摘要
目的：比较短疗程经鼻雾化吸入布地奈德混悬液和口服甲泼尼龙治疗鼻息肉的疗效和安全性。方法：入选50例嗜酸粒细胞性鼻窦炎伴鼻息肉患者,随机分为雾化吸入组和对照组,每组各25例。其中雾化吸入组接受吸入用布地奈德混悬液1mg/2ml经鼻雾化吸入,2次/d;对照组口服甲泼尼龙24mg,1次/d;疗程均为1周。在治疗前后评价鼻塞、流涕、嗅觉、头（面）痛症状的视觉模拟评分（VAS）,进行内镜Kennedy评分和晨起血清糖皮质激素测定,并对手术时间和术野评分进行评估。结果：经过1周的治疗,对照组4例脱落。雾化吸入组的4个鼻部症状评分均明显减少,其中以鼻塞的改善最为明显（用药前为8.25±0.53,用药后为4.97±0.97,P〈0.01）。内镜下息肉评分亦有明显减少（用药前为4.64±0.63,用药后为3.40±0.76,P〈0.01）。治疗后对照组的症状评分与内镜下息肉评分有显著下降,手术时间和术野评分亦低于雾化吸入组。雾化吸入组的手术时间较对照组延长（P〈0.05）。雾化吸入组的晨起血清糖皮质激素浓度在治疗后略有降低[用药前后分别为（17.18±2.83）、（16.24±2.93）μg/dl,P〉0.05],但仍在正常范围内（正常值为5~25μg/dl）;对照组的晨起血清糖皮质激素浓度在治疗后显著降低[用药前、后分别为（18.19±2.81）、（2.26±0.70）μg/dl,P〈0.01],呈现明显的肾上腺皮质功能抑制效应。结论：短疗程使用布地奈德混悬液经鼻雾化吸入治疗鼻息肉,可迅速改善鼻部症状、减小息肉体积,且对肾上腺皮质功能无明显影响,较口服激素更安全,可作为鼻息肉术前的治疗选择之一。
Objective：To evaluate the efficacy and safety of a short course of nebulized budesonide via tran- snasal inhalation in chronic rhinosinusitis with nasal polyps. Method：Fifty patients with severe eosinophilic nasal polyps were randomized devided into study group （n=25） and control group （n= 25）. The study group received budesonide inhalation suspension （1 mg twice daily） via transnasal nebulization for one week and the control group received oral prednisone （24 mg QD）. Visual analogue scales （VAS）of nasal symptoms, endoscopic polyp scores （kennedy scores） and morning serum cortisol concentrations were assessed in both groups pre- and post-treat- ment. Operation time and surgical field bleeding were evaluated. Result： Four subjects dropped out in control group. Budesonide transnasa[ nebulization caused a significant improvement in all nasal symptoms especially nasal obstruc- tion （baseline： 8.25±0.53; after treatment： 4.97±0.97, P〈0.01） and reduced polyp size significantly （baseline： 4.64±0.63; after treatment： 3.40±0.76, P〈0.01） compared to pre-treatment. The patients treated with oral prednisone, however, showed more obvious improvement in nasal symptoms and polyp size, shorter operation time and better surgical field than budesonide group. Additionally, the morning serum cortisol concentration was mildly decreased after one week treatment in budesonide group Ebaseline （17.18 ±2.83）μg/dl, after treatment （16.24±2.93）μg/dl,P〈0.05], but all values were still located in normal range （normal range： 5±-25 μg/dl）. Conversely, the morning serum cortisol concentration in oral prednisone group was lower than normal limit [baseline （18.19± 2.81 ） μg/dl, after treatment （ 2. 26 ± 0.70 ）μg/dl, P〈 0.01 ]. Conclusion： Twice daily budesonide transnasal nebulization is an effective and safe treatment,as evidenced by significant improvements in nasal symp- toms and reduction in polyp size, coupled with an absence of hypothalamic-pituitary-
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
北大核心
2015年第9期792-796,共5页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
基金
国家自然科学基金重点国际合作与交流项目(No:81420108009)
国家自然科学基金面上项目(No:81470678)
国家自然科学基金青年基金项目(No:81400444)
科技部"十二五"国家科技支撑计划课题(No:2014BAI07B04)
北京市医院管理局临床医学发展专项(No:ZYLX201310)
北京市自然科学基金(No:7131006)
