發(fā)布時(shí)間：2019-05-18 10:07

【摘要】：背景 圍手術(shù)期綜合治療作為提高臨床療效的手段,已經(jīng)被廣泛應(yīng)用于各種手術(shù)領(lǐng)域,怎樣利用圍手術(shù)期處理提高慢性鼻-鼻竇炎手術(shù)的療效,備受到耳鼻喉科臨床醫(yī)生的關(guān)注。圍手術(shù)期綜合治療應(yīng)該包括術(shù)前消腫抗炎、術(shù)中保護(hù)正常粘膜及術(shù)后隨訪治療,包括術(shù)后抗炎消腫、促排、抗細(xì)菌生物膜等藥物治療,清理術(shù)腔、密切隨訪病情等綜合治療。鼻腔沖洗作為局部治療的一種措施,已逐漸被應(yīng)用于鼻腔及鼻竇各種疾病的治療中,包括急性和慢性鼻竇炎、變應(yīng)性和非變應(yīng)性鼻炎、鼻腔術(shù)后、鼻咽癌放療后等情況,甚至哮喘、病毒性感冒等上呼吸道疾病,它借助一定的裝置,通過物理沖刷、局部給藥等作用機(jī)制,清除鼻腔炎性分泌物、提高粘膜纖毛運(yùn)輸功能,減輕局部炎癥反應(yīng),療效肯定；鼻腔沖洗配合圍手術(shù)期藥物治療,勢必能促進(jìn)鼻竇炎患者病情的恢復(fù)。 目的 旨在觀察脾胃濕熱證慢性鼻竇炎患者在圍手術(shù)期應(yīng)用鼻竇炎沖洗液的療效,對比單純生理鹽水沖洗,通過綜合療效評價(jià),了解中藥沖洗在圍手術(shù)期治療中的優(yōu)勢。 方法 1根據(jù)病例納入標(biāo)準(zhǔn),收集符合條件病例120例,隨機(jī)分組為治療組(中藥沖洗)、對照組(生理鹽水沖洗),除常規(guī)圍手術(shù)期藥物治療外,術(shù)后24-48h后開始行鼻腔沖洗治療,治療1個(gè)月,隨訪6個(gè)月,分別于術(shù)前、術(shù)后3個(gè)月、6個(gè)月,采集相關(guān)研究數(shù)據(jù)； 2療效評定內(nèi)容分為主、客觀兩方面,①客觀療效：進(jìn)行鼻內(nèi)鏡復(fù)查,利用Lund-Kennedy評分法對術(shù)腔進(jìn)行計(jì)分；②主觀療效：進(jìn)行癥狀和生活質(zhì)量問卷調(diào)查(VAS評分、SNOT20評分)。 結(jié)果 客觀療效：術(shù)后所有患者(3個(gè)月、6個(gè)月)Lund-Kennedy評分都較術(shù)前有明顯改善；不同組別之間的術(shù)腔上皮化情況具有差異性,中藥沖洗組優(yōu)于鹽水沖洗組療效(P0.05)。 主觀療效：術(shù)后(3個(gè)月、6個(gè)月)VAS、SNOT-20總評分都較術(shù)前有明顯改善,其中SNOT-20不同維度的比較中,鼻部癥狀的改善最明顯。對比治療組與對照組的主觀療效指標(biāo),中藥沖洗組的VAS評分、SNOT-20在不同維度的改善程度均有較大的優(yōu)勢,在改善生活質(zhì)量方面作用突出,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論 鼻竇炎沖洗液中藥鼻腔沖洗能夠提高臨床治療效果,改善生活質(zhì)量,減輕鼻流涕、頭痛、睡眠障礙及疲倦、焦慮等局部和全身癥狀,減輕術(shù)后鼻腔粘膜炎癥,促進(jìn)粘膜上皮化,減少鼻腔分泌物,療效優(yōu)于單純生理鹽水沖洗。
[Abstract]:Background as a means to improve the clinical efficacy, perioperative comprehensive treatment has been widely used in various surgical fields. How to use perioperative management to improve the curative effect of chronic rhinosinusitis surgery. It has attracted the attention of clinicians in otolaryngology. Perioperative comprehensive treatment should include preoperative detumescence and anti-inflammation, intraoperative protection of normal mucous membrane and postoperative follow-up treatment, including postoperative anti-inflammatory and detumescence, promoting excretion, anti-bacterial biofilm and other drugs, cleaning the cavity, closely following up the condition and so on. As a measure of local treatment, nasal lavage has been gradually used in the treatment of various diseases of nasal cavity and paranasal sinuses, including acute and chronic sinusitis, allergic and non-allergic rhinitis, nasal cavity surgery, nasopharyngeal carcinoma after radiotherapy and so on. Even asthma, viral colds and other upper respiratory diseases, with the help of certain devices, through physical scour, local administration and other mechanisms, clear nasal inflammatory secretions, improve mucous ciliated transport function, reduce local inflammatory reactions. The curative effect was positive; Nasal lavage combined with perioperative drug treatment is bound to promote the recovery of sinusitis patients. Objective to observe the curative effect of washing liquid of sinusitis in patients with chronic sinusitis of spleen and stomach dampness-heat syndrome during perioperative period, and to compare with saline washing alone, and to understand the advantages of traditional Chinese medicine washing in perioperative treatment through comprehensive evaluation of curative effect. Methods 1 according to the inclusion criteria of the cases, 120 eligible cases were randomly divided into treatment group (traditional Chinese medicine flushing) and control group (saline flushing), in addition to routine perioperative drug treatment. 24 hours after operation, nasal lavage was performed for 1 month and followed up for 6 months. The relevant research data were collected before operation, 3 months and 6 months after operation. (2) the content of curative effect evaluation was mainly divided into two aspects: (1) objective curative effect: nasal endoscopic reexamination was carried out, and Lund-Kennedy score method was used to score the operative cavity; Subjective efficacy: symptom and quality of life questionnaire (VAS score, SNOT20 score). Results objective curative effect: the Lund-Kennedy score of all patients (3 months, 6 months) was significantly improved compared with that before operation. The effect of traditional Chinese medicine flushing group was better than that of saline flushing group (P 0.05), and the effect of traditional Chinese medicine flushing group was better than that of saline flushing group (P 0.05). Subjective efficacy: the total score of VAS,SNOT-20 was significantly improved after operation (3 months, 6 months), and the improvement of nasal symptoms was the most obvious in the comparison of different dimensions of SNOT-20. Compared with the subjective curative effect index of the treatment group and the control group, the VAS score and SNOT-20 of the traditional Chinese medicine flushing group had great advantages in the improvement of different dimensions, and played a prominent role in improving the quality of life, the difference was statistically significant (P 0.05). Conclusion nasal lavage can improve the clinical treatment effect, improve the quality of life, reduce the local and systemic symptoms such as runny nose, headache, sleep disorder, fatigue, anxiety and so on, and reduce the inflammation of nasal cavity after operation. The effect of promoting mucous epithelial transformation and reducing nasal secretions is better than that of saline alone.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R765.9

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