克拉霉素联合布地奈德应用对儿童鼻-鼻窦炎的疗效观察

目的探讨长期小剂量大环内酯类药物克拉霉素联合鼻用糖皮质激素布地奈德治疗儿童慢性鼻-鼻窦炎(CRS)的临床疗效。方法 93例诊断为CRS的儿童随机分为克拉霉素口服和布地奈德鼻喷剂组、克拉霉素口服组和布地奈德鼻喷剂组,克拉霉素口服125mg,每日1次;布地奈德鼻喷剂64μg,每日2次。给药时间12～34周,平均16.4周。采用VAS评估症状,鼻内镜观察评估鼻腔,时间窗分别安排在治疗前和治疗后1、3、6个月,CT评估:时间窗分别安排在治疗前和治疗后6个月。结果流涕、鼻塞、头痛症状在3组患儿治疗后均较治疗前明显好转(P<0.05),治疗后3个月及6个月联合用药组VAS评分低于单独用药组(P<0.05)。治疗前和治疗后不同时间鼻内镜评分显示,治疗后3组患儿评分均显著低于治疗前(P<0.05),治疗后3个月联合用药组评分显著低于单独应用克拉霉素组(P<0.205),治疗后6个月联合用药组评分显著低于单独用药组(P<0.05)。治疗前和治疗后6个月鼻窦CT评分显示,3组患儿治疗后病变均较治疗前有显著改善(P<0.05),其中联合用药组评分较单独用药组低(P<0.05)。结论长期小剂量克拉霉素与布地奈德联合应用是治疗儿童CRS一种安全有效的方法,联合用药的效果优于单独用药。

Clinical observation of clarithromycin combined with budesonide intranasal spray for pediatric chronic rhinosinusitis

Objective To observe the clinical treatment effectiveness of Clarithromycin combined with budesonide intranasal spray for pediatric chrnonic rhinosinusitis(CRS).Methods Ninty-three cases of pediatric CRS were randomly divided into three groups,i.e.Clarithromycin and budesonide intranasal spray,Clarithromycin,budesonide intranasal spray were given respectively.Effect were assessed by visual analogue score(VAS) and nasal endoscopy pretreatment and post-treatment in 1,3 and 6 months respectively.Assessment of CT was arranged pretreatment and post-treatment in 6 months.Results Scores of VAS,endoscopic and CT parameter were significantly decreased post-treatment compared with pretreatment in all of the three groups(P<0.05).VAS scores of Clarithromycin and budesonide intranasal spray group were significantly lower than Clarithromycin group and budesonide intranasal spray group in post-treatment 3 and 6 month(P<0.05).Endoscopic scores of Clarithromycin and budesonide intranasal spray group were significantly lower than Clarithromycin group in post-treatment 3 month(P<0.05),and significantly lower than Clarithromycin group and budesonide intranasal spray group in post-treatment 6 month(P<0.05).Scores of CT assessment in Clarithromycin and budesonide intranasal spray group were significantly lower than Clarithromycin group and budesonide intranasal spray group in post-treatment 6 month(P<0.05).Conclusion Treatment with long term use of low dosage Clarithromycin combined with budesonide intranasal spray on pediatric CRS was safe and efficacy.