本文選題：鼻竇炎　切入點(diǎn)：鼻息肉　出處：《臨床耳鼻咽喉頭頸外科雜志》2016年16期 　論文類型：期刊論文

【摘要】：目的:探討不保留中、上鼻甲的內(nèi)鏡鼻竇手術(shù)對(duì)伴有嗅覺功能障礙的慢性全組鼻-鼻竇炎伴鼻息肉患者的生存質(zhì)量以及嗅覺功能的影響。方法:81例伴嗅覺功能障礙的慢性全組鼻-鼻竇炎伴鼻息肉患者,均在全身麻醉下施行不保留中、上鼻甲的內(nèi)鏡鼻竇手術(shù),圍手術(shù)期給予鼻腔沖洗、局部激素噴鼻、口服黏液促排劑、酌情應(yīng)用大環(huán)內(nèi)酯類藥物等規(guī)范化藥物治療。使用鼻腔鼻竇結(jié)局測試20(SNOT-20)中文版量表評(píng)估患者術(shù)前、術(shù)后的生存質(zhì)量;使用TT嗅覺功能檢測法及視覺模擬量表(VAS)評(píng)估患者的嗅覺功能。結(jié)果:通過SNOT-20量表評(píng)估,術(shù)前必須擤鼻涕、缺乏高質(zhì)量睡眠、流黏稠鼻涕、難以進(jìn)入睡眠、尷尬5個(gè)條目對(duì)患者生存質(zhì)量的影響較為突出,術(shù)后第2周、術(shù)后1個(gè)月及術(shù)后3個(gè)月各項(xiàng)評(píng)分均較術(shù)前呈下降趨勢(shì)(P0.05)。嗅覺情況:術(shù)前81例(162側(cè))患者中54例(108側(cè))嗅覺完全喪失,27例不同程度嗅覺減退(10例為雙側(cè)對(duì)稱性嗅覺減退,17例為雙側(cè)不對(duì)稱性嗅覺減退)。術(shù)后3個(gè)月嗅覺功能較術(shù)前改善者70例(86.4%),其中雙側(cè)嗅覺功能完全恢復(fù)者43例(53.1%),未完全恢復(fù)但有不同程度改善者27例(33.3%);嗅覺功能無改善者11例(13.6%)。術(shù)后隨訪1年以上者61例,術(shù)后1年嗅覺功能較術(shù)前改善者53例(86.9%),其中雙側(cè)嗅覺功能完全恢復(fù)者31例(50.8%),未完全恢復(fù)但有不同程度改善者22例(36.1%);嗅覺功能無改善者8例(13.1%);余20例正在隨訪中。TT嗅覺功能檢測法術(shù)前與術(shù)后3個(gè)月比較差異有統(tǒng)計(jì)學(xué)意義(P0.05);VAS評(píng)分術(shù)前與術(shù)后3個(gè)月比較差異亦有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:對(duì)于伴有嗅覺功能障礙的雙側(cè)慢性全組鼻-鼻竇炎伴鼻息肉患者,采用不保留中、上鼻甲的內(nèi)鏡鼻竇手術(shù)、結(jié)合圍手術(shù)期規(guī)范的藥物治療,可以有效改善患者的生存質(zhì)量和嗅覺功能。未發(fā)現(xiàn)因切除組織較多導(dǎo)致的過度通氣及鼻干等癥狀。
[Abstract]:Objective: to explore the unreserved process, Effects of endoscopic sinus surgery on the quality of life and olfactory function in patients with chronic rhinosinusitis and nasal polyps with olfactory dysfunction methods 81 cases of chronic nasosinusitis with olfactory dysfunction. Patients with inflammation and nasal polyps, Under general anesthesia, endoscopic sinus surgery for upper turbinate was performed under general anesthesia. Nasal irrigation, local hormone spray, oral mucus excretion agent were given to the upper turbinate during the perioperative period. To evaluate the quality of life (QOL) of patients before and after operation with the Chinese version of the nasal sinus outcome test (20 SNOT-20). The olfactory function of patients was evaluated by TT olfactory function test and visual analogue scale (VASS). Results: SNOT-20 scale was used to evaluate the patients' olfactory function. Results: the patients must blow their noses before operation, lack of high quality sleep, runny and sticky nose, and difficult to get into sleep. The effect of embarrassing five items on the quality of life of the patients was significant, and the second week after operation, At 1 month after operation and 3 months after operation, the scores showed a downward trend (P 0.05). Olfactory status: 54 cases (108 sides) had complete loss of olfactory, and 10 cases had bilateral symmetry olfactory loss (n = 27). The olfactory function was improved in 70 cases 3 months after operation compared with that before operation in 70 cases, among which 43 cases had complete recovery of bilateral olfactory function, 27 cases had different degree of improvement of olfactory function. There were 11 cases with no improvement in function, 61 cases were followed up for more than one year after operation. One year after operation, the olfactory function was improved in 53 cases (86.9%), in which bilateral olfactory function was completely recovered in 31 cases (50.8%), incomplete but improved in 22 cases (36.1%), no improvement in 8 cases (13.1%), and 20 cases in follow-up. There was significant difference in VAS score between before and 3 months after olfactory function test. Conclusion: for patients with olfactory dysfunction, there is a significant difference in VAS scores before and 3 months after operation. Conclusion: for patients with olfactory dysfunction, there is no significant difference between them. Sinusitis with nasal polyps, Endoscopic sinus surgery without reservation of upper turbinate combined with standard drug therapy during perioperative period could effectively improve the quality of life and olfactory function of the patients. No symptoms such as hyperventilation and nasal dryness caused by excision of tissues were found.
【作者單位】： 青島大學(xué)附屬醫(yī)院耳鼻咽喉頭頸外科;
【分類號(hào)】：R765.9

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