主客观评估对慢性鼻窦炎患者鼻塞围手术期的指导作用

发布时间：2018-03-20 19:33

本文选题：慢性鼻窦炎　切入点：视觉模拟评分　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨术前主客观评估对慢性鼻窦炎(chronic rhinosinusitis,CRS)患者鼻塞围手术期个性化处理的指导作用。方法:对拟行鼻内镜手术以鼻塞为主诉的CRS患者,因收治在相同年资相似经验的高年资医师组不同,而被分为实验组和对照组。术前两组患者均采用视觉模拟量表(visual analog scale,VAS)对CRS患者鼻塞进行主观评分,采用鼻阻力(rhinomanometry,RM)、鼻声反射(acoustic rhinometry,AR)进行鼻塞客观评估,同时行鼻内镜检查和鼻窦CT检查并采用Lund-Kennedy评分法和Lund-Mackay评分法进行整体及病情严重程度评估。对术前鼻塞VAS评分5分者,实验组围手术期严格依据主客观评估采取个性化的处理策略,而对照组仅依据术者的临床经验进行围手术期处理。经过术前准备,局麻或全麻下行功能性鼻内镜手术。术后随访6月和1年,两组患者均进行主客观评估、疗效和患者满意度评估。用SPSS21.0进行统计学分析。结果:(1)实验组完成随访102例,对照组53例。术前两组患者一般情况、鼻塞VAS评分、鼻总阻力、Lund-Kennedy评分、Lund-Mackay评分相比,差异均无统计学意义(P0.05)。(2)术后6月、术后1年,两组患者在鼻塞VAS评分、鼻总阻力、Lund-Kennedy评分间相比,差异均有统计学意义(P0.05)。(3)两组患者术后6月、术后1年分别与术前相比,鼻塞VAS评分、鼻总阻力、Lund-Kennedy评分间均有统计学意义(P0.05),而术后1年与术后6月相比,实验组间差异亦有统计学意义(P0.05),但对照组间差异无统计学意义(P0.05)。(4)术后两组患者疗效评估及患者满意度自评分相比,差异均有统计学意义(P0.05)。结论:术前鼻塞主客观评估,不仅可用于CRS鼻塞症状严重程度及治疗效果的评估,而且两者综合应用可用于指导CRS围手术期的个性化诊断和治疗,可提高CRS的疗效及患者的满意度。
[Abstract]:Objective: to explore the guiding effect of preoperative subjective and objective evaluation on the individualized management of nasal congestion in patients with chronic sinusitis (CRS). Methods: nasal obstruction was the main complaint in nasal endoscopic surgery for CRS patients. Two groups were divided into experimental group and control group because of their differences in the same seniority and similar experience. Before operation, the patients in the two groups were assessed by visual analog scale-vas to evaluate nasal congestion in CRS patients. Nasal obstruction was evaluated by nasal resistive rhinomorphometry and acoustic acoustic rhinometryometry (ARR). Nasal sinus CT and nasal endoscopy were used to evaluate the severity of nasal congestion. The severity of nasal congestion was evaluated by Lund-Kennedy score and Lund-Mackay score. The VAS score of nasal obstruction was 5 points before operation. In the experimental group, the perioperative period was strictly based on subjective and objective evaluation, while in the control group, the perioperative period was treated only according to the clinical experience of the operator. Functional endoscopic sinus surgery was performed under local anesthesia or general anesthesia. All patients in the two groups were followed up on June and 1 year. The patients in both groups underwent subjective and objective evaluation, evaluation of efficacy and patient satisfaction. SPSS21.0 was used for statistical analysis. There was no significant difference between the two groups in VAS score, Lund-Kennedy score and Lund-Mackay score. There was no significant difference between the two groups in the VAS score of nasal obstruction on June and 1 year after operation. There were significant differences in total nasal resistance and Lund-Kennedy score between the two groups on June. VAS score of nasal obstruction and Lund-Kennedy score of total nasal resistance were significantly different from those before operation in one year after operation, and there was significant difference between one year after operation and June after operation. The difference between the two groups was also statistically significant (P 0.05), but there was no significant difference between the control group and the control group (P 0.05). Conclusion: there was significant difference between the two groups in the evaluation of curative effect and the self-score of patients' satisfaction after operation. Conclusion: the subjective and objective evaluation of nasal obstruction before operation is significant. It can be used not only to evaluate the severity of nasal congestion in CRS, but also to guide the individualized diagnosis and treatment of CRS during perioperative period. It can improve the curative effect of CRS and the satisfaction of the patients.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R765.9

【参考文献】