医生及患者对慢性鼻—鼻窦炎主、客观评价的相关性分析

发布时间：2018-06-21 04:56

本文选题：鼻窦炎 + 生活质量　；参考：《山东大学》2013年硕士论文

【摘要】：[研究背景和目的] 慢性鼻-鼻窦炎(Chronic fungal rhino-sinusitis, CRS)是耳鼻喉科最常见的慢性疾病之一,患有慢性鼻-鼻窦炎的患者很难被完全治愈,其对社会心理的影响也很难定量,使患者的身体、心理、社会功能受到极大影响,越来越受到耳鼻喉科医师的重视。但是目前关于耳鼻喉科临床医生主观评与CRS病情严重程度相关性分析的研究较少,本文主要从临床医生及患者的角度,分别比较他们的视觉模拟量表(visual analogue scale)VAS评分与计算机CT扫描、鼻内镜检查以及鼻腔鼻窦结局测量20条(sino-nasal outcome test-20, SNOT-20)之间的是否存在相关性,进一步了解哪个因素更能反映CRS病情的严重程度。 [研究方法] 本研究采用汉化SNOT-20、VAS评分、Lund—Kennedy鼻内镜评分系统以及Lund-Mackay CT评分系统前瞻性对110例慢性鼻-鼻窦炎患者进行研究。由三位耳鼻喉临床医生根据患者的临床资料分别对CRS病情严重程度进行VAS主观评分,并与患者的主观评估、客观检查结果进行相关性比较。同时将全部患者分为真菌性鼻窦炎组(fungal rhino-sinusitis, FRS)、CRS伴有鼻息肉(CRS with nasal polyps, CRSwNP)以及CRS不伴有鼻息肉(CRS without nasal polyps, CRSnNP)三个亚组后进行临床医生VAS评分与患者的主观评估、客观检查进行相关性分析。 [结果] 三位临床医生对慢性鼻-鼻窦患者术前生活质量的VAS均呈正相关(r=0.7105P＜0.0001, r=0.5644P＜0.0001, r=0.5204P＜0.0001)；在未分组的情况下,三位临床医生VAS评分平均数和Lund—Kennedy鼻内镜检查评分呈正相关(r=0.6103,P＜0.0001),三位临床医生VAS评分平均数与Lund—Mackay CT评分呈正相关(r=0.7252,P＜0.0001)；真菌性鼻-鼻窦炎亚组中,三位临床医生VAS评分平均数与Lund—Kennedy鼻内镜检查评分呈正相关(r=0.6056,P=0.01),与Lund—Mackay CT评分呈正相关(r=0.7199,P＜0.0011)；慢性鼻窦炎不伴鼻息肉亚组中,三位临床医生VAS评分平均数与Lund—Kennedy鼻内镜检查评分呈正相关(r=0.6135,P=0.0003),与Lund—MackayCT评分呈正相关(r=0.4624,P＜0.0101)；慢性鼻窦炎伴有鼻息肉组亚中,三位临床医生VAS评分平均数与Lund—Kennedy鼻内镜检查评分呈正相关(r=0.4419,P=0.0003),与Lund—Mackay CT评分呈正相关(r=0.7625,P＜0.0001)；无论是在分组前还是分组后,三位临床医生VAS评分平均数与SNOT-20评分和VAS评分均呈无相关(P＞0.05)；Lund—Kennedy鼻内镜检查评分以及Lund—MackayCT评分在三个亚组之间存在显著差异(P＜0.001),SNOT-20评分和VAS评分均无统计学差异(P＞0.05)。 [结论] 临床医生VAS评分能够反映CRS病情严重程度,没有发现与患者的生活质量之间的相关性。患者VAS评分主要与患者生活质量相关,在一定程度也能反映病变严重程度。真菌性鼻-鼻窦炎、慢性鼻窦炎伴有鼻息肉,慢性鼻窦炎不伴鼻息肉亚组在鼻内镜检查、CT评分以及医生评分之间存在显著差异,慢性鼻窦炎伴有鼻息肉得分较高。
[Abstract]:[background and objective] chronic rhino-sinusitis (CRSs) is one of the most common chronic diseases in the department of otolaryngology. Patients with chronic rhinosinusitis can hardly be completely cured and their psychosocial effects are difficult to quantify. Patients' physical, psychological and social functions are greatly affected, and more attention is paid by otolaryngologists. However, there are few studies on the correlation between the subjective evaluation of clinicians in otolaryngology and the severity of CRS. To compare the correlation between visual analogue scaleanalogue score and CT scan, nasal endoscopy and nasal sino-nasal outcome test-20 (SNOT-20) in their visual analogue scale. Better understand which factors reflect the severity of CRS. [methods] in this study, 110 patients with chronic rhinosinusitis were studied prospectively by Chinese SNOT-20 VAS and Lund-Kennedy nasal endoscopic scoring system and Lund-Mackay CT scoring system. According to the clinical data of the patients, three otolaryngology clinicians evaluated the severity of CRS by VAS subjective score, and compared with the subjective evaluation and objective examination results. At the same time, all the patients were divided into three subgroups: fungal rhino-sinusitis, FRSS-CRS with nasal polyposis (CRS with nasal polyps, SwNPN) and CRS without nasal polyps, CRSnNPs without nasal polyps (CRS without nasal polyps, CRSnNPN), and then the clinicians' VAS scores and subjective evaluation of the patients were evaluated. Objective examination was carried out for correlation analysis. [results] the VAS of the three clinicians were positively correlated with the quality of life (QOL) of chronic naso-paranasal sinus patients (P < 0.0001, P < 0.0001, r = 0.5644P < 0.0001, r = 0.5204P < 0.0001). The mean VAS score of three clinicians was positively correlated with Lund-Kennedy nasal endoscopy score (P < 0.0001), and the mean VAS score of three clinicians was positively correlated with Lund-Mackay CT score (P < 0.0001), while in the fungal rhinosinusitis subgroup, there was a positive correlation between the mean VAS score and Lund-Mackay CT score (P < 0.0001). The mean VAS score of three clinicians was positively correlated with Lund-Kennedy nasal endoscopy score and Lund-Mackay CT score was 0.6056, P < 0.00111.In the patients with chronic sinusitis without nasal polyps, there was a positive correlation between VAS score and Lund-Mackay CT score. The mean VAS score of three clinicians was positively correlated with Lund-Kennedy nasal endoscopy score, and was positively correlated with Lund-MackayCT score and Lund-MackayCT score (P < 0.0101). The mean VAS score of three clinicians was positively correlated with Lund-Kennedy nasal endoscopy score 0.0003 and Lund-Mackay CT score 0.7625 (P < 0.0001). There was no correlation between the average VAS score and SNOT-20 score and VAS score among the three clinicians (P > 0.05). There was no significant difference in Lund-Kennedy nasal endoscopy and Lund-MackayCT scores among the three subgroups (P < 0.001). There was no significant difference in SNOT-20 score and VAS score between the three subgroups (P > 0.05). [conclusion] the VAS score of clinicians can reflect the severity of CRS, and there is no correlation between VAS and quality of life. The VAS score is mainly related to the quality of life of the patients, and to some extent can also reflect the severity of the disease. Fungal rhinosinusitis, chronic sinusitis with nasal polyps, chronic sinusitis without nasal polyp subgroup had significant difference in nasal endoscopy CT score and doctor's score, chronic sinusitis with nasal polyp score was higher.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R765.21

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