鼻窦方冲洗联合穴位针刺对慢性鼻窦炎鼻内镜术后患者鼻黏膜功能形态恢复及相关炎性指标的影响

目的观察鼻窦方冲洗联合穴位针刺治疗对慢性鼻窦炎鼻内镜术后患者鼻黏膜功能形态恢复、相关炎性因子水平的影响。方法将2015年9月—2017年9月丹东市第一医院收治的148例慢性鼻窦炎鼻内镜术后患者随机分为2组,对照组74例给予激素吸入治疗,观察组74例在此基础上给予鼻窦方冲洗联合穴位针刺治疗,2组均治疗4周。对2组患者治疗前后血清白细胞介素-1β(IL-1β)、IL-5、IL-6及IL-17水平及主观症状评分、鼻内镜评分(Lund-Kennedy)、鼻窦炎疾病特异性生存质量量表(SNOT-20)评分进行分析,并统计2组患者术后并发症发生率和术后1年复发率。结果观察组治疗后主观症状评分、息肉评分、水肿评分、鼻漏评分、SNOT-20评分均明显低于治疗前及对照组(P均<0.05),瘢痕评分和结痂评分均明显高于治疗前及对照组(P均<0.05);2组治疗后血清IL-1β、IL-5、IL-6、IL-17水平均较治疗前显著降低(P均<0.05),且观察组治疗后以上指标水平均显著低于对照组(P均<0.05)。观察组术后并发症发生率和术后1年复发率均显著低于对照组(P均<0.05)。结论鼻窦方冲洗联合穴位针刺可促进慢性鼻窦炎鼻内镜术后鼻腔黏膜修复,下调血清IL-1β、IL-5、IL-6、IL-17表达,有助于改善患者生活质量,降低术后并发症和远期复发风险。     

针刺配合肠炎散保留灌肠治疗肛窦炎临床研究

目的观察肛窦炎应用针刺配合肠炎散保留灌肠治疗的效果。方法选取2017年10月-2018年10月就诊的72例肛窦炎患者,采用随机数字表法分为观察组(n=36)与对照组(n=36)。对照组给予肠炎散保留灌肠治疗,观察组为针刺配合肠炎散保留灌肠治疗,比较2组症状、疗效及安全性。结果观察组症状(放射痛、指诊症状及镜检症状)少于对照组,总有效率高于对照组,差异有统计学意义(P<0.05);2组安全性相比,差异无统计学意义(P>0.05)。结论针对肛窦炎患者,予以针刺配合肠炎散保留灌肠治疗效果确切,可减少临床症状,加快疾病转归,且治疗安全性较好。     

Infections and foreign bodies in ENT

Infections of the ear, nose and throat are common. The majority of these infections are managed by the primary care physicians and they settle with conservative and medical management. However, a small group can progress to become troublesome and develop complications to the extent that they may require surgical intervention. Some of the infections can lead to life-threatening complications, therefore awareness and correct diagnosis along with appropriate management is paramount. Foreign bodies in the ear, nose and throat are commonly encountered. The location and type of foreign body can have an implication on the urgency of action and the possible complications. In this article the common ENT infections and foreign bodies and their management are discussed.     

Guidelines of the French Society of Otorhinolaryngology (SFORL): Nonsteroidal anti-inflammatory drugs (NSAIDs) and pediatric ENT infections. Short version

ObjectivesTo present the guidelines of the French Society of Otolaryngology-Head and Neck Surgery concerning the use of non-steroidal anti-inflammatory drugs (NSAIDs) in pediatric ENT infections.MethodsBased on a critical analysis of the medical literature up to November 2016, a multidisciplinary workgroup of 11 practitioners wrote clinical practice guidelines. Levels of evidence were classified according to the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) system: GRADE A, B, C or “expert opinion”. The first version of the text was reworked by the workgroup following comments by the 22 members of the reading group.ResultsThe main recommendations are: NSAIDs are indicated at analgesic doses (e.g. 20–30 mg/kg/day for ibuprofen) in combination with paracetamol (acetaminophen) in uncomplicated pediatric ENT infections (acute otitis media, tonsillitis, upper respiratory infections, and maxillary sinusitis) if: o pain is of medium intensity (visual analogue scale (VAS) score 3–5 or “Evaluation Enfant Douleur” (EVENDOL) child pain score 4–7) and insufficiently relieved by first-line paracetamol (residual VAS ≥ 3 or EVENDOL ≥ 4); o pain is moderate to intense (VAS 5–7 or EVENDOL 7–10). When combined, paracetamol and ibuprofen are ideally taken simultaneously every 6 h. It is recommended: (1) o not to prescribe NSAIDs in severe or complicated pediatric ENT infections; (2) o to suspend NSAIDs treatment in case of unusual clinical presentation of the infection (duration or symptoms); (3) o not to prescribe NSAIDs for more than 72 h.     

Appropriate extent of surgery for aspirin-exacerbated respiratory disease

The current literature lacks strong guidelines regarding surgical management of patients with aspirin-exacerbated respiratory disease (AERD), who present with the clinical triad of chronic rhinosinusitis with nasal polyposis (CRSwNP), bronchial asthma, and aspirin/nonsteroidal anti-inflammatory drug intolerance. To further define the effectiveness of sinus surgery in treating AERD patients, this review article discusses current evidence regarding outcomes associated with more extensive surgery, the benefits of frontal sinus surgery on polyposis, and the role of Draf III intervention. Numerous studies suggest that Draf III frontal sinusotomy may be an efficacious early intervention due to increased neo-ostial patency and subsequent distribution of topical therapies. Future studies that further investigate the efficacy and safety of extensive surgery in AERD patients are warranted.     

Ⅱ型固有淋巴样细胞在嗜酸性粒细胞性慢性鼻窦炎发病机制中的作用研究进展

慢性鼻窦炎(CRS)是一种常见的慢性非特异感染性鼻部疾病,病理分型主要分为Th2细胞介导的嗜酸性粒细胞性鼻窦炎(ECRS)和Th1细胞介导的非嗜酸性粒细胞性鼻窦炎(非ECRS)2种表型。欧洲国家CRS患病人群主要表现为ECRS,而随着亚洲国家的急剧工业化发展,其ECRS的比例也在急剧增加。ECRS发病机制复杂,涉及多种免疫细胞和相关因子相互作用。其治疗方法包括抗生素、激素药物治疗及手术治疗等,但仍有部分患者症状难以改善或存在复发的风险。Ⅱ型固有淋巴样细胞(ILC2s)是一种非B、非T的新型淋巴细胞,与Th2免疫应答关系密切。文章就ILC2s在ECRS发病机制中的作用进行综述,以期为ECRS的诊断和治疗提供理论参考。