發(fā)布時間：2018-07-03 05:38

  本文選題：慢性鼻-鼻竇炎 + 鼻息肉��； 參考：《福建中醫(yī)藥大學(xué)》2010年碩士論文

【摘要】： 目的：對慢性鼻-鼻竇炎患者采用功能性鼻內(nèi)鏡手術(shù),術(shù)后以生理鹽水沖洗術(shù)腔為對照組,觀察術(shù)后“通竅洗劑”術(shù)腔沖洗在臨床癥狀、體征改善程度,記錄術(shù)腔清潔時間、術(shù)腔上皮化時間,反映本方對鼻內(nèi)鏡術(shù)后患者黏膜炎癥恢復(fù)的治療作用,客觀評價本方對慢性鼻-鼻竇炎術(shù)后患者的療效和安全性,并通過研究中藥“通竅洗劑”對患者鼻黏膜中超氧化物歧化酶活性(SOD)和丙二醛(MDA)變化的影響,討論慢性鼻-鼻竇炎、鼻息肉的發(fā)病機制。 方法：符合納入標準、均接受功能性鼻內(nèi)鏡鼻竇手術(shù)的慢性鼻-鼻竇炎患者54例,按照入院的先后次序,依照隨機對照的原則分為A組(治療組),B組(對照組)。術(shù)后治療組以“通竅洗劑”沖洗術(shù)腔,對照組以生理鹽水沖洗術(shù)腔,所有的患者均采用Messerklinger術(shù)式。分別記錄患者治療前及治療12周鼻塞、鼻漏、嗅覺障礙、頭面部疼痛不適等癥狀程度的改變；治療12周內(nèi)鼻內(nèi)鏡觀察鼻腔黏膜的轉(zhuǎn)歸愈合情況；治療前、治療12周在鼻內(nèi)鏡下取患者鼻道竇口周圍黏膜,觀察術(shù)后鼻黏膜超氧化物歧化酶(SOD)活性與丙二醛(MDA)表達情況。經(jīng)統(tǒng)計學(xué)分析處理,評判其療效。 結(jié)果：兩組的性別、年齡、病程等一般資料經(jīng)統(tǒng)計學(xué)處理無顯著性差異,具有可比性。①兩組癥狀積分比較,治療12周后,自身治療前后癥狀總分對照分別經(jīng)配對t檢驗,兩組治療比較(P0.001),具有顯著性差異；兩組間癥狀總評分采用t檢驗,t=-4.538,P0.05,認為兩種治療后總分差異有統(tǒng)計學(xué)意義,兩組各項癥狀積分比較,采用t檢驗,鼻塞、鼻漏、頭面部疼痛方面積分比較均有顯著性差異,嗅覺障礙方面比較無顯著性差異；兩組術(shù)腔體征積分比較,在治療后2周、4周無明顯差異,治療12周積分經(jīng)t檢驗,t值為-3.200,P0.05,說明兩組有顯著性差異；兩組術(shù)腔清潔時間經(jīng)t檢驗,t值為-2.324,P0.05,有顯著性差異。說明中藥通竅洗劑比生理鹽水術(shù)腔沖洗更能發(fā)揮清潔術(shù)腔的作用,達到術(shù)腔清潔的目的,以利于促進下一步的術(shù)腔黏膜上皮化；兩組術(shù)腔上皮化時間經(jīng)t檢驗,t值為-2.015,P0.05,具有顯著性差異,說明中藥通竅洗劑術(shù)腔清洗比生理鹽水術(shù)腔沖洗能更有效地促進和加速術(shù)腔黏膜上皮化；②治療12周,兩組鼻腔黏膜組織超氧化物歧化酶(SOD)活性經(jīng)成組t檢驗,t值2.345,P0.05,有顯著性差異。兩組鼻腔黏膜組織MDA含量經(jīng)成組t檢驗,t值-17.559,P0.01,有顯著性差異,說明中藥“通竅洗劑”起到糾正氧自由基代謝或紊亂的作用。 結(jié)論：①中藥“通竅洗劑”術(shù)腔清洗比生理鹽水沖洗鼻腔更能有效地促進和加速術(shù)腔黏膜上皮化,“通竅洗劑”可以提高功能性鼻內(nèi)鏡治療慢性鼻-鼻竇炎、鼻息肉的手術(shù)療效,是安全有效的中藥制劑；②慢性鼻-鼻竇炎病人清除自由基能力下降,脂質(zhì)過氧化反應(yīng)活躍,自由基代謝紊亂可能在慢性鼻-鼻竇炎的發(fā)病機制中起重要作用。
[Abstract]:Objective: to observe the improvement of clinical symptoms and signs in patients with chronic rhinosinusitis by functional endoscopic sinus surgery. The time of epithelialization of the operative cavity reflects the therapeutic effect of our prescription on the recovery of mucosal inflammation in patients with nasal endoscopy, and objectively evaluates the efficacy and safety of the prescription in patients with chronic rhinosinusitis after surgery. By studying the effect of Tongqiao lotion on the changes of superoxide dismutase (SOD) and malondialdehyde (MDA) in nasal mucosa, the pathogenesis of chronic rhinosinusitis and nasal polyps was discussed. Methods: 54 patients with chronic rhinosinusitis underwent functional endoscopic sinus surgery were divided into group A (treatment group) and group B (control group) according to the order of admission and the principle of randomized control. The treatment group was irrigated with Tongqiao lotion and the control group with normal saline. All the patients were treated with Messerklinger. The symptoms of nasal obstruction, rhinorrhea, olfactory disorder, head and facial pain and discomfort were recorded before and after 12 weeks of treatment. After 12 weeks of treatment, the mucosa around the nasal sinus orifice was taken under nasal endoscope to observe the activity of superoxide dismutase (SOD) and the expression of malondialdehyde (MDA) in nasal mucosa. The curative effect was evaluated by statistical analysis. Results: there was no significant difference in sex, age and course of disease between the two groups, but there was no significant difference between the two groups after 12 weeks of treatment. After 12 weeks of treatment, the total scores of symptoms before and after treatment were compared by paired t test. There was significant difference between the two groups (P0.001), the total score of symptoms between the two groups was t test -4.538% P0.05, the result showed that the total scores of the two groups after treatment were statistically significant, the scores of symptoms of the two groups were compared with t test, nasal obstruction, rhinorrhea, and rhinorrhea. There were significant differences in the scores of head and face pain, but no significant differences in olfactory disorders, and there was no significant difference between the two groups in the scores of signs and signs 2 weeks after treatment, 4 weeks after treatment, and 4 weeks after treatment, there was no significant difference between the two groups. After 12 weeks of treatment, the t value of the two groups was -3.200 t test, which indicated that there was a significant difference between the two groups, and the t value of the two groups was -2.324% P0.05, there was significant difference in the cleaning time of the two groups. The results showed that Tongqiao lotion could play a more important role in cleaning the cavity than that of normal saline in order to promote the mucosal epithelization in the next step. The time of epithelization of the two groups was significantly different by t test (t = -2.015, P 0.05), which indicated that the washing of the cavity of Tongqiao lotion was more effective than that of saline in promoting and accelerating the treatment of 12 weeks of mucosal epithelialization. The activity of superoxide dismutase (SOD) in nasal mucosa of the two groups was significantly different by t test. The content of MDA in nasal mucosal tissue of the two groups was significantly different by t test (P 0.01), indicating that Tongqiao lotion could correct the metabolism or disorder of oxygen free radical. Conclusion "Tongqiao lotion" can promote and accelerate mucosal epithelization more effectively than normal saline washing. "Tongqiao lotion" can improve functional nasal endoscopy in the treatment of chronic rhinosinusitis. The surgical effect of nasal polyps is a safe and effective traditional Chinese medicine preparation for chronic rhinosinusitis patients with decreased ability to scavenge free radicals and active lipid peroxidation. Free radical metabolic disorder may play an important role in the pathogenesis of chronic rhinosinusitis.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R765.4

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