鼻腔冲洗治疗变应性鼻炎的疗效观察

目的：比较鼻腔冲洗及鼻用激素治疗对变应性鼻炎（AR）患者鼻部症状及气道炎症相关指标的影响,探讨鼻腔冲洗在AR治疗中的意义。方法：将61例经变应原皮肤点刺试验诊断为AR的患者随机分为3组：A组17例（单纯鼻用激素治疗）,B组21例（单纯鼻腔冲洗）,C组23例（鼻腔冲洗联合鼻用激素）。观察各组治疗前、治疗3个月后鼻部症状视觉模拟量表（VAS）评分和鼻炎结膜炎生活质量（RQLQ）评分及下气道呼出气一氧化氮（FENO）值。结果：3组患者治疗前VAS、RQLQ评分及FENO值比较差异无统计学意义（P〉0.05）,具有可比性。治疗3个月后3组患者VAS、RQLQ评分及FENO值均明显降低（P〈0.05）。治疗3个月后3项指标减少差值比较,VAS、RQLQ评分3组间差异无统计学意义,FENO值A、C组与B组比较均差异有统计学意义（均P〈0.05）。结论：鼻腔冲洗能改善AR患者的鼻部症状,提高患者的生活质量,降低下气道炎症。鼻腔冲洗治疗AR有效,与鼻用激素联合使用能取得更明显的效果。     

应用鼻腔冲洗器冲洗鼻腔对慢性鼻-鼻窦炎患者鼻腔黏液纤毛功能的影响

目的观察应用鼻腔冲洗器冲洗鼻腔对慢性鼻-鼻窦炎患者鼻腔黏膜纤毛功能的影响。方法60例单纯性慢性鼻-鼻窦炎患者,随机分为治疗组和对照组。治疗组用3%高渗盐水经鼻腔冲洗器冲洗鼻腔,对照组用3%高渗盐水经灌肠袋冲洗鼻腔,均为每日两次,连续冲洗14天,并辅以短期药物辅助治疗。分别于治疗前、治疗2周及疗后3月以糖精试验法检测鼻腔黏液纤毛清除率,比较两组鼻腔黏膜纤毛功能恢复情况和症状与体征的变化。结果治疗前2组的鼻腔黏液纤毛清除率差异无统计学意义;治疗2周后治疗组清除率为6.15±2.16mm/min,对照组为4.99±1.35mm/min,P＜0.05,前者的症状改善程度也较为明显;疗后3月治疗组清除率为6.81±1.45mm/min,对照组为6.69±2.41mm/min,P＞0.05。结论用鼻腔冲洗器冲洗鼻腔可有效促进鼻腔黏膜纤毛功能的早期恢复,对慢性鼻-鼻窦炎有辅助治疗作用。     

鼻腔冲洗对鼻腔功能的影响

鼻腔黏液纤毛传动系统是呼吸道重要的防御机制,鼻腔冲洗后能使黏膜纤毛清除频率得到改善,但目前有关鼻腔冲洗的使用频率、持续时间和冲洗液选择等尚无统一标准,还缺乏具体、直接、客观的指标来判断鼻腔冲洗后的临床效果.本文对常见的鼻腔冲洗液在鼻腔冲洗中的应用情况进行综述,并比较其优缺点.     

不同鼻腔冲洗液在鼻窦炎鼻内镜手术前应用的效果分析

目的观察鼻内镜术前鼻腔冲洗对慢性鼻窦炎患者围手术期鼻部症状、体征的影响及不同鼻腔冲洗液对患者鼻内镜手术治疗效果的影响。方法选取2016年1月~2016年12月因慢性鼻窦炎在本院耳鼻咽喉科行鼻内镜下鼻窦手术治疗的患者100例。随机分为四组,每组25例患者。第一组患者术前不进行鼻腔冲洗,为对照组,其余三组患者在手术前分别用0.9%等渗盐水、2.2%高渗盐水和林格氏溶液进行鼻腔冲洗,一天2次。四组患者分别在冲洗前、冲洗第一天后、冲洗第二天后分别进行鼻部症状(鼻塞、鼻痒、流涕、喷嚏、嗅觉)评分。患者入院时、术中、出院时分别进行鼻部体征(黏膜充血程度、鼻甲肿大程度、分泌物量)评分,比较冲洗前后及不同冲洗液组间的评分差异。结果四组患者在入院时鼻部症状评分无显著差异。术前行鼻腔冲洗的患者较未经鼻腔冲洗的患者在鼻部症状和体征评分上有显著差异,三组行鼻腔冲洗的治疗组患者鼻部症状和体征评分显著低于未进行鼻腔冲洗的对照组。而三种不同冲洗液行鼻腔冲洗的患者组间症状评分无显著差异。结论对慢性鼻窦炎的患者在手术前进行鼻腔冲洗可显著改善患者的术前鼻部症状,改善术中及术后鼻部体征,安全性高,值得在临床推广使用。     

鼻用糖皮质激素改善变应性鼻炎眼部症状的临床观察

目的通过与口服抗组胺药和鼻腔冲洗进行比较,评估鼻用糖皮质激素在改善变应性鼻炎(allergic rhinitis,AR)眼部症状中的临床价值。方法间歇性或持续性AR患者135例,随机分为3组:鼻用激素组、口服抗组胺药组和鼻腔冲洗组分别给予丙酸氟替卡松鼻喷剂200μg、氯雷他定片10mg和生理性海水鼻喷剂,每日1次,疗程6天。根据患者眼部症状(眼痒、流泪、结膜充血)的主观感受进行评分,比较治疗前后眼部症状总评分(TOSS)及各项症状的改善情况。结果治疗前鼻用激素组、口服抗组胺药组和鼻腔冲洗组TOSS的基线评分分别为6.20±0.99、6.08±1.24和6.36±1.11,差异无统计学意义(P0.05)。在6天的治疗期间,3组患者TOSS分别减少3.15±1.13、2.51±1.02和1.60±0.62,差异有统计学意义(P0.01)。从治疗第3天起,鼻用激素组与口服抗组胺药组相比较TOSS下降更为显著(P0.05)。在单个眼部症状中流泪改善最为明显,3组患者6天治疗期间的流泪症状评分分别下降1.80±0.92、1.03±0.59和1.06±0.59,差异有统计学意义(P0.05);同样,鼻用激素组的疗效优于口服抗组胺药组也出现在治疗3天后(P0.01)。结论鼻内局部使用丙酸氟替卡松可明显改善AR患者的眼部症状,但作用机制有待进一步研究。     

指南解析鼻腔冲洗在变应性鼻炎及慢性鼻-鼻窦炎中的治疗地位

鼻腔冲洗近年来被国际各大指南性文件提及和推荐使用,其疗效虽不如鼻用糖皮质激素显著,但是为首位的鼻科辅助治疗,能改善鼻部症状的同时具备远期疗效,对鼻腔手术术后护理及鼻黏膜修复也有益处。但由于鼻腔冲洗的研究还停留在临床观察与鼻纤毛运动学上,缺乏充分的理论依据,同时对于冲洗液选择、冲洗频次、时间和方法上存在很大的主观性,这也一定程度上影响鼻腔冲洗在各大指南性文件中的撰写。本文通过总结国际上相关指南性文件中关于鼻腔冲洗在变应性鼻炎及慢性鼻-鼻窦炎的应用,对这一治疗进行解读。     

鼻腔冲洗研究新进展

鼻腔是呼吸道的门户,由于解剖部位表浅及鼻黏膜的吸收功能等特性,给鼻部的干预治疗提供了条件,鼻内局部用药已成为治疗鼻病的主要手段.鼻腔冲洗足局部治疗的有效疗法之一,鼻腔冲洗义称盥洗、灌洗或清洗,是指借助某种装置,将冲洗液输送到鼻腔,通过药液与鼻腔靶组织的接触,达到清洁鼻腔及药物治疗等目的的一种治疗方法.     

下鼻甲外移联合低温等离子消融术治疗慢性肥厚性鼻炎疗效分析

目的探讨下鼻甲外移联合低温等离子消融术对以鼻塞为主要症状的成人慢性肥厚性鼻炎患者的主观症状、鼻腔黏膜纤毛清除功能及鼻阻力的疗效。方法将门诊诊断为慢性肥厚性鼻炎的76例患者分为手术组和药物组,分别行下鼻甲外移联合低温等离子消融术治疗和等渗盐水鼻腔冲洗加鼻内糖皮质激素治疗。治疗后1年检测患者主观症状、黏膜纤毛清除时间及鼻阻力变化,并与治疗前进行对比分析。结果治疗前患者平均糖精清除时间为17.42min;治疗后手术组患者平均糖精清除时间为17.47min,药物组患者平均糖精清除时间为16.82min,手术组与药物组比较差异无统计学意义(P>0.05)。鼻阻力检测示,手术组鼻阻力明显减小,且其减小程度与药物组比较差异具有统计学意义(P<0.01)。与治疗前相比,视觉模拟量表(VAS)评分示手术组患者鼻塞症状明显改善(P<0.05),且改善程度优于药物组。结论下鼻甲外移联合低温等离子消融术治疗对慢性肥厚性鼻炎患者鼻腔黏膜清除功能影响不明显,但可显著减小鼻阻力,且对患者主观症状改善明显。     

功能性鼻内镜手术联合糖皮质激素鼻腔冲洗对慢性鼻窦炎患者鼻黏膜纤毛功能及鼻腔微生态的影响#br#

目的　功能性鼻内镜手术（functional endoscopic sinus surgery,FESS）联合糖皮质激素鼻腔冲洗对慢性鼻窦炎（CRS）患者鼻黏膜纤毛功能及鼻腔微生态的影响。方法　选择2020年1月～2021年3月长治市人民医院收治的CRS行FESS的患者126例作为研究对象,随机分为对照组（n=63）与观察组（n=63）。对照组采用鼻用糖皮质激素（糠酸莫米松鼻喷雾剂）鼻腔喷入,2喷/侧,1次/d,每次200 μg。观察组在对照组基础上予以0.9%氯化钠注射液及布地奈德进行鼻腔冲洗,每次冲洗量240 ml,每侧鼻腔一半,1次/d。 两组均治疗3个月。比较两组临床疗效。应用糖精实验检测两组治疗3个月后鼻黏膜纤毛功能,包括黏液纤毛清除速度、黏液纤毛清除率;采用Mmhur软件对两组治疗前、治疗3个月后鼻腔微生态菌落进行分析（主要为Chaol指数、Ace指数、Simpson指数及Shannon指数）。结果　观察组术后CRS控制率98.41%（62/63）大于对照组87.30%（53/63）,差异有统计学意义（P＜0.05）;观察组黏液纤毛清除速度、黏液纤毛清除率均大于对照组,差异有统计学意义（P＜0.05）;治疗后两组Chaol指数、Ace指数、Shannon指数均明显下降,且观察组明显低于对照组,Simpson指数明显升高,且观察组明显高于对照组,差异有统计学意义（P＜0.05）。结论　CRS患者FESS联合糖皮质激素鼻腔冲洗,可提高鼻黏膜纤毛功能,改善鼻腔微生态,减少菌群的异常增殖。     

鼻渊汤鼻腔冲洗配合西药治疗肺脾气虚型儿童慢性鼻-鼻窦炎的临床观察

目的 观察鼻渊汤鼻腔冲洗配合西医疗法治疗肺脾气虚型儿童慢性鼻-鼻窦炎的临床疗效.方法 肺脾气虚型慢性鼻-鼻窦炎患儿随机分为治疗组和对照组,每组各30例.治疗组在常规西医治疗基础上加用鼻渊汤鼻腔冲洗,对照组在常规西医治疗基础上加用生理盐水鼻腔冲洗,疗程均为4周.分别在治疗前、治疗4周及治疗后12周,采用视觉模拟量表评估其症状,鼻内镜观察评估鼻腔病变情况,糖精法测量鼻黏液纤毛传输速率;治疗前及治疗后12周时采用Lund-Mackay评分法评估鼻窦CT影像,比较两组疗效.结果 虽然两组病例均显示明显疗效,治疗后症状视觉模拟量表评分、鼻内镜评分均明显下降,黏液纤毛传输速率均较治疗前明显加快,但治疗组疗效更优于对照组,差异具有统计学意义(P＜0.05).结论 鼻渊汤鼻腔冲洗对肺脾气虚型儿童慢性鼻-鼻窦炎有辅助治疗意义.     

Ringer-Lactate solution versus isotonic saline solution on mucociliary function after nasal septal surgery

Irrigation with isotonic saline is one of the most frequently used solutions after nasal surgery. However, the effect of saline solutions on mucociliary clearance is not well known. In a previous study, it was found that isotonic saline solution had a negative effect on ciliary beat frequency but Ringer-Locke solution had no effect in vitro. In this study we compared the effects of Ringer-Lactate solution and isotonic saline solution on mucociliary transport time before, and after, nasal septal surgery in patients with nasal septal deviation. We found that patients who used Ringer-Lactate solution as irrigation after surgery had a significantly better mucociliary transport time than the patients using isotonic saline solution (p < 0.05). In conclusion, it is better to use Ringer-Lactate solution instead of 0.9 per cent saline solution for nasal irrigation.     

高渗盐水对慢性鼻窦炎患者鼻腔黏膜纤毛清除功能的影响

目的：探讨高渗盐水对成年慢性鼻窦炎患者鼻腔黏膜纤毛运动功能的影响。方法：选取住院待行鼻内窥镜下慢性鼻窦炎手术的患者为研究对象,用鼻腔黏膜纤毛清除功能糖精清除率法检测正常状态、鼻腔生理盐水喷雾和高渗盐水喷雾后糖精清除时间,统计学方法采用Wilcoxon检验。结果：慢性鼻窦炎患者平均糖精清除时间为19.62min,生理盐水和高渗盐水冲洗后患者平均糖精清除时间分别为17.74min和13.22min。与冲洗前相比,生理盐水未明显加快糖精清除速度（P＞0.05）,而高渗盐水冲洗后患者平均糖精清除时间明显缩短（P＜0.01）,平均缩短6.4min。结论：高渗盐水可使慢性鼻窦炎患者的黏膜清除时间缩短,促进黏膜的清除功能。等渗生理盐水对黏膜清除时间影响不明显。     

Tap water nasal irrigation in adults with seasonal allergic rhinitis: a randomized double-blind study

Saline nasal irrigation is effective in the treatment of seasonal allergic rhinitis, and sodium chloride itself has no antiallergic effects. The mechanism of saline nasal irrigation depends mainly on washing away allergens and inflammatory mediators induced by allergic reactions. Tap water has the same washing effects as saline. In this study, it was investigated if tap water nasal irrigation was effective in the treatment of seasonal allergic rhinitis. Sixty-four patients diagnosed with seasonal allergic rhinitis were enrolled. Patients were randomized to tap water nasal irrigation group and non-tap water nasal irrigation group for treatment. Patients of both groups were treated with desloratadine. Treatment outcomes were measured using allergic rhinitis Quality of Life (QoL) survey was completed at baseline and after 3 weeks of therapy. There were statistically significant differences in QoL scores between tap water nasal irrigation group and non-tap water nasal irrigation group. The tap water nasal irrigation group had better QoL scores than the non-tap water nasal irrigation group. Tap water nasal irrigation can be a valuable adjuvant therapy for patients with seasonal allergic rhinitis.     

Effects of sodium chloride hypertensive solution on maxillary clearance in patients with acute purulent maxillary sinusitis

In addition to clinical picture of acute purulent maxillary inflammation (APMI), radionuclide tests data were examined to assess maxillary clearance by function of mucociliary system and forced nasal breathing in APMI patients treated with sodium chloride (crystalline and liquid) or furacin. Dry dispersion of sodium chloride and its 3% solution, furacin solution have no effect on clearance of the sinuses. Only a 6% concentration of sodium chloride hypertensive solution significantly improves the clearance in forced nasal breathing.     

Functional Roles of Nasal Nitric Oxide in Nasal Patency and Mucociliary Function

The purpose of this study was twofold: (i) to clarify whether it is possible to change the amount of nasal nitric oxide (NO) artificially; and (ii) to confirm that the artificially altered nasal NO has biological properties such as vasodilatation and mucociliary function. We measured nasal NO and nasal airway resistance (NAR) in healthy subjects before and after topical administration of sodium nitroprusside (SNP), an NO donor. We also measured nasal NO and saccharin transport time after administration of SNP or L-N G -nitroarginine methylester (L-NAME), a NO synthase inhibitor. In addition, we examined the effect of SNP and L-NAME on nasal NO and saccharin transport time after pretreatment with flutropium bromide (FB), an anticholinergic agent. Administration of SNP elicited increases in nasal NO and NAR in a dose-dependent manner. Nasal NO decreased significantly after topical administration of L-NAME. Saccharin transport time, an indicator of mucociliary function, was shortened after topical administration of SNP and prolonged after administration of L-NAME. Moreover, these phenomena were observed even after pretreatment with FB. These results suggest that artificially altered nasal NO may affect NAR and mucociliary function.     

Endoscopic dacryocystorhinostomy appears to impair nasal mucociliary clearance

We conducted a prospective study of 50 adults to investigate changes in nasal mucociliary clearance following endoscopic intranasal dacryocystorhinostomy (DCR). Each operation was performed with the use of a drill to perforate the lateral nasal wall in order to reach the lacrimal sac. Each patient's mucociliary clearance time (MCT) was determined by the saccharin test on both the operated and nonoperated sides; the preoperative times were compared with postoperative measurements made 1 and 3 months following DCR. Preoperatively, the mean MCTs were 14.48 minutes on the operated side and 14.50 minutes on the nonoperated side-not a statistically significant difference (p > 0.05). Postoperatively, the corresponding MCTs were 25.22 and 14.98 minutes at 1 month and 18.44 and 15.62 minutes at 3 months. On the operated side, both postoperative MCTs were significantly longer than the preoperative value (p < 0.001), while on the nonoperated side, neither postoperative MCT was significantly different from the preoperative value (p > 0.05). Also, the postoperative MCTs were significantly longer on the operated side than on the nonoperated side at both 1 month (p < 0.001) and 3 months (p < 0.05). Only 1 of the 50 operations was considered to be unsuccessful; the reason for this surgical failure was the patient's ongoing complaints of chronic postoperative dacryocystitis. We conclude that endoscopic DCR disturbs mucociliary clearance. Changes in MCTs may be attributable to injury to the nasal mucosa or to the continuous flow of tears through the nasal mucosa.     

The effectiveness of nasal saline irrigation (seawater) in treatment of allergic rhinitis in children

Objective

To evaluate the effect of nasal saline irrigation in the treatment of allergic rhinitis (AR) in children and to assess whether nasal saline irrigation could be used as a complementary therapy for AR in children in combination with the intranasal corticosteroids (INS).

Method

In total, 61 children with AR were divided into three groups: the nasal irrigation, intranasal corticosteroid, and combined treatment groups. Symptoms and signs of AR and eosinophils (EOS) in the nasal secretions were evaluated after 4 weeks, 8 weeks, and 12 weeks of treatment.

Results

In AR children treated with nasal irrigation and a decreased the INS dose, a significant improvement in symptoms and signs and a significant decrease in the mean EOS count in nasal secretions were observed at week 12.

Conclusion

Nasal saline irrigation with physiological seawater is well tolerated and benefits the patients with AR, and can thus be considered a good adjunctive treatment option to maintain the effectiveness of the INS at a lower dose, thus resulting in reduced side effects and a decreased economic burden.     

Nasal obstruction and sleep-disordered breathing: a study using acoustic rhinometry

BACKGROUND: The relationship between nasal airway function and sleep-disordered breathing (SDB) remains unclear. Although correction of nasal obstruction can significantly improve nighttime breathing in some patients, nasal obstruction may not play a role in all cases of SDB. An effective method of stratifying these patients is needed. Acoustic rhinometry (AR) is a reliable, noninvasive method of measuring the dimensions of the nasal airway. METHODS: In 44 patients, we performed acoustic rhinometric measurements of nasal airway cross-sectional area, followed by hospital-based polysomnography and nasal continuous positive airway pressure (nCPAP) level titration. We compared anatomic nasal obstruction to perceived nasal obstruction, as well as respiratory distress index and nCPAP titration level, using the Pearson correlation and multiple linear regression analysis within body mass index groups. RESULTS: Perceived nasal obstruction correlated significantly with objective anatomic obstruction as measured by AR (r = 0.45, p < 0.01). For certain subgroup analyses in patients with a body mass index below 25, AR measurements correlated significantly with both nCPAP titration pressure (r = 0.85, p < 0.01) and respiratory distress index (r = 0.67, p = 0,03). CONCLUSION: Nasal airway function may be a significant component of SDB in some patients, perhaps playing a larger role in patients who are not overweight. The best responders to nasal surgery for SDB may be nonoverweight patients with nasal obstruction. AR along with nasal examination may be helpful in the evaluation and treatment of the SDB patient.     

Scintigraphic evaluation of nasal mucociliary activity in unilateral chronic otitis media

Mucociliary clearance is a key defence mechanism in human upper and lower airways. Although mucociliary activity is present in both ears of the patients, most cases of chronic otitis media are unilateral.In this study, we aim to evaluate the difference between nasal mucociliary activity of the affected and non-affected sides in patients with unilateral chronic otitis media. Both nasal transport times of 36 patients with unilateral chronic otitis media were compared statistically with each other and with the control group by independent samples t-test. The nasal mucociliary transport times of the nasal cavity at the same side as the affected ear and as the non-affected ear are significantly different, in the same patients. Our study shows that impaired or decreased nasal mucociliary activity may result in dysfunction of the eustachian tube and middle-ear ciliary activity, which plays an important role in the aetiopathogenesis of chronic otitis media.     

Functional roles of nasal nitric oxide in nasal patency and mucociliary function

The purpose of this study was twofold: (i) to clarify whether it is possible to change the amount of nasal nitric oxide (NO) artificially; and (ii) to confirm that the artificially altered nasal NO has biological properties such as vasodilatation and mucociliary function. We measured nasal NO and nasal airway resistance (NAR) in healthy subjects before and after topical administration of sodium nitroprusside (SNP), an NO donor. We also measured nasal NO and saccharin transport time after administration of SNP or L-N(G)-nitroarginine methylester (L-NAME), a NO synthase inhibitor. In addition, we examined the effect of SNP and L-NAME on nasal NO and saccharin transport time after pretreatment with flutropium bromide (FB), an anticholinergic agent. Administration of SNP elicited increases in nasal NO and NAR in a dose-dependent manner. Nasal NO decreased significantly after topical administration of L-NAME. Saccharin transport time, an indicator of mucociliary function, was shortened after topical administration of SNP and prolonged after administration of L-NAME. Moreover, these phenomena were observed even after pretreatment with FB. These results suggest that artificially altered nasal NO may affect NAR and mucociliary function.