规范化药物治疗慢性鼻-鼻窦炎的近期疗效观察

目的：评价规范化药物治疗慢性鼻-鼻窦炎患者的疗效。方法：采用前瞻性研究设计,依据2008年制订的＂慢性鼻-鼻窦炎诊断和治疗指南＂,对54例慢性鼻-鼻窦炎患者联合使用鼻内局部糖皮质激素、大环内酯类（14元环）药物、黏液促排剂和鼻腔冲洗规范化治疗并随访3个月。采用视觉模拟量表（VAS）、鼻腔鼻窦结局测试-20中文版量表（SNOT-20CV）、Lund-Mackay CT方法和Lund-Kennedy鼻内镜方法进行主客观评分,综合评价患者治疗前后的临床疗效。结果：①规范化药物治疗3个月后,VAS、SNOT-20CV、CT和鼻内镜整体评分均较治疗前明显改善（均P〈0.01）。②慢性鼻-鼻窦炎伴息肉（CRSwNP）组和慢性鼻-鼻窦炎不伴息肉（CRSsNP）组治疗前后均差异有统计学意义（均P〈0.01）。CRSwNP组药物治疗3个月后主观评价有效率为66.7%,CT评价有效率为94.4%;CRSsNP组的主观评价有效率为91.7%,CT评价有效率为97.2%。③CRSwNP组和CRSsNP组比较,主观疗效中仅治愈率差异有统计学意义,好转率和无效率均差异无统计学意义（均P〉0.05）;而CT评价中,治愈率和好转率均差异有统计学意义（均P〈0.05）。④CRS患者以其自测为基础的主观调查表与客观评估之间呈正相关性。结论：联合鼻内局部糖皮质激素、大环内酯类（14元环）药物、黏液促排剂和鼻腔冲洗规范化治疗CRS疗效肯定。

Short-term efficacy of standardized medication offor chronic rhinosinusitis

Objective：To evaluate the efficacy of standardized medication for patienls with chronic rhinosinus- iris. Method：According to the diagnosis and treatment guidelines on chronic rhinosinusitis formulated in 2008, by means of prospective study, we studied 54 patients suffering from chronic rhinosinusitis treated with standardized medication including, a combination of local intranasal corticosteroids, macrolides, mucus discharging agent and nasal irrigation treatment and followed up for 3 monlhs. Visual analogue scale（VAS）, sino-nasal outcome test 20 Chinese version scales（SN（）T 20 CV）, I.und-Mackay CT and 1.und-Kennedy endoscopy methods were employed to conduct the subjective and objective assessment and comprehensively evaluate the clinical efficacy before and after treatment. Result ： （j） After three months of standardized medication, the patients＇ total scores of VAS, SN（）T-20 CV,CT and endoscopy were improved significantly compared with those before -treatment （P＇~0.01 for all these scoring systems）. （~）There was statistically significant difference between the clinical efficacies of chronic rhinosi- nusitis patients with and without nasal polyps groups（P~0.01）. After 3 months of standardized medication, the effective rates of the CRSwNP group evaluated by subjective assessment and CT evaluation were 66. 7~ and 94.4% respectively,while those of the CRSsNP group＇s were 91. 7~ and 97.2~ respectively. （~）Between CRSw- NP and CRSsNP groups, there was no significant difference in the improvement rate or inefficiency rate in subjec tive assessment except for the cure rate,while there were significant differences in both cure rate and improvement rate in CT evaluation. （~ The CRS patients＇ self-testing-based questionnaires results showed positive correlation with objective assessments. Conclusion=The standardized medication with combination of intranasal local glucocor- ticoid, macrolides（14-memhered ring）,the mucus discharging agent and nasal irrigation on CRS was effective.