慢性鼻-鼻窦炎-鼻息肉伴哮喘患者鼻内镜围手术期药物治疗

目的 探讨慢性鼻-鼻窦炎-鼻息肉(CRSwNP)伴支气管哮喘患者鼻内镜围手术期药物治疗原则及效果。方法 收集2010年6月至2013年12月山东大学齐鲁医院耳鼻咽喉科收治的109例CRSwNP伴支气管哮喘患者行鼻内镜手术(ESS)的临床资料。术前均对哮喘进行全面评估, 哮喘完全控制6个月后行ESS手术治疗, 围手术期采用雾化吸入及全身糖皮质激素等药物治疗。结果 围手术期无哮喘急性发作, 仅1例患者术后第2天因口服镇痛剂出现喘息;术后随访1~3年, 采用鼻内镜检查并行ESS临床疗效评估, 病情完全控制者5例(4.59%), 病情部分控制者94例(86.24%), 病情未控制10例(9.17%);仅1例术后13个月因股骨头坏死行手术治疗。结论 全面细致的哮喘病情评估和ESS围手术期药物治疗有利于防止围手术期哮喘发作及控制术后CRSwNP患者鼻息肉复发, 有利于提高手术疗效。

Perioperative treatment in endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps and asthma

Objective To explore the perioperative medicine treatment and notes of endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps(CRSwNP) and asthma. Methods From June 2010 to December 2013, 109 patients with CRSwNP accompanying with asthma were treated by endoscopic sinus surgery(ESS). All patients with asthma were evaluated pre-operation and performed ESS 6 months after completely controlled. Medication such as atomization inhalation and systemic corticosteroids were given to control and prevent asthma attack during peri-operation. Results No asthma attack happened during the treatment process. Only 1 patient had wheezing on the 2nd day post-operation by oral analgesics. Endoscopy examination was administrated in a follow-up period of 1 to 3 years after the surgery. Among them, 5 patients(4.59%) were completely controlled, 94(86.24%) were partly controlled and 10(9.17%) were not. Only 1 patient was treated with operation because of avascular necrosis of the femoral head 13 months after ESS. Conclusion It is useful to prevent asthma attack and improve ESS efficacy in CRSwNP that depends on asthma evaluation before ESS and rigorous medicine peri-operative treatment.