慢性鼻-鼻窦炎伴支气管哮喘患者内镜手术综合治疗疗效观察

目的 研究以内镜手术为主的综合治疗对慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)伴支气管哮喘患者的疗效.方法 2006年9月至2009年3月共收治CRS伴支气管哮喘患者25例,行内镜鼻窦手术,围手术期使用鼻内糖皮质激素、口服大环内酯类抗生素、鼻腔冲洗等治疗.分别于术前、术后1年、3年对临床疗效进行评估.CRS疗效评估的指标为视觉模拟量表(visual analogue scale,VAS)、患者自评及鼻内镜Lund-Kennedy评分,哮喘评估指标为哮喘控制量表评分和分级、用药量和肺功能.结果 术后1年随访23例(92%),术后3年随访12例(48%).CRS疗效:整体症状的VAS评分术后1年为(3.20±2.19)分((x)±s,以下同),术后3年为(3.79±2.32)分,分别较术前(8 12±0.60)分]有显著改善(P值均为0.000),术后1年、3年之间差异无统计学意义(P=0.851);鼻内镜Lund-Kennedy评分术后1年为(4.35±3.21)分,3年为(5.50±2 64)分,分别较术前(9.80±2.10)分]有显著改善(P值均为0.000),术后1年、3年之间差异无统计学意义(P=0.606).支气管哮喘疗效:哮喘控制量表评分术前为(21.96±2.16)分,术后1年为(23.61±1.94)分,术后3年为(22 33±3 47)分,行双向方差分析,三者之间差异无统计学意义(F=2.871,P=0 065);术后1年14例患者哮喘用药不变,术后3年9例患者哮喘用药不变;第1秒用力呼气容积与用力肺活量的比值术前为74.68±11.09,术后1年为73.27±12.27,术后3年为73.50±7.87,三者之间差异无统计学意义(F=0.076,P>0.05).结论 以内镜手术为主的综合治疗对CRS伴哮喘患者疗效显著且持久,但治愈者极少;哮喘临床控制水平、用药量和肺功能均保持稳定.

Abstract：

Objective To evaluate the efficacy of endoscopic sinus surgery (ESS)-based on multidisciplinary treatment for patients with chronic rhinosinusitis ( CRS) and asthma. Methods The study included 25 CRS patients with asthma who received ESS from September 2006 to March 2009, besides surgery, who also used corticosteroid nasal spray, oral macrolide antibiotics and nasal irrigation perioperatively. Evaluation was performed before ESS, 1 year and 3 years post-ESS. Evaluation index included visual analogue scale(VAS) and endoscopy Lund-Kennedy assessment for CRS, and asthma control test (ACT) and pulmonary function tests for asthma. Results Twenty-three (92% ) patients were followed up for 12 months. Twelve (48% ) of them were followed up for 36 months. CRS efficacy: VAS of general symptom significantly improved after ESS compared to pre-ESS (8. 12 ±0. 60, (x) ±s) , after 1 year (3. 20 ±2. 19) and 3 year (3.79 ±2.32) follow up(both P =0.000). There was no statistic difference between 1 year and 3 year follow up (P = 0. 851). Endoscopy Lund-Kennedy score significantly improved in postESS after 1 year (4.35 ±3.21) and 3 year (5.50 ±2. 64) follow up compared to pre-ESS(9. 80 ±2. 10,both P = 0. 000 ) , and there was no difference between 1 year and 3 year follow up (P = 0. 606 ). Asthma efficacy: ACT pre-ESS, 1 year and 3 year were 21. 96 ± 2. 16, 23.61 ±1.94 and 22. 33 ±3.47, without statistic difference ( F = 2. 871, P = 0. 065 ). Pulmonary function showed no significant change after surgery (Pre-ESS 74.68 ± 11.09, 1 year 73.27 ± 12.27, 3 year 73.50 ± 7.87, F = 0.076, P > 0.05).Conclusions ESS improves CRS with asthma significantly and persistently. Asthma control level, antiasthma drug dose and pulmonary function remain stable after ESS.

Efficacy of endoscopic sinus surgery-based on multidisciplinary treatment for chronic rhinosinusitis with asthma

Objective To evaluate the efficacy of endoscopic sinus surgery (ESS)-based on multidisciplinary treatment for patients with chronic rhinosinusitis ( CRS) and asthma. Methods The study included 25 CRS patients with asthma who received ESS from September 2006 to March 2009, besides surgery, who also used corticosteroid nasal spray, oral macrolide antibiotics and nasal irrigation perioperatively. Evaluation was performed before ESS, 1 year and 3 years post-ESS. Evaluation index included visual analogue scale(VAS) and endoscopy Lund-Kennedy assessment for CRS, and asthma control test (ACT) and pulmonary function tests for asthma. Results Twenty-three (92% ) patients were followed up for 12 months. Twelve (48% ) of them were followed up for 36 months. CRS efficacy: VAS of general symptom significantly improved after ESS compared to pre-ESS (8. 12 ±0. 60, (x) ±s) , after 1 year (3. 20 ±2. 19) and 3 year (3.79 ±2.32) follow up(both P =0.000). There was no statistic difference between 1 year and 3 year follow up (P = 0. 851). Endoscopy Lund-Kennedy score significantly improved in postESS after 1 year (4.35 ±3.21) and 3 year (5.50 ±2. 64) follow up compared to pre-ESS(9. 80 ±2. 10,both P = 0. 000 ) , and there was no difference between 1 year and 3 year follow up (P = 0. 606 ). Asthma efficacy: ACT pre-ESS, 1 year and 3 year were 21. 96 ± 2. 16, 23.61 ±1.94 and 22. 33 ±3.47, without statistic difference ( F = 2. 871, P = 0. 065 ). Pulmonary function showed no significant change after surgery (Pre-ESS 74.68 ± 11.09, 1 year 73.27 ± 12.27, 3 year 73.50 ± 7.87, F = 0.076, P > 0.05).Conclusions ESS improves CRS with asthma significantly and persistently. Asthma control level, antiasthma drug dose and pulmonary function remain stable after ESS.