本文選題：鼻竇灌注液　切入點(diǎn)：鼻腔沖洗　出處：《廣州中醫(yī)藥大學(xué)》2014年碩士論文

【摘要】：目的： 鼻息肉的高復(fù)發(fā)率是鼻息肉治療的難點(diǎn),研究表明鼻息肉的復(fù)發(fā)是因?yàn)楸乔谎装Y持續(xù)狀態(tài)存在,而細(xì)胞因子與鼻腔炎癥關(guān)系密切。以往研究認(rèn)為鼻竇灌注液有良好的抗炎作用,故本文通過(guò)鼻內(nèi)鏡術(shù)后使用鼻竇灌注液沖洗鼻腔的研究,驗(yàn)證鼻竇灌注液的療效并觀察它對(duì)細(xì)胞因子(IL-5、IL-8、IL-10、IFN-γ、GM-CSF、TNF-α)的影響。方法： 選取2012年3月至2013年6月在廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院進(jìn)行手術(shù)的鼻息肉患者作為研究對(duì)象,將符合研究標(biāo)準(zhǔn)的研究對(duì)象分為2組,所有患者均在鼻內(nèi)鏡術(shù)后接受3個(gè)月的鼻腔沖洗治療,鼻竇灌注液組使用鼻竇灌注液沖洗鼻腔,而生理鹽水組使用0.9%生理鹽水。采用SNOT-20及Lund-Kennedy評(píng)分評(píng)估療效,并在術(shù)中以及術(shù)后3個(gè)月時(shí)分別取鼻腔中鼻道黏膜組織作為檢驗(yàn)標(biāo)本,采用酶聯(lián)免疫法(ELISA)檢測(cè)兩組黏膜組織中的6項(xiàng)細(xì)胞因子水平(IL-5、IL-8、IL-10、IFN-γ、TNF-α、GM-CSF)。將所得數(shù)據(jù)應(yīng)用SPSS17.0進(jìn)行統(tǒng)計(jì)學(xué)分析,分別對(duì)比兩組療效、治療前后細(xì)胞因子改變以及兩組的組間差異。結(jié)果： 符合入選標(biāo)準(zhǔn)的研究對(duì)象共39例,其中男性25例,女性14例,男性明顯多于女性；年齡在21歲至63歲之間,平均年齡為37.9±12.35歲；濕熱蘊(yùn)積鼻竅型27例,寒濕凝聚鼻竅型14例。 SNOT-20及Lund-Kennedy評(píng)分方面,兩組自身前后對(duì)比均有顯著性差異,術(shù)后3月兩組評(píng)分均較術(shù)前降低(P0.05)；兩組組間比較,治療前及治療后兩組間均無(wú)顯著差異(P0.05)。 細(xì)胞因子水平方面,兩組自身前后對(duì)比均有顯著性差異,術(shù)后3月兩組各項(xiàng)細(xì)胞因子水平(IL-5、IL-8、IL-10、IFN-γ、TNF-α、GM-CSF)較術(shù)前顯著降低(P0.05)；兩組間比較,術(shù)前鼻竇灌組和生理鹽水組之間各項(xiàng)細(xì)胞因子水平無(wú)明顯差異(P0.05),術(shù)后鼻竇灌注液組IL-5、IL-8、IL-10、IFN-γ水平明顯低于生理鹽水組(P0.05),而術(shù)后兩組TNF-α、GM-CSF水平相當(dāng)(P0.05)。結(jié)論： 術(shù)后3月鼻竇灌注液組與生理鹽水組在對(duì)改善研究對(duì)象生活質(zhì)量及鼻腔形態(tài)方面的療效相當(dāng),而鼻竇灌注液對(duì)IL-5、IL-8、IL-10、IFN-γ的調(diào)節(jié)作用強(qiáng)于生理鹽水,提示經(jīng)長(zhǎng)期觀察也許能降低鼻息肉的復(fù)發(fā)率。
[Abstract]:Objective:The high recurrence rate of nasal polyps is a difficult point in the treatment of nasal polyps. Studies show that the recurrence of nasal polyps is due to the persistent state of nasal inflammation, and cytokines are closely related to nasal inflammation.Previous studies have shown that the nasal sinus perfusion fluid has a good anti-inflammatory effect. Therefore, the study of nasal cavity irrigation with nasal sinus perfusion fluid after nasal endoscopy was carried out to verify the efficacy of nasal sinus perfusion fluid and to observe its effect on cytokine IL-8 IL-10 IL-10 IFN- 緯 GM-CSFU TNF- 偽.Methods:From March 2012 to June 2013, the patients with nasal polyps who underwent surgery in the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine were selected as the study objects. The subjects who met the research criteria were divided into two groups.All the patients were treated with nasal cavity irrigation for 3 months after nasal endoscopy. The nasal cavity was washed with nasal sinus perfusion solution in the nasal sinus perfusion group and 0.9% normal saline was used in the normal saline group.The data were analyzed by SPSS17.0, and the results were compared between the two groups, the changes of cytokines before and after treatment and the differences between the two groups.Results:There were 39 subjects who met the inclusion criteria, including 25 males and 14 females, with more males than females, aged from 21 to 63 years, with an average age of 37.9 鹵12.35 years, 27 cases with dampness and heat accumulation of nasal orifices, and 14 cases with cold and wet condensed nose orifices.In terms of SNOT-20 and Lund-Kennedy scores, there were significant differences between the two groups before and after treatment. The scores of the two groups were significantly lower than those of the preoperation at 3 months after operation, and there was no significant difference between the two groups before and after treatment (P 0.05).In terms of cytokine levels, there were significant differences between the two groups before and after operation. The levels of IL-5, IL-8, IL-10, IFN- 偽, TNF- 偽 and GM-CSF in the two groups were significantly lower than those before operation (P 0.05).There was no significant difference in the levels of cytokines between the nasal sinus perfusion group and the normal saline group before operation (P 0.05). The levels of IL-5, IL-8, IL-10, IFN- 緯 in the nasal sinus perfusion fluid group were significantly lower than those in the normal saline group, while the levels of TNF- 偽 GM-CSF in the two groups were similar to that in the normal saline group (P 0.05).Conclusion:Three months after operation, the nasal sinus perfusion solution group and the normal saline group had the same effect on improving the quality of life and the nasal cavity morphology, while the nasal sinus perfusion fluid had stronger regulation effect on IL-5 IL-8 + IL-10 and IFN- 緯 than normal saline, and the effect of the nasal sinus perfusion solution on the improvement of the quality of life and nasal cavity morphology was similar to that of the normal saline group.It suggests that long-term observation may reduce the recurrence rate of nasal polyps.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R276.1

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