本文選題：慢性鼻竇炎　切入點(diǎn)：視覺(jué)模擬評(píng)分　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討術(shù)前主客觀評(píng)估對(duì)慢性鼻竇炎(chronic rhinosinusitis,CRS)患者鼻塞圍手術(shù)期個(gè)性化處理的指導(dǎo)作用。方法:對(duì)擬行鼻內(nèi)鏡手術(shù)以鼻塞為主訴的CRS患者,因收治在相同年資相似經(jīng)驗(yàn)的高年資醫(yī)師組不同,而被分為實(shí)驗(yàn)組和對(duì)照組。術(shù)前兩組患者均采用視覺(jué)模擬量表(visual analog scale,VAS)對(duì)CRS患者鼻塞進(jìn)行主觀評(píng)分,采用鼻阻力(rhinomanometry,RM)、鼻聲反射(acoustic rhinometry,AR)進(jìn)行鼻塞客觀評(píng)估,同時(shí)行鼻內(nèi)鏡檢查和鼻竇CT檢查并采用Lund-Kennedy評(píng)分法和Lund-Mackay評(píng)分法進(jìn)行整體及病情嚴(yán)重程度評(píng)估。對(duì)術(shù)前鼻塞VAS評(píng)分5分者,實(shí)驗(yàn)組圍手術(shù)期嚴(yán)格依據(jù)主客觀評(píng)估采取個(gè)性化的處理策略,而對(duì)照組僅依據(jù)術(shù)者的臨床經(jīng)驗(yàn)進(jìn)行圍手術(shù)期處理。經(jīng)過(guò)術(shù)前準(zhǔn)備,局麻或全麻下行功能性鼻內(nèi)鏡手術(shù)。術(shù)后隨訪6月和1年,兩組患者均進(jìn)行主客觀評(píng)估、療效和患者滿意度評(píng)估。用SPSS21.0進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:(1)實(shí)驗(yàn)組完成隨訪102例,對(duì)照組53例。術(shù)前兩組患者一般情況、鼻塞VAS評(píng)分、鼻總阻力、Lund-Kennedy評(píng)分、Lund-Mackay評(píng)分相比,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(2)術(shù)后6月、術(shù)后1年,兩組患者在鼻塞VAS評(píng)分、鼻總阻力、Lund-Kennedy評(píng)分間相比,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)兩組患者術(shù)后6月、術(shù)后1年分別與術(shù)前相比,鼻塞VAS評(píng)分、鼻總阻力、Lund-Kennedy評(píng)分間均有統(tǒng)計(jì)學(xué)意義(P0.05),而術(shù)后1年與術(shù)后6月相比,實(shí)驗(yàn)組間差異亦有統(tǒng)計(jì)學(xué)意義(P0.05),但對(duì)照組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(4)術(shù)后兩組患者療效評(píng)估及患者滿意度自評(píng)分相比,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:術(shù)前鼻塞主客觀評(píng)估,不僅可用于CRS鼻塞癥狀嚴(yán)重程度及治療效果的評(píng)估,而且兩者綜合應(yīng)用可用于指導(dǎo)CRS圍手術(shù)期的個(gè)性化診斷和治療,可提高CRS的療效及患者的滿意度。
[Abstract]:Objective: to explore the guiding effect of preoperative subjective and objective evaluation on the individualized management of nasal congestion in patients with chronic sinusitis (CRS). Methods: nasal obstruction was the main complaint in nasal endoscopic surgery for CRS patients. Two groups were divided into experimental group and control group because of their differences in the same seniority and similar experience. Before operation, the patients in the two groups were assessed by visual analog scale-vas to evaluate nasal congestion in CRS patients. Nasal obstruction was evaluated by nasal resistive rhinomorphometry and acoustic acoustic rhinometryometry (ARR). Nasal sinus CT and nasal endoscopy were used to evaluate the severity of nasal congestion. The severity of nasal congestion was evaluated by Lund-Kennedy score and Lund-Mackay score. The VAS score of nasal obstruction was 5 points before operation. In the experimental group, the perioperative period was strictly based on subjective and objective evaluation, while in the control group, the perioperative period was treated only according to the clinical experience of the operator. Functional endoscopic sinus surgery was performed under local anesthesia or general anesthesia. All patients in the two groups were followed up on June and 1 year. The patients in both groups underwent subjective and objective evaluation, evaluation of efficacy and patient satisfaction. SPSS21.0 was used for statistical analysis. There was no significant difference between the two groups in VAS score, Lund-Kennedy score and Lund-Mackay score. There was no significant difference between the two groups in the VAS score of nasal obstruction on June and 1 year after operation. There were significant differences in total nasal resistance and Lund-Kennedy score between the two groups on June. VAS score of nasal obstruction and Lund-Kennedy score of total nasal resistance were significantly different from those before operation in one year after operation, and there was significant difference between one year after operation and June after operation. The difference between the two groups was also statistically significant (P 0.05), but there was no significant difference between the control group and the control group (P 0.05). Conclusion: there was significant difference between the two groups in the evaluation of curative effect and the self-score of patients' satisfaction after operation. Conclusion: the subjective and objective evaluation of nasal obstruction before operation is significant. It can be used not only to evaluate the severity of nasal congestion in CRS, but also to guide the individualized diagnosis and treatment of CRS during perioperative period. It can improve the curative effect of CRS and the satisfaction of the patients.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R765.9

【參考文獻(xiàn)】

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本文編號(hào)：1640501