不同健康教育在鼻内镜术后患者中的应用

目的探讨门诊强化性健康教育对提高患者鼻腔冲洗依从性、患者舒适度及预后的影响。方法纳入2017年4月~2018年3月间收治的鼻窦炎鼻息肉患者,经鼻内镜手术后第1次门诊复诊时随机分成门诊强化性宣教组(干预组)和常规宣教组(对照组)。收集患者一般资料以及3个月门诊随访时鼻腔冲洗依从性、鼻腔冲洗知识掌握度、主观症状、鼻内镜下鼻腔黏膜愈合情况。结果84例患者完成随访及问卷资料收集。干预组在术后3个月时每日冲洗>1次的占57.1%,对照组占14.2%,干预组依从性显著好于对照组(P=0.001)。84例患者的主观症状VAS得分分别为:鼻塞3.11分(95%CI:2.25~3.97),流涕2.08分(95%CI:1.21~2.95),头面部疼痛1.29分(95%CI:0.52~2.05),脓涕3.36分(95%CI:2.48~4.23),嗅觉减退3.01分(95%CI:1.90~4.12)。鼻塞(P=0.007)和鼻内干痂(P=0.041)在干预组中明显优于对照组。其他症状和鼻腔条件的比较结果在2组间差异无统计学意义。结论进行门诊随访时的鼻腔冲洗教育对患者出院3个月时的鼻腔冲洗维持具有显著效果。门诊鼻腔冲洗教育对患者鼻腔冲洗的改进可能减少患者鼻塞症状以及干痂的出现。

Application of different kinds of health education in patients after functional endoscopic sinus surgery

Objective To evaluate the affection of outpatient continuing health education in improving nasal irrigation compliance, patient comfort and prognosis in post-surgical chronic rhinosinusitis (CRS) patients. Methods Patients with chronic rhinosinusitis who had undergone functional endoscopic surgery between April 2017 and March 2018 were included in this study. At the first outpatient referral, patients were randomly divided into intervention group and the control group receiving different type of post-surgical education. We collected general patient information and the differences in nasal irrigation compliance, subjective symptoms, objective nasal mucosal healing under endoscopy at 3-month follow-up. Results Eighty-four patients completed follow-up and questionnaire data collection. A percent of 57.1% patients in intervention group at 3 months after the operation had nasal irrigation more than once a day which was significantly higher than control group(P=0.001). Average visual analogue scales for both group were nasal congestion 3.11(95%CI:2.25~3.97),nasal discharge 2.08(95%CI:1.21~2.95),head/facial pain1.29(95%CI:0.52~2.05),thick nasal discharge 3.36(95%CI:2.48~4.23),and loss of smell 3.01(95%CI:1.90~4.12). Among these symptoms, patients in intervention group had significant lower nasal congestion(P=0.007) and nasal dry scab (P=0.041) scores. Conclusions Education for nasal irrigation at outpatient follow-up has a significant effect on nasal irrigation maintenance at 3 months after discharge from the hospital; improvements in nasal irrigation during outpatient may reduce nasal congestion and dry scab in patients.