慢性鼻-鼻窦炎伴鼻息肉合并哮喘患者肺功能分析

目的分析慢性鼻-鼻窦炎伴鼻息肉(CRSw NP)合并哮喘患者肺功能情况。方法选取74例经鼻内镜手术(FESS)的CRSw NP合并哮喘患者,分组进行肺功能比较:男49例(男性组),女25例(女性组);吸烟32例(吸烟组),不吸烟42例(非吸烟组);血清特异性IgE阳性者27例(IgE组),阴性者47例(非IgE组);外周血嗜酸粒细胞升高(外周血嗜酸粒细胞绝对值>0.5×109/L)者27例(外周血嗜酸粒细胞升高组),未升高者47例(外周血嗜酸粒细胞非升高组);术后送检鼻息肉组织嗜酸粒细胞升高(嗜酸粒细胞平均>10个/HPF)者31例(组织嗜酸粒细胞升高组),未升高者43例(组织嗜酸粒细胞非升高组)。所有肺功能检测均在具有上岗资质变态反应科专业医师指导下完成,检测数据由德国康讯肺功能仪(Power CubeBody)采集,肺功能指标包括第1秒用力呼气容积(FEV1)占预计值的百分比(FEV1%pre)、FEV1与用力肺活量(FVC)的比值占预计值的百分比(FEV1/FVC%pre)、最大通气量(M VV)占预计值的百分比(M VV%pre)、用力呼出50%肺活量时的瞬间呼气流(FEF50%)、用力呼出75%肺活量时的瞬间呼气流(FEF75%)及最大呼气中期流量(MMEF)。74例患者评估肺功能下降程度后针对性给予雾化吸入治疗,2～3次/d,沙美特罗替卡松粉吸入剂1吸,2次/d,予孟鲁司特钠10 mg/d,氯雷他定10 mg/d口服,同时给予盐酸氮卓斯汀鼻喷剂2次/d+布地奈德鼻喷雾剂2次/d喷鼻治疗。自入院至术前,患者行药物治疗时间为1～14 d。所有患者术前30 min雾化吸入1次,麻醉前行沙美特罗替卡松粉吸入剂1吸。对术前药物干预后肺功能改善情况进行判定。结果 74例患者均顺利完成手术。入院时女性组FEF50%、FEF75%及MMEF低于男性组(t分别为3.213、2.829、3.644,P分别为0.002 0、0.006 1、0.000 5),吸烟组较非吸烟组、外周血及鼻息肉组织中嗜酸粒细胞升高组均较非升高组FEV1/FVC%pre下降(t分别为2.032、2.259、2.634,P分别为0.045 8、0.029 2、0.010 3),同时鼻息肉组织嗜酸粒细胞升高组较非升高组MVV%pre降低(t=2.453,P=0.0166)。经术前规范药物干预后,患者肺功能指标FEV1%pre、FEV1/FVC%pre、M VV%pre、FEF50%、FEF75%及MMEF均较入院时改善(t分别为6.640、6.071、8.166、5.554、6.137、4.256,P均为0.000 0)。结论 CRSw NP合并哮喘患者中,女性较男性更易伴发小气道功能障碍;吸烟、外周血及鼻息肉组织嗜酸粒细胞升高亦可影响肺功能;规范的术前药物干预可有效改善CRSw NP合并哮喘患者的肺功能,减少围术期哮喘急性发作风险,有助于手术顺利实施。

Analysis of pulmonary function of patients who developed chronic rhinosinusitis with nasal polyps and asthma

Objective To analyze the pulmonary function of patients who developed chronic rhinosinusitis with nasal polyps(CRSwNP). Methods The pulmonary function of 74 patients who underwent functional endoscopic sinus surgery(FESS)was measured and analyzed. The patients were divided into comparable groups under different criteria: male(49 patients)and female(25 patients)groups, smoking(32 patients)and non-smoking(42 patients)groups, serum-specific immunoglobulin E(IgE)-positive(27 patients)and serum-specific IgE-negative(47 patients)groups, elevated eosinophils in peripheral blood(27 patients)and non-elevated eosinophils in peripheral blood(47 patients)groups, and elevated eosinophils in nasal polyps(31 patients)and non-elevated eosinophils in nasal polyps(43 patients)groups. The pulmonary function of all the patients were completed under guidance of a professional allergist with qualifications; test data were collected using the German GANSHORN Pulmonary Function Instrument(PowerCube-Body). Analyzed indices of pulmonary function included the percentage of forced expiratory volume in the first second(FEV₁%pre), percentage of predicted value of the ratio of FEV₁ to forced vital capacity(FVC)(FEV₁/FVC% pre), percentage of maximum ventilatory volume estimated(MVV% pre),forced expiratory flow at 50% of FVC(FEF_50%), forced expiratory flow at 75% of FVC(FEF_75%), and maximal mid-expiratory flow(MMEF). After pulmonary function was evaluated, all 74 patients accepted individualized specific aerosol inhalation twice or thrice a day, combined with one inhalation of salmeterol xinafoate and fluticasone propionate powder twice a day. In addition, 10 mg of oral montelukast sodium and loratadine were administered once a day separately, along with a nasal spray of azelastine hydrochloride and budesonide twice a day. The medical therapy persisted for 1-14 days from admission to preoperation, and the patients were administered another aerosol inhalation 30 min before surgery and one inhalation of salmeterol xinafoate and fluticasone propionate powder before general anesthesia. The improvement in pulmonary function after medical treatment was also evaluated. Results All 74 patients underwent FESS unremarkably. On admission, FEF_50%, FEF_75%, and MMEF in the female group were lower than in the male group(t=3.213, 2.829, and 3.644, respectively; P=0.002 0, 0.006, and 0.000 5, respectively); FEV₁/FVC% pre was lower in the smoking group than in the non-smoking group(t=2.032, P=0.045 8), in the elevated eosinophils in peripheral blood group than in the non-elevated eosinophils in peripheral blood group(t=2.259, P=0.029 2), and in the elevated eosinophils in nasal polyps group than in the non-elevated eosinophils in nasal polyps group(t=2.634, P=0.010 3); and MVV% pre decreased significantly in the elevated eosinophils in nasal polyps group compared to in the non-elevated eosinophils in nasal polyps group(t=2.453, P=0.016 6). Pulmonary function indices including FEV₁%pre, FEV₁/FVC% pre, MVV% pre, FEF_50%, FEF_75%, and MMEF improved significantly after standardized medical treatment(P=0.000 0). Conclusion Female patients are more likely to develop small airway dysfunction compared to male patients among those who develop CRSwNP and asthma. Smoking and elevated eosinophils in peripheral blood and in nasal polyps may also influence pulmonary function. Standardized preoperative medical treatment is efficient in improving the pulmonary function of patients with CRSwNP and asthma and in decreasing the potential of acute attacks of asthma. Therefore, unremarkable surgeries are guaranteed.