慢性鼻-鼻窦炎鼻息肉伴支气管哮喘的围手术期治疗

目的探讨慢性鼻-鼻窦炎(CRS)、鼻息肉伴有支气管哮喘患者的围手术期治疗。方法对72例伴有支气管哮喘的CRS、鼻息肉患者行鼻内镜下鼻窦功能性手术(FESS),观察不同麻醉下术中及术后哮喘发作情况并给予相应的治疗。结果局麻下30例手术患者中5例术中出现一过性焦虑、呼吸不畅,但无哮喘发作;3例术后轻度哮喘发作;全麻下42例手术患者术中均平稳,4例术后哮喘发作,其中1例哮喘持续状态,经治疗后好转。结论伴有哮喘的鼻-鼻窦炎、鼻息肉患者行FESS手术是必要、安全的。     

哮喘伴慢性鼻窦炎治疗

目的探讨支气管哮喘伴有慢性鼻窦炎及鼻息肉患者行鼻内镜手术(endoscopicsinussurgery,ESS)的治疗效果。方法1998年8月～2002年10月,对25例支气管哮喘伴有慢性鼻窦炎及鼻息肉经药物治疗无效的患者,采用鼻内镜手术,按Messerklinger’s术式,切除钩突、摘除息肉、开放筛窦及上颌窦,清理窦口鼻道复合体病变组织;围手术期应用抗生素和类固醇皮质激素等。结果随访18个月～3年,支气管哮喘症状疗效为:有效10例,好转10例,无效5例;鼻窦炎及鼻息肉疗效为:治愈10例,好转12例,无效3例。结论ESS对支气管哮喘伴有慢性鼻窦炎及鼻息肉患者的治疗,可降低哮喘的发作频率和对类固醇皮质激素的依赖。     

慢性鼻-鼻窦炎伴哮喘患者鼻内镜围手术期临床观察

目的：探讨慢性鼻-鼻窦炎伴哮喘患者鼻内镜围手术期处理,以减少并发症及不良事件的发生,提高治愈率。方法：对152例慢性鼻-鼻窦炎伴哮喘患者鼻内镜围手术期的临床资料进行回顾性分析。结果：经过规范的围手术期治疗,全部患者术前哮喘控制情况良好,116例患者术毕返回病房后13例哮喘不同程度发作;35例术毕直接送往ICU观察24~48h,返回病房后1例哮喘急性发作;1例术毕拔管后即刻出现哮喘发作;以上患者经治疗后均好转。术后随访1年,恢复良好。结论：应充分认识慢性鼻-鼻窦炎与哮喘的密切关系,规范围手术期处理,掌握哮喘急性发作时的处理原则。只要做好充分围手术期准备,伴哮喘的鼻内镜手术是安全的,并可有良好的疗效。     

慢性鼻-鼻窦炎伴鼻息肉围术期哮喘急性发作的原因分析与处理[论著]

目的　分析慢性鼻-鼻窦炎伴鼻息肉（chronic rhinosinusitis with nasal polyps，CRSwNP）患者围术期哮喘急性发作的原因及抢救措施。方法　回顾性分析2011年2月～2018年1月我科9例CRSwNP患者围术期哮喘急性发作的临床病例资料，对其发病原因及抢救措施进行总结分析。结果　9例患者入院后进行气道评估及干预后肺功能均达到手术标准。哮喘急性发作于术中3例，术后6例。9例患者经过高流量吸氧、β2受体激动剂、布地奈德混悬液及肾上腺素等雾化吸入，和/或甲强龙、茶碱类、抗感染等药 物联合应用，联合麻醉科、变态反应科、重症医学科等多学科抢救后均控制良好。结论　CRSwNP患者围术期相关危险因素可能诱发哮喘急性发作，加强围术期气道管理将有效降低哮喘急性发作，多学科联合救治最大程度降低死亡率。     

老年慢性鼻-鼻窦炎伴鼻息肉患者鼻内镜术后复发的影响因素分析

目的 探讨老年慢性鼻-鼻窦炎伴鼻息肉(chronic rhinosinusitis with or without nasal polyps,CRSwNP)患者鼻内镜术后复发的影响因素.方法 行鼻内镜治疗的老年CRSwNP患者126例,根据是否复发分为复发组(52例)和未复发组(74例),对可能影响其术后复发的相关因素...     

口服糖皮质激素在慢性鼻窦炎伴鼻息肉围手术期的应用现状

鼻内镜鼻窦手术(ESS)已成为外科治疗慢性鼻窦炎伴鼻息肉(CRSwNP)的“金标准”,鼻内镜鼻窦手术围手术期管理对手术效果有重要影响。目前口服糖皮质激素因其抗炎和免疫抑制作用已作为ESS围术期辅助用药以增强手术效果,但在其剂量剂型及疗效等方面仍存在争议。回顾近年来研究口服糖皮质激素与CRSwNP围手术期疗效的相关文献,对口服糖皮质激素在围手术期的效果及治疗策略进行综述,以求提供更多的治疗选择和研究方向。     

合并哮喘的慢性鼻-鼻窦炎的鼻内镜手术治疗

慢性鼻-鼻窦炎(CRS)是一种异质性的疾病,其中合并哮喘的患者占到10%~40%,且在全球范围内呈上升趋势。在哮喘患者中,CRS的发病率也高于一般人群。目前大部分的研究认为鼻内镜手术结合药物治疗对合并哮喘的CRS患者的鼻部症状有明显的改善作用,且有利于哮喘的长期管理。但是此类患者术后易复发,围手术期手术风险也较高。将重点论述合并哮喘的CRS患者的术前评估和围手术期管理、手术方式的选择及鼻内镜手术术后对哮喘的影响等。     

哮喘合并鼻息肉手术后的治疗

目的报告哮喘合并鼻息肉患者在鼻息肉手术后的疗效.方法为哮喘合并鼻息肉12例施行鼻内镜下鼻息肉切除和筛窦开放术,比较术前术后口服激素和吸入性激素的用量.结果术后激素用量减少,9例(75%)哮喘减轻,其中7例明显减轻,2例轻度减轻,3例(25%)未减轻.结论哮喘合并鼻息肉的患者根据病情行鼻内窥镜下鼻息肉切除和鼻窦开放术,有利于哮喘的治疗与缓解哮喘的发作.     

老年慢性鼻-鼻窦炎鼻息肉患者功能性鼻内镜围手术期治疗

目的:探讨老年慢性鼻-鼻窦炎鼻息肉患者在鼻内镜术围手术期的治疗特点。方法:回顾分析187例老年慢性鼻-鼻窦炎鼻息肉患者(年龄≥60岁)的临床资料。结果:经系统有针对性围手术期治疗后,治愈132例(72.5%),好转43例(23.6%),无效7例,总有效率96%,无一例发生手术并发症。结论:老年患者经系统有针对性的围手术期治疗后行鼻内镜手术是安全有效的。     

修正性鼻内镜手术治疗复发性 慢性鼻-鼻窦炎的临床分析

目的探讨修正性鼻内镜手术治疗复发性慢性鼻-鼻窦炎的临床疗效分析。方法回顾性分析2011年1月~2016年1月收治的68例复发性慢性鼻-鼻窦炎患者的临床资料，所有患者均在鼻内镜下行规范化修正性手术，并在围手术期进行规范化的综合处理，对患者进行术后12个月以上随访，观察其对临床疗效的影响。结果68例复发性慢性鼻-鼻窦炎患者术后1年，不伴鼻息肉41例,总有效率为90.2%,伴鼻息肉27例，总有效率为81%，均未发生严重眶内及颅内并发症。结论鼻内镜手术疗效显著，具有十分重要的临床意义。     

鼻内镜手术对成人慢性鼻-鼻窦炎伴哮喘患者疗效的影响

目的　分析并探讨鼻内镜手术对成人慢性鼻-鼻窦炎（chronic rhinosinusitis,CRS）伴哮喘患者疗效的影响。方法　采用前瞻性对照分组设计,对我院诊断为CRS并接受鼻内镜手术治疗的325例患者依入组标准选择92例患者进行跟踪随访,于术前、术后评估所有患者鼻部和哮喘各指标变化情况。结果　共92例完成3个月随访,90例完成12个月随访。鼻内镜手术后鼻部总体症状和鼻塞、流涕的视觉模拟量表评分以及鼻内镜Lund-Kennedy评分均明显改善,喷嚏、嗅功能、头面部疼痛视觉模拟量表评分结果也有不同程度改善。伴哮喘患者鼻内镜手术后哮喘控制测试评分在术后明显升高,而肺功能各指标变化无统计学差异。结论　以鼻内镜手术为中心的综合治疗对成人CRS伴哮喘患者的鼻部症状改善和减少用药量有显著作用;短期内鼻内镜手术对提高哮喘患者哮喘控制水平和减少哮喘用药量有积极作用。     

慢性鼻窦炎伴鼻息肉与哮喘的相关性机制及治疗策略研究进展

慢性鼻窦炎伴鼻息肉(CRSwNP)和哮喘作为上下呼吸道最具代表性的慢性炎症性疾病,二者在发病过程中常相互并存,临床诊治棘手。目前对CRSwNP和哮喘的相互作用机制尚未阐明。欧洲鼻窦炎鼻息肉诊疗指南(EPOS 2012)对治疗CRSwNP伴或不伴哮喘已给出具体的指导意见,其常规治疗包括鼻用糖皮质激素、生理盐水洗鼻等,并进一步根据CRSwNP的特点、症状严重程度等进行后续的联合治疗。据报道,鼻窦手术和药物治疗CRSwNP对合并支气管哮喘的转归有益。但CRSwNP合并哮喘患者经药物与手术治疗后的疗效判定尚缺乏足够的随机对照试验证据。     

Treatment of intractable diseased tissue in the maxillary sinus after endoscopic sinus surgery with high-pressure water jet and preservation of the periosteum

OBJECTIVE: To describe a new high-pressure water jet (HPWJ) treatment to remove intractable diseased mucosa persisting in the maxillary sinus several months after endoscopic sinus surgery (ESS) while preserving the periosteum. DESIGN: A retrospective review of HPWJ treatment in 45 consecutive patients with at least 12 months follow-up. SETTING: A private surgicenter in Japan. PATIENTS: Patients (25 male and 20 female) ranged in age from 8 to 59 years. All patients had diffuse intractable lesions in the opened maxillary sinus after the initial ESS, with or without disease of the ethmoid and other major sinuses. MAIN OUTCOME MEASURES: Resolution of diffuse intractable disease in the maxillary sinus and postoperative change in the size of the cavity were evaluated using nasal endoscopy and computed tomographic scan. RESULTS: Twenty-six (81%) of 32 sides in 25 patients with isolated persistent maxillary sinus disease were restored after HPWJ procedures; 25 (93%) of 27 sides in 20 patients who also had ethmoiditis also were restored. In the latter group, ethmoiditis recurred in 5 sides, which also included 2 sides of unrestored maxillary sinuses. Of the 51 restored sides, 33 (65%) were restored within 3 months after HPWJ treatment under endoscopic observation. No complications were seen during the surgery. Except for 1 side in 1 patient from which all diseased mucosa was removed almost completely, along with the periosteum, no reduction of the cavity by scar tissue formation was observed. This method did not affect the development of the maxillary bone in children. CONCLUSION: Removing diffuse intractable diseased mucosa in the maxillary sinus while preserving the periosteum with HPWJ treatment is an effective surgical therapy that fulfills the ultimate purpose of ESS.     

慢性鼻窦炎鼻息肉合并支气管哮喘患者鼻窦内镜术后对支气管哮喘疗效的影响

目的观察鼻窦内镜术(endoscopic sinu ssurgery，ESS)对慢性鼻窦炎伴支气管哮喘患者哮喘发作的影响。方法对210例慢性鼻窦炎患者施行ESS术，其中伴有支气管哮喘病史者42例(20．0％)。210例患者均于术前、术后采用酶联免疫吸附测定法(ELISA)检测外周血单个核细胞(PBMC)培养上清液中的白细胞介素4(IL-4)，干扰素γ(IFN-γ)，可溶性白细胞介素2受体(sIL-2R)和可溶性IgE低亲和力受体(solube CD23，sCD23)的含量，并与20例正常对照组进行比较。通过主观和客观标准评定42例患者哮喘发作及对皮质类固醇的耐受状况，并对术后患者进行为期1年(10例)和3年(32例)的随访。结果鼻窦炎合并支气管哮喘患者术前PBMC培养上清液中IL-4，sIL-2R、sCD23含量较对照组显著升高，而IFN-γ含量较对照组显著减少。术后IL-4、sIL-2R、sCD23含量较对照组显著降低，而IFN-γ含量显著增高。术后哮喘改善水平由随访术后1年的45％提高到术后3年的70％。42例中32例(76％)哮喘发作次数明显减少，术前长期服用类固醇的2l例中，14例(67％)减少了对口服类固醇的使用。结论ESS对慢性鼻窦炎伴支气管哮喘患者的治疗有较满意的远期疗效。ESS能调节IL-4、IFN-γ sIL-2R、sCD23水平，降低哮喘的发作频率和对类固醇的依赖。     

Evaluation of aspirin hypersensitivity in patients with chronic rhinosinusitis

Conclusion The recurrence rates of chronic rhinosinusitis (CRS) were higher in the aspirin nasal provocation test (ANPT)-positive group, regardless of the presence of nasal polyps. Thus, a careful endoscopic examination is required during follow-up in ANPT-positive patients with CRS. Objectives The aim of this study was to evaluate the clinical features and prognosis after surgical treatment in patients with CRS and aspirin hypersensitivity. Methods In a prospective study, 100 patients were analyzed with CRS who underwent endoscopic sinus surgery at the hospital from October 2012 to March 2013. This study measured changes in nasal volume and symptoms before and after the ANPT and examined patient’s asthma history, allergy, Lund–Mackay score (LMS), total immunoglobulin E, percentage of peripheral eosinophils, and objectively measured relapse at 6 months. Results Patients wwith CRS and nasal polyps (CRSwNP) were more likely to have a positive ANPT test result compared to those without nasal polyps (CRSsNP) (21.4% vs 5.5%). The ANPT-positive group had a higher LMS and required more revision endoscopic sinus surgery than those in the ANPT-negative group. The results were that similar results were observed in CRSwNP and CRSsNP.     

慢性鼻-鼻窦炎伴鼻息肉患者鼻内镜术后症状与病理学指标相关分析

目的：评估病理学指标对预测慢性鼻-鼻窦炎伴鼻息肉患者鼻内镜术后疗效的价值。方法：通过对53例接受鼻内镜手术1年以上的慢性鼻-鼻窦炎伴鼻息肉患者的临床症状问卷调查,阅读这些患者的手术标本病理切片,统计相关病理指标,统计学分析慢性鼻-鼻窦炎伴鼻息肉患者接受鼻内镜术后的主要症状及其与病理学指标之间的联系。结果：慢性鼻-鼻窦炎伴鼻息肉患者接受鼻内镜手术后最主要的症状有鼻塞、流脓涕、流清涕或打喷嚏,其中杯状细胞与打喷嚏、流脓涕症状,病理性腺体形成与头昏症状,组织水肿程度与后鼻滴漏症状相关（P〈0.05）。结论：病理学指标有助于预测慢性鼻-鼻窦炎伴鼻息肉患者鼻内镜术后疗效。     

鼻内镜术后中药鼻腔雾化吸入辅佐治疗慢性鼻-鼻窦炎的主客观评估

目的 评价慢性鼻-鼻窦炎(chronic rhinosinusitis, CRS)患者在鼻内镜术(endoscopic sinus surgery, ESS)后用中药进行鼻腔超声雾化吸入辅佐治疗的疗效。方法 63例CRS患者随机分为治疗组(33例)和对照组(30例),ESS术后第3天行鼻腔超声雾化吸入。治疗组雾化用药为鼻窦炎口服液,每天早晚各1次,每次8mL,连续5d,后改为每周1次,连续3个月。对照组使用生理盐水鼻腔雾化吸入,方法相同。雾化前(术后第2天)、雾化5d和3个月后分别采用视觉模拟量表、Lund Kennedy评分系统、Lund Mackay评分法进行相关评估。结果 通过对主观症状、鼻内镜及鼻窦CT扫描进行检查评估,治疗组与对照组在雾化前后及组间比较差异均有统计学意义。结论 CRS患者ESS术后中药雾化吸入能明显提高手术疗效。     

Endoscopic sinus surgery improves pulmonary function in patients with asthma associated with chronic sinusitis

We evaluated the clinical efficacy of endonasal endoscopic sinus surgery (ESS) in patients with asthma associated with chronic sinusitis. Twenty-one patients (13 men and 8 women) from 27 to 72 years old were enrolled in this study. All patients had had sinus-related symptoms for more than 3 months and had computed tomographic evidence of paranasal sinus opacification. Fifteen patients underwent bilateral endonasal ESS under local anesthesia, and 6 other patients without surgery were controls. The sinus-related symptoms of the preoperative and postoperative periods were assessed via a questionnaire. The period 6 months prior to surgery was compared with that 6 months postoperatively with regard to peak expiratory flow and total dosage of systemic glucocorticoids. Sinus-related symptoms in the ESS group were significantly improved 6 months postoperatively. The average peak expiratory flow 6 months following surgery was improved in the ESS patients, ranging from 40 to 190 L/min. Seven patients showed a reduction in the need for corticosteroids, whereas 2 patients were unchanged and 2 patients required larger dosages. The remaining 4 patients needed no corticosteroids before or after ESS. No significant changes in sinus-related symptoms or peak expiratory flow were obtained for the control group. Improvement of paranasal sinus disease by successful ESS can alleviate pulmonary dysfunction in asthma associated with chronic sinusitis. We believe that adequate and positive treatment for chronic sinusitis would reduce not only the nasal and sinus-related symptoms evoked by chronic sinusitis, but also some of the signs induced by asthma.     

影响内窥镜鼻窦手术远期疗效的原因分析

目的 :探讨影响经鼻内窥镜鼻窦手术疗效的原因。方法 :采用经鼻内窥镜手术治疗慢性鼻窦炎、鼻息肉 2 0 1例 (35 3侧 ) ,术后系统换药 ,结合局部用药及鼻窦冲洗。结果 :随访 1～ 2年 ,其中治愈 134例 (6 7.7% ) ,好转41例 (2 0 .4% ) ,无效 2 6例 (12 .9% )。结论 :提高鼻内窥镜手术操作技术 ,术后系统换药 ,局部用药及冲洗 ,是提高内窥镜鼻窦手术疗效的三个重要环节。