四黄灌洗液对慢性鼻窦炎和鼻息肉术后粘膜形态和功能转归的影响

目的 探讨慢性鼻窦炎经鼻内镜鼻窦开放术后应用四黄灌洗液冲洗对术腔粘膜形态和功能恢复及术后早期疗效的影响。方法 对218例慢性鼻窦炎患者行经鼻内镜鼻窦开放术,随机分为治疗组(术后四黄灌洗液鼻腔冲洗组)和对照组(术后庆大霉素+地塞米松鼻腔冲洗组)作对比观察,随访6个月。各组随机选取32例患者于术前、术后6个月进行糖精试验。每组6例患者分别于术前、术后1个月、6个月取窦口鼻道复合体粘膜进行电镜观察。结果 尽管两组的治愈率无明显差异,但治疗组鼻腔粘膜形态和功能恢复时间均较对照组显著提前(P<0.05)。两组患者治疗前的SIgA无显著性差异(P>0.05),治疗后1个月治疗组患者SIgA与对照组比较显著升高(P<0.05)。术前治疗组纤毛传输速率为(3.14±1.05)mm/min,两组比较差异无显著性(P>0.05);术后3个月治疗组纤毛传输速率为(6.09±2.63)mm/min,与术前比较差异有显著性(P<0.01),对照组为(5.04±1.22)mm/min,两组之间比较有显著性差异(P<0.05)。电镜观察:术前粘膜上皮纤毛脱落,术后纤毛排列整齐,粗细均匀,呈“9+2”微管结构。结论 术后鼻腔应用四黄灌洗液冲洗能加快鼻腔粘膜形态和功能的恢复。

Effects of irrigating solution of Sihuang on morphology and function of nasal mucosa following surgery for chronic sinusitis and nasal polyps

Objective To investigate the effect of the irrigating solution of Sihuang (ISSH) given after endoscopic surgery for chronic sinusitis and nasal polyps. Methods ISSH was used to irrigate the operated sinus cavity for 4 weeks in 109 patients with chronic sinusitis and/or polyps treated by endoscopic surgery, and 0.9% normal saline (NS) was given in the same manner in another 109 patients receiving ISSH for similar problems, and the effects of the irrigating solutions was compared. Before and 3 months after the surgery, respectively, 32 patients with sinusitis were selected from each group for saccharin test. The mucosa in the ostiomeatal complex region was examined by electron microscopy in 6 patients before, two weeks and one month after surgery, respectively. Results The total effective rate was not significantly different between the two groups, but the postoperative morphological and functional recovery of the nasal mucosa occurred earlier in ISSH than in NS group (P<0.05). The level of SIgA was similar between the two groups before treatment (P>0.05), whereas after ISSH treatment, the SIgA level was significantly elevated in the treated group. Mucociliary transport rate was similar between ISSH and NS groups before the surgery (3.14±1.05 mm/min vs 3.31±1.09 mm/min, P>0.05), but 3 month after the surgery, the mucociliary transport rate increased to 6.09±2.63 mm/min in ISSH group and 5.04±1.22 mm/min in NS group, showing significant difference between them. Under electron microscope, the cilia of the epithelial cells were found exfoliated preoperatively but regularly arranged after the surgery, presenting the "9+2" architecture of the microtubule. Conclusion ISSH used after operation can improve the therapeutic effect of endoscopic surgery for chronic sinusitis and/or nasal polyps.