperative nasal glucocorticoid combined with 0.9%normal saline irrigation treatment,and the observation group was given postoperative nasal glucocorticoid combined with AmB sinus irrigation treatment.The nasal mucosal outcomes at 2 and 4 weeks after operation were analyzed in the two groups.The levels of inflammatory factors[interleukin(IL)17A,IL-6]were detected before treatment and after 2 and 4 weeks of treatment in two groups.The differences in nasal ciliary transport velocity,sinus CT score,LundKennedy score(L-K)under nasal endoscopy,and T&T olfactory recognition test(T&T)score before treatment,4,and 24 weeks after treatment were compared in two groups.Adverse reactions during treatment were counted.Results The incidence of nasal vesicles(32.00%and 18.00%)and nasal secretions(20.00%and 0.00%)in the observation group were lower than those in the control group at 2 and 4 weeks after operation(56.82%and 43.18%)and the incidence of nasal vesicles and nasal secretions(52.72%and 63.64%),the differences were statistically significant(P<0.05).After two and four weeks of treatment,the levels of IL-17A,IL-6 in observation group and control group were lower than those before treatment,those in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).After 4 and 24 weeks of treatment,the nasal cilia transport speed in both groups increased compared to before surgery,and the observation group was higher than the control group,the differen
作者
李源泉
蒲茜作
王安生
吴春成
杨洪斌
LI Yuan-quan;PU Qian-zuo;WANG An-sheng(Department of Otorhinolaryngology,Affiliated Hospital of North Sichuan Medical College,Nanchong Sichuan 637000,China)
出处
《临床和实验医学杂志》
2023年第16期1758-1762,共5页
Journal of Clinical and Experimental Medicine
基金
四川省卫生厅科研基金项目(编号:1931392)。
