常年性变应性鼻炎的外科治疗以及对变应原和患者生活质量的初步分析

发布时间：2018-04-10 09:47

本文选题：变应性鼻炎　切入点：聚焦超声　出处：《中国医科大学》2010年硕士论文

【摘要】： 目的 1、对比观察聚焦超声治疗术与布地奈德鼻喷剂在治疗常年性变应性鼻炎中的疗效。 2、针对变应性鼻炎伴鼻中隔偏曲、下鼻甲肥大且鼻塞明显的患者,分析手术治疗的疗效,并比较不同手术方法的效果。 3、分析辽宁地区常年性持续性中重度变应性鼻炎患者变应原的种类和分布情况。 4、分析常年性持续性中重度变应性鼻炎患者的鼻炎相关生活质量状况,评价不同指标间的相关性,比较不同治疗方法在治疗前后生活质量的改善情况。方法和材料将符合纳入标准的65例患者按鼻腔结构是否异常分成两部分。第一部分,鼻腔结构正常者20例,均接受聚焦超声治疗,作为手术组；选取同期接受布地奈德喷鼻治疗的符合入选条件的同等数量患者作为药物组。观察期3个月。记录症状评分,VAS视觉评分和生活质量评分。第二部分,伴有鼻中隔偏曲、下鼻甲肥大患者45例,分为三组,分别行A：鼻中隔偏曲矫正、下鼻甲外移部分切除治疗术；B：鼻中隔偏曲矫正、下鼻甲聚焦超声治疗术；C：鼻中隔偏曲矫正、下鼻甲外移部分切除联合聚焦超声治疗术。完成6个月随访,记录症状评分。所有入选患者均于门诊行皮肤点刺试验(SPT),并初步分析变应原检查结果。入院时、随访时记录生活质量评分,并分析结果。结果 1、在鼻腔结构正常的患者中,手术组的各项评分在术后的各次随访中均优于药物组。 2、在伴有鼻中隔偏曲、下甲肥大、鼻塞明显的患者中,三种不同的手术方法在术后6个月的评分均比术前有显著的改善,C组(鼻中隔偏曲矫正、下鼻甲外移部分切除联合聚焦超声治疗术)的评分最好。B组(鼻中隔偏曲矫正、下鼻甲聚焦超声治疗术),鼻堵项的评分较差。A组(鼻中隔偏曲矫正、下鼻甲外移部分切除治疗术)在喷嚏、鼻涕、鼻痒症状上的评分均不如B组、C组。 3、39例皮肤点刺试验分析结果：粉尘螨19例、屋尘螨20例、豚草16例、艾蒿19例、花粉1例、猫毛2例、德国小蠊2例、霉菌1例。 4、生活质量相关性分析结果：缺乏良好睡眠和鼻堵症状评分显著相关；睡眠总分和非鼻-结膜炎症状总分显著相关；缺乏良好睡眠和工作效率下降显著相关；变应性鼻炎症状对日常活动影响的分布和程度分析结果：工作、社交活动、吸尘器打扫房间、做家务依次是选择最多的日常活动而割草、养宠物、散步、吸尘器打扫房间依次是选择分数最高的日常活动。结论 1、聚焦超声治疗对比药物治疗,起效快、短期疗效显著。 2、对伴有鼻腔结构异常的变应性鼻炎患者,手术治疗可以明显改善症状；但聚焦超声对下鼻甲的减容效果不如下鼻甲部分切除术。鼻中隔偏曲矫正、下鼻甲外移部分切除联合聚焦超声治疗术这种手术疗法效果最好。 3、尘螨是辽宁地区变应性鼻炎的首位过敏原。 4、相关性分析提示鼻部症状可能是影响睡眠质量的主要原因,睡眠质量可以影响非鼻-结膜炎症状。
[Abstract]:objective
1, the efficacy of focused ultrasound therapy and budesonide nasal spray in the treatment of perennial allergic rhinitis was compared.
2, for allergic rhinitis and deviation of nasal septum, inferior turbinate and nasal congestion in patients with obvious curative effect analysis of surgical treatment, and the effect of different surgical procedures.
3, analysis of the types and distribution of allergens in patients with perennial persistent moderate and severe allergic rhinitis in Liaoning.
4, we analyzed the status of rhinitis related quality of life in perennial persistent moderate severe allergic rhinitis, evaluated the correlation between different indicators, and compared the improvement of quality of life before and after treatment with different treatments.
Methods and materials
Will meet the inclusion criteria of 65 cases of patients according to whether the abnormal nasal structure is divided into two parts. The first part, 20 cases of normal nasal structure, were treated with focused ultrasound therapy, were selected as operation group; treatment with budesonide nasal spray eligible patients with the same number as drug group. The observation period was 3 months. The symptoms recorded score, VAS score and visual quality of life score. In the second part, with deviation of nasal septum, 45 cases of inferior turbinate hypertrophy patients were divided into three groups, respectively: A nasal septum and inferior turbinate outfracture partial resection; B: nasal septum, inferior turbinate focused ultrasound therapy; C the nasal septum, partial resection combined with focused ultrasound treatment of inferior turbinate outfracture. Completed 6 months of follow-up, record the symptom score. All patients in the outpatient department for skin prick test (SPT), and preliminary analysis of allergen detection At the time of admission, the quality of life was recorded and the results were analyzed.
Result
1, among the patients with normal nasal structure, the scores of the operation group were better than those in the drug group after all the postoperative follow-up.
2, in patients with deviation of nasal septum, inferior turbinate hypertrophy, nasal congestion significantly in patients with three different surgical methods in 6 months after operation were significantly improved compared with the preoperative group (C, nasal septum, inferior turbinate outfracture resection combined with focused ultrasound therapy the best score) group.B (nasal septum, inferior turbinate focused ultrasound therapy), nasal blockage scores. Group.A (the nasal septum and inferior turbinate outfracture part resection) in the nose, sneezing, nasal itching symptoms were less than that of B group, C group.
Results 3,39 cases of skin prick test: 19 cases of 20 cases of dust mites, house dust mite, ragweed mugwort in 16 cases, 19 cases, 1 cases of 2 cases of pollen, cat hair, 2 cases of Blattella germanica, 1 cases of fungus.
4, quality of life correlation analysis results: the lack of good sleep and nasal symptom scores were significantly related to blocking was significantly related to total sleep; and non - nasal conjunctivitis symptoms score; the lack of good sleep and work efficiency decreased significantly; the distribution and degree of influence analysis results of allergic rhinitis symptoms on daily activities: work, social activities, cleaner clean the room and do the housework in turn is to choose the most daily activities and mowing, pets, a vacuum cleaner to clean the room in turn is to choose the highest score of the daily activities.
conclusion
1, focused ultrasound treatment compared with drug treatment, quick effect, short term curative effect.
2, the allergic rhinitis patients with structural abnormality of nasal cavity, surgical treatment can significantly improve the symptoms; but focused ultrasound on the inferior turbinate reduction effect than inferior turbinectomy. The nasal septum, partial resection combined with focused ultrasound therapy the best surgical treatment of inferior turbinate outfracture.
3, dust mites are the first anaphylaxis in the allergic rhinitis in Liaoning.
4, correlation analysis suggests that nasal symptoms may be the main factors affecting the quality of sleep, and the quality of sleep can affect the symptoms of non nasal conjunctivitis.

【学位授予单位】：中国医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R765.21

【参考文献】