中国临床实用医学
中國臨床實用醫學
중국림상실용의학
CHINA CLINICAL PRACTICAL MEDICINE
2015年
4期
27-30
,共4页
慢性鼻-鼻窦炎%药物治疗
慢性鼻-鼻竇炎%藥物治療
만성비-비두염%약물치료
Chronic rhinosinusitis%Drug therapy
目的：观察药物治疗慢性鼻-鼻窦炎（CRS）疗效。方法选择2012年1月至2015年1月沈阳军区总医院收治的12周岁以上，根据症状、鼻内镜检查及CT表现确诊为不伴鼻息肉的CRS患者150例，口服克拉霉素缓释片、盐酸氨溴索片（沐舒坦）和鼻渊通窍颗粒3种药物，糠酸莫米松鼻喷雾剂喷鼻。治疗4～6周复查，若患者主观症状缓解或消失，CT提示CRS消失，将克拉霉素减半继续服用至12周，停用其他药物。若仅有主观症状改善，CT显示仍有CRS存在，则继续合并用药，最长用药12周，治疗后4周，根据治疗前后症状及CT表现，分别采用视觉模拟量表（VAS）和Lund-Mackey鼻窦CT扫描病变范围评分系统对临床疗效进行主观与客观评估。结果150例CRS患者治疗前VAS得分为（7.65±1.63）分，治疗后为（2.12±1.18）分，治疗前后得分比较差异有统计学意义（t=28.13，P<0.01）。Lund-Mackey鼻窦CT量化评估：治疗前（8.27±1.46）分，治疗后为（2.34±1.58）分，治疗前后得分比较差异有统计学意义（t=27.35， P<0.01）。按左右两侧（共259侧）进行Lund-Mackey鼻窦CT量化评估，治疗前后炎症变化的构成比较，治疗前中度以上炎症比率高达78.76%，治疗后仅为9.27%，差异有统计学意义（χ2=184.98， P<0.01）。结论沐舒坦联合克拉霉素缓释片及鼻渊通窍颗粒对CRS疗效明显，12岁以上不伴鼻息肉CRS应首选药物治疗。
目的：觀察藥物治療慢性鼻-鼻竇炎（CRS）療效。方法選擇2012年1月至2015年1月瀋暘軍區總醫院收治的12週歲以上，根據癥狀、鼻內鏡檢查及CT錶現確診為不伴鼻息肉的CRS患者150例，口服剋拉黴素緩釋片、鹽痠氨溴索片（沐舒坦）和鼻淵通纖顆粒3種藥物，糠痠莫米鬆鼻噴霧劑噴鼻。治療4～6週複查，若患者主觀癥狀緩解或消失，CT提示CRS消失，將剋拉黴素減半繼續服用至12週，停用其他藥物。若僅有主觀癥狀改善，CT顯示仍有CRS存在，則繼續閤併用藥，最長用藥12週，治療後4週，根據治療前後癥狀及CT錶現，分彆採用視覺模擬量錶（VAS）和Lund-Mackey鼻竇CT掃描病變範圍評分繫統對臨床療效進行主觀與客觀評估。結果150例CRS患者治療前VAS得分為（7.65±1.63）分，治療後為（2.12±1.18）分，治療前後得分比較差異有統計學意義（t=28.13，P<0.01）。Lund-Mackey鼻竇CT量化評估：治療前（8.27±1.46）分，治療後為（2.34±1.58）分，治療前後得分比較差異有統計學意義（t=27.35， P<0.01）。按左右兩側（共259側）進行Lund-Mackey鼻竇CT量化評估，治療前後炎癥變化的構成比較，治療前中度以上炎癥比率高達78.76%，治療後僅為9.27%，差異有統計學意義（χ2=184.98， P<0.01）。結論沐舒坦聯閤剋拉黴素緩釋片及鼻淵通纖顆粒對CRS療效明顯，12歲以上不伴鼻息肉CRS應首選藥物治療。
목적：관찰약물치료만성비-비두염（CRS）료효。방법선택2012년1월지2015년1월침양군구총의원수치적12주세이상，근거증상、비내경검사급CT표현학진위불반비식육적CRS환자150례，구복극랍매소완석편、염산안추색편（목서탄）화비연통규과립3충약물，강산막미송비분무제분비。치료4～6주복사，약환자주관증상완해혹소실，CT제시CRS소실，장극랍매소감반계속복용지12주，정용기타약물。약부유주관증상개선，CT현시잉유CRS존재，칙계속합병용약，최장용약12주，치료후4주，근거치료전후증상급CT표현，분별채용시각모의량표（VAS）화Lund-Mackey비두CT소묘병변범위평분계통대림상료효진행주관여객관평고。결과150례CRS환자치료전VAS득분위（7.65±1.63）분，치료후위（2.12±1.18）분，치료전후득분비교차이유통계학의의（t=28.13，P<0.01）。Lund-Mackey비두CT양화평고：치료전（8.27±1.46）분，치료후위（2.34±1.58）분，치료전후득분비교차이유통계학의의（t=27.35， P<0.01）。안좌우량측（공259측）진행Lund-Mackey비두CT양화평고，치료전후염증변화적구성비교，치료전중도이상염증비솔고체78.76%，치료후부위9.27%，차이유통계학의의（χ2=184.98， P<0.01）。결론목서탄연합극랍매소완석편급비연통규과립대CRS료효명현，12세이상불반비식육CRS응수선약물치료。
Objective To observe the effect in the treatment of chronic rhinosinusitis(CRS) with drug therapy. Methods More than 12 years old patients,based on the symptoms,endoscopic and CT shows,150(259 sides) cases with chronic rhinosinusitis without nasal polyp were studied with the drugs of macrolideantibiotics (Clarithromycin sustained release tablets ),mucolytic agent (Mucosolvan),ready made patent drugs(Biyuan tongqiao particles) and steroid nasal spray,and reviewed after 4~6 weeks of the drug therapy.If the patients felt and CT showed very well,the drugs were stoped except clarithromycin,but only half dose of clarithromycin was remained using up to 12 weeks.If not,all the drug would be continued and whether be regulated or continued depending on the show of symptoms and CT .the longest time of therapy was 12 weeks.Finaly,the therapeutic effect was evaluated using methods of Visual analogue scale(VAS) and Lund-Mackey after 4 weeks of stoping drugs. Results The scores of VAS were respectively (7.65±1.63) and (2.12±1.18),and the scores of Lund-Mackey were respectively(8.27±1.46) and (2.34±1.58) before and after therapy,there were significant difference in the evaluation of VAS (t=28.13,P<0.01) and Lund-Mackey (t=27.35,P<0.01)between before and after therapy.At the change of proportion of 259 sides of both left and right with CRS on the evaluation of analysis of side accounts using Lund-Mackey, CRS over middle degree accounted for 78.76%before therapy,but it only was 9.27%after therapy. There was also significant difference(χ2=184.98,P<0.01). Conclusion Mucosolvan combined with Clarithromycin sustained release tablets and Biyuan tongqiao particles has a significant and stable effect for CRS without nasal polyps, it should be the first choice for the patients of more than 12 years old .
