CAJ | 학술논문

目的研究以内镜手术为主的综合治疗对慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)伴支气管哮喘患者的疗效.方法 2006年9月至2009年3月共收治CRS伴支气管哮喘患者25例,行内镜鼻窦手术,围手术期使用鼻内糖皮质激素、口服大环内酯类抗生素、鼻腔冲洗等治疗.分别于术前、术后1年、3年对临床疗效进行评估.CRS疗效评估的指标为视觉模拟量表(visual analogue scale,VAS)、患者自评及鼻内镜Lund-Kennedy评分,哮喘评估指标为哮喘控制量表评分和分级、用药量和肺功能.结果术后1年随访23例(92%),术后3年随访12例(48%).CRS疗效:整体症状的VAS评分术后1年为(3.20±2.19)分((x)±s,以下同),术后3年为(3.79±2.32)分,分别较术前[(8 12±0.60)分]有显著改善(P值均为0.000),术后1年、3年之间差异无统计学意义(P=0.851);鼻内镜Lund-Kennedy评分术后1年为(4.35±3.21)分,3年为(5.50±2 64)分,分别较术前[(9.80±2.10)分]有显著改善(P值均为0.000),术后1年、3年之间差异无统计学意义(P=0.606).支气管哮喘疗效:哮喘控制量表评分术前为(21.96±2.16)分,术后1年为(23.61±1.94)分,术后3年为(22 33±3 47)分,行双向方差分析,三者之间差异无统计学意义(F=2.871,P=0 065);术后1年14例患者哮喘用药不变,术后3年9例患者哮喘用药不变;第1秒用力呼气容积与用力肺活量的比值术前为74.68±11.09,术后1年为73.27±12.27,术后3年为73.50±7.87,三者之间差异无统计学意义(F=0.076,P>0.05).结论以内镜手术为主的综合治疗对CRS伴哮喘患者疗效显著且持久,但治愈者极少;哮喘临床控制水平、用药量和肺功能均保持稳定.
목적 연구이내경수술위주적종합치료대만성비-비두염(chronic rhinosinusitis,CRS)반지기관효천환자적료효.방법 2006년9월지2009년3월공수치CRS반지기관효천환자25례,행내경비두수술,위수술기사용비내당피질격소、구복대배내지류항생소、비강충세등치료.분별우술전、술후1년、3년대림상료효진행평고.CRS료효평고적지표위시각모의량표(visual analogue scale,VAS)、환자자평급비내경Lund-Kennedy평분,효천평고지표위효천공제량표평분화분급、용약량화폐공능.결과 술후1년수방23례(92%),술후3년수방12례(48%).CRS료효:정체증상적VAS평분술후1년위(3.20±2.19)분((x)±s,이하동),술후3년위(3.79±2.32)분,분별교술전[(8 12±0.60)분]유현저개선(P치균위0.000),술후1년、3년지간차이무통계학의의(P=0.851);비내경Lund-Kennedy평분술후1년위(4.35±3.21)분,3년위(5.50±2 64)분,분별교술전[(9.80±2.10)분]유현저개선(P치균위0.000),술후1년、3년지간차이무통계학의의(P=0.606).지기관효천료효:효천공제량표평분술전위(21.96±2.16)분,술후1년위(23.61±1.94)분,술후3년위(22 33±3 47)분,행쌍향방차분석,삼자지간차이무통계학의의(F=2.871,P=0 065);술후1년14례환자효천용약불변,술후3년9례환자효천용약불변;제1초용력호기용적여용력폐활량적비치술전위74.68±11.09,술후1년위73.27±12.27,술후3년위73.50±7.87,삼자지간차이무통계학의의(F=0.076,P>0.05).결론 이내경수술위주적종합치료대CRS반효천환자료효현저차지구,단치유자겁소;효천림상공제수평、용약량화폐공능균보지은정.
Objective To evaluate the efficacy of endoscopic sinus surgery (ESS)-based on multidisciplinary treatment for patients with chronic rhinosinusitis ( CRS) and asthma. Methods The study included 25 CRS patients with asthma who received ESS from September 2006 to March 2009, besides surgery, who also used corticosteroid nasal spray, oral macrolide antibiotics and nasal irrigation perioperatively. Evaluation was performed before ESS, 1 year and 3 years post-ESS. Evaluation index included visual analogue scale(VAS) and endoscopy Lund-Kennedy assessment for CRS, and asthma control test (ACT) and pulmonary function tests for asthma. Results Twenty-three (92% ) patients were followed up for 12 months. Twelve (48% ) of them were followed up for 36 months. CRS efficacy: VAS of general symptom significantly improved after ESS compared to pre-ESS (8. 12 ±0. 60, (x) ±s) , after 1 year (3. 20 ±2. 19) and 3 year (3.79 ±2.32) follow up(both P =0.000). There was no statistic difference between 1 year and 3 year follow up (P = 0. 851). Endoscopy Lund-Kennedy score significantly improved in postESS after 1 year (4.35 ±3.21) and 3 year (5.50 ±2. 64) follow up compared to pre-ESS(9. 80 ±2. 10,both P = 0. 000 ) , and there was no difference between 1 year and 3 year follow up (P = 0. 606 ). Asthma efficacy: ACT pre-ESS, 1 year and 3 year were 21. 96 ± 2. 16, 23.61 ±1.94 and 22. 33 ±3.47, without statistic difference ( F = 2. 871, P = 0. 065 ). Pulmonary function showed no significant change after surgery (Pre-ESS 74.68 ± 11.09, 1 year 73.27 ± 12.27, 3 year 73.50 ± 7.87, F = 0.076, P > 0.05).Conclusions ESS improves CRS with asthma significantly and persistently. Asthma control level, antiasthma drug dose and pulmonary function remain stable after ESS.