变应性因素对于慢性鼻鼻窦炎病变严重程度的影响

发布时间：2018-06-23 06:04

本文选题：变应性因素 + 慢性鼻鼻窦炎　；参考：《吉林大学》2012年硕士论文

【摘要】：目的：探讨变应性因素对慢性鼻-鼻窦炎严重程度有无影响，为进一步探讨变应性鼻炎与慢性鼻鼻窦炎之间的关系提供依据。方法：对2009年1月-2011年12月就诊于吉林大学中日联谊医院耳鼻喉头颈外科，经保守治疗无效后接受功能性鼻内镜下鼻窦手术的67例患者的临床资料进行回顾性分析,通过调查问卷、门诊复查及电话回访的方式,对这些患者的临床资料进行统计。本研究将患者分为慢性鼻鼻窦炎伴变应性鼻炎组与慢性鼻鼻鼻窦炎不伴变应性鼻炎组，分别比较二者鼻窦炎症状如鼻塞、流粘脓性鼻涕、嗅觉丧失及头面部胀闷感四项状的VAS评分，术前鼻内镜Lund and Kennedy评分、术前Lund-Mackay CT评分是否存在差异，并比较对不同过敏原敏感的患者，慢性鼻鼻窦炎症状是否存在区别。统计学应用spss17.0统计软件，依据VAS评分、Lund and Kennedy内镜评分系统及Lund-MackayCT系统评分数值分布不同，分别采用t检验及秩和检验的方法，率的比较应用χ2检验。结果：皮肤点刺及特异性IgE阳性与皮肤点刺特异性IgE阴性的慢性鼻鼻窦炎患者相比，病史时间长短、鼻塞、流粘(脓)性鼻涕、嗅觉丧失、头面部胀闷感等慢性鼻窦炎症状术前VAS评分、术前鼻内镜Lund and Kennedy评分、术前Lund-Mackay CT评分均无显著区别(p0。05)。经功能性鼻窦内窥镜手术及术后规范化随诊治疗，，无论皮肤点刺及特异性IgE阳性还是阴性的慢性鼻鼻窦炎患者，其慢性鼻鼻窦炎症状（包含鼻塞、流粘脓性鼻涕、嗅觉丧失及头面部胀闷感四项）均有所改善，但对于变应性阳性组与阴性组患者，治疗前后鼻窦炎症状改善情况，二者并无显著区别。皮肤点刺及特异性IgE阳性的患者群中，术后清水样涕及阵发性喷嚏症状改善明显，而鼻痒、眼痒等症状均无显著改善。结论：1、变应性因素对于保守治疗无效的慢性鼻鼻窦炎的病变严重程度并无明显影响：包括患者的症状学VAS评分、鼻内镜评分以及CT评分。2、变应性因素对于功能性鼻内镜手术术后一个月疗效影响不大，无论变应性因素是否存在，功能性鼻窦内窥镜手术术后的患者，慢性鼻鼻窦炎症状均有所改善。IgE阳性的患者，经过功能性鼻窦内窥镜手术后，变应性症状也有所改善。变应性因素对术后远期效果的影响，尚需要长时间随访及观察。
[Abstract]:Objective: to investigate the effect of allergic factors on the severity of chronic rhinosinusitis and to provide evidence for further study on the relationship between allergic rhinitis and chronic rhinosinusitis. Methods: the clinical data of 67 patients who received functional endoscopic sinus surgery from January 2009 to December 2011 in the otolaryngology and neck surgery of Sino-Japanese Friendship Hospital of Jilin University were retrospectively analyzed. The clinical data of these patients were statistically analyzed by questionnaire, outpatient reexamination and telephone return visit. Patients were divided into chronic rhinosinusitis with allergic rhinitis group and chronic sinusitis without allergic rhinitis group. There were significant differences in four types of scores of olfactory loss and facial distention, preoperative Lund and Kennedy score, preoperative Lund-Mackay CT score, and whether there were differences in chronic rhinosinusitis symptoms in patients with different allergen sensitivities. Spss17.0 software was used in statistics. According to the different value distribution of Lund and Kennedy endoscopic scoring system and Lund-MackayCT system, t test and rank sum test were used, and 蠂 2 test was used to compare the rate. Results: compared with patients with chronic rhinosinusitis with skin puncturing and specific IgE negative, patients with chronic nasal sinusitis had a long history, nasal obstruction, mucous (purulent) nasal runny, loss of olfaction. There was no significant difference in preoperative VAS score, Lund and Kennedy score and Lund-Mackay CT score between the patients with chronic sinusitis symptoms such as head and facial distention and stuffy feeling (p0.05). After functional endoscopic sinus surgery and standardized follow-up treatment, chronic sinusitis symptoms (including nasal congestion, mucous purulent nose) were found in patients with chronic nasal sinusitis, whether skin prick or specific IgE positive or negative. Four items of olfactory loss and head and facial distention were improved, but there was no significant difference between the allergic positive group and the negative group in the improvement of sinusitis symptoms before and after treatment. In the group of patients with skin prick and specific IgE positive, the symptoms of clear water snot and paroxysmal sneezing were improved obviously, but the symptoms of nasal itching and eye itching were not significantly improved. Conclusion the allergic factors have no significant effect on the severity of chronic rhinosinusitis with ineffective conservative treatment, including the symptom VAS score of the patients. Nasal endoscopy score and CT score. 2. Allergic factors had little effect on the curative effect of functional endoscopic sinus surgery one month after operation, regardless of whether the allergic factors existed or not, the patients after functional sinus endoscopic surgery were not affected. The symptoms of chronic sinusitis were improved. The allergic symptoms were also improved after functional endoscopic sinus surgery. The effect of allergy factors on the long-term postoperative outcome still needs to be followed up and observed for a long time.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R765.4

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