功能性鼻内镜鼻窦手术后换药应用布地奈德混悬液的效果分析

目的 探讨在慢性鼻-鼻窦炎患者术后应用布地奈德混悬液（普米克令舒）的效果。方法 分析280例慢性鼻-鼻窦炎行鼻内镜手术的患者，随机分为2组，A组常规换药，术后常规使用布地奈德鼻喷剂喷鼻；B组对有囊泡及水肿明显者在术后换药过程中清理后予以明胶海绵浸润布地奈德混悬液置于囊泡及水肿部位，每周1~2次，观察术后1个月、3个月及6个月的疗效，包括VAS视觉量表主观评估及鼻内镜Lund-Kennedy客观评估。结果 A、B组术后1、3、6个月VAS评分分别为4.48±1.33，2.16±0.81，2.04±0.96；3.85±1.09，1.90±0.88，1.93±0.74。A、B组术后1、3、6个月Lund-Kennedy评分分别为11.44±1.73，4.51±1.05，3.94±0.86；6.82±2.08，4.26±1.17，2.17±0.79。两组患者的VAS评分在术后三个时间点差异均有统计学意义（P<0.05）；术后3个月、6个月与术后1个月比较，差异有统计学意义（P<0.05）；而术后3个月与术后6个月相比，差异无统计学意义。两组间Lund-Kennedy 客观评估比较，在术后1个月和6个月两个时间点差异有统计学意义（P<0.05），而在术后3个月，两组比较差异无统计学意义；术后3个月、6个月与术后1个月比较，差异有统计学意义（P<0.05）；而术后3个月与术后6个月相比，A组在两个时间点差异有统计学意义，B组在两个时间点差异无统计学意义。结论 慢性鼻-鼻窦炎鼻内镜术后应用布地奈德混悬液能更好地减少术后囊泡形成、减轻水肿，促进黏膜上皮化。

Budesonide used after functional endoscopic sinus surgery

Objective To investigate the effect of Budesonide after functional endoscopic sinus surgery（ FESS） for chronic nasal-sinusitis. Methods A total of 280 cases of chronic nasal-sinusitis（ CRS） which underwent FESS were randomly divided into two groups： A group was regular dressing group with Budesonide nasal spray; B group was put gelatin sponge with Budesonide infiltration at vesicles and edema place in the post-operative dressing process,1-2 times a week. Then we adopted VAS visual assessment and Lund-Kennedy assessment to assess the dressing effect after one,three and six months of FESS. Results The VAS scores and Lund-Kennedy scores of A and B groups at 1,3 and 6months were 4. 48 ± 1. 33,2. 16 ± 0. 81,2. 04 ± 0. 96; 3. 85 ± 1. 09,1. 90 ± 0. 88,1. 93 ± 0. 74 and 11. 44 ± 1. 73,4. 51 ± 1. 05,3. 94 ± 0. 86; 6. 82 ± 2. 08,4. 26 ± 1. 17,2. 17 ± 0. 79. The VAS score at the three time points was statistically significant between the two groups（ P〈0. 05）; The VAS score of the 3 and 6 months was statistically significant with that of 1 month（ P〈0. 05）; while it was not statistically significant between the 3 and 6 months. The Lund-Kennedy score at 1 and 6 months was statistically significant between the two groups（ P〈0. 05）; The Lund-Kennedy score at 3 and 6 months was statistically significant（ P〈0. 05）; while between 3 months and 6 months,it was statistically significant in the A group,but not in the B group. Conclusion Budesonide after FESS of CRS can better reduce vesicle formation,mitigate edema and promote mucosal epithelium.