CAJ | 학술논문

目的探讨慢性鼻-鼻窦炎鼻息肉内镜鼻窦手术后生存质量(quality of life,QOL)的转归规律及影响因素.方法以医学结局研究短表36条(medical outcome study short-form 36-items,MOS SF-36)和鼻腔鼻窦结局测试20条(sino-nasal outcome test-20,SNOT-20)量表作为工具,通过前瞻性随机对照设计,对120例慢性鼻-鼻窦炎鼻息肉患者术前和术后3、6、9和12个月QOL状况连续调查评估,同时与200例健康体检者的状况对照,分析患者QOL的变化规律及影响因素.结果 ①SF-36评估:患者术前6个维度评分均低于健康者(P值均＜0.01),术后6个月评分值及正常评分者构成比恢复正常(P值均＞0.05),并保持;②SNOT-20评估:患者术前20个条目总分和5大条目总分均高于健康者(P值均＜0.01),术后9、12个月两项指标分别恢复正常(P值均＞0.05),术后12个月评分值及正常评分者构成比亦恢复正常(P值均＞0.05);③根据SNOT-20评分转归,求得预测QOL恢复正常的时间进度公式:时间(月)=39-(标准QOL评分/术前QOL评分)×50;④通过Logistic回归分析,农村来源、病程长、病变范围大和伴发息肉是术前QOL评分(SNOT-20评分)高的危险因素(OR值分别为0.19、0.88、0.90和4.02),室内工作环境、手术范围不充分和术前SNOT-20评分高是术后QOL评分改善程度的危险因素(OR值分别为0.29、0.99和1.14).结论慢性鼻-鼻窦炎鼻息肉患者内镜鼻窦手术后需12个月才能全面恢复正常QOL,依此建议术后短期随访时间定为1年.术前QOL状态与城乡来源、病程、病变范围和是否伴发鼻息肉相关,术后QOL改善程度与工作环境、手术范围和术前QOL评分相关.
목적 탐토만성비-비두염비식육내경비두수술후생존질량(quality of life,QOL)적전귀규률급영향인소.방법 이의학결국연구단표36조(medical outcome study short-form 36-items,MOS SF-36)화비강비두결국측시20조(sino-nasal outcome test-20,SNOT-20)량표작위공구,통과전첨성수궤대조설계,대120례만성비-비두염비식육환자술전화술후3、6、9화12개월QOL상황련속조사평고,동시여200례건강체검자적상황대조,분석환자QOL적변화규률급영향인소.결과 ①SF-36평고:환자술전6개유도평분균저우건강자(P치균＜0.01),술후6개월평분치급정상평분자구성비회복정상(P치균＞0.05),병보지;②SNOT-20평고:환자술전20개조목총분화5대조목총분균고우건강자(P치균＜0.01),술후9、12개월량항지표분별회복정상(P치균＞0.05),술후12개월평분치급정상평분자구성비역회복정상(P치균＞0.05);③근거SNOT-20평분전귀,구득예측QOL회복정상적시간진도공식:시간(월)=39-(표준QOL평분/술전QOL평분)×50;④통과Logistic회귀분석,농촌래원、병정장、병변범위대화반발식육시술전QOL평분(SNOT-20평분)고적위험인소(OR치분별위0.19、0.88、0.90화4.02),실내공작배경、수술범위불충분화술전SNOT-20평분고시술후QOL평분개선정도적위험인소(OR치분별위0.29、0.99화1.14).결론 만성비-비두염비식육환자내경비두수술후수12개월재능전면회복정상QOL,의차건의술후단기수방시간정위1년.술전QOL상태여성향래원、병정、병변범위화시부반발비식육상관,술후QOL개선정도여공작배경、수술범위화술전QOL평분상관.
Objective To explore the quality of life(QOL) outcome of patients with chronic rhinosinusitis(CRS) after endoscopic sinus surgery(ESS) and its influencing factors. Methods A prospective trial was conducted to survey the QOL status of 120 CRS patients undergoing ESS,in contrast to that of 200 healthy individuals passing health examination, at the baseline and at 12-months after operation by Medical Outcomes Study Short Form-36(SF-36) and Sino-Nasal Outcome Test-20(SNOT-20). QOL changes and its influencing factors were analyzed statistically. Results (1) By the assessment of SF-36,the scores of 6 domains were less than that of healthy individuals preoperatively(P＜0.01). After 6 months, the scores of these domains resumed normal level and the proportion of scores also restored normally(P＞0.05). (2)By the assessment of SNOT-20,the total scores of 20 items and 5 most important items of patients were more than that of healthy obsjects(P＜0.01). After 9 and 12 months,the former and latter returned to normal, respectively(P＞0.05). In 12 months setting,the proportion of scores also restored normally(P＞0.05). (3)According to the survey of SNOT-20,we concluded the following equation:conyalescent time(months) =39-(normal scores/preoperative scores) × 50,by which the time of coming back to normal QOL status can be computed. (4) By analysis of Logistic Regression,residence in city or country, course of disease, extension of diseased sinus,and coexistence of nasal polyposis or not were correlated to the preoperative QOL scores;working environments,surgical extension,and preoperative scores of QOL were correlated to the score difference between pre and post operation.Conclusions CRS patients undergoing ESS could obtain entirely normal QOL status at 12 months postoperatively,so we suggest that the essential follow-up period should last at least one year. The risk factors influencing patients'QOL status preoperatively includes residence in country,longer course of disease, more extension of diseased sinus,and coexistence of nasal polyposis. The risk factors hindering the improvement of QOL status postoperatively includes exposure to indoor working environments,insufficient surgical extension,and lower preoperative QOL scores.