内窥镜鼻窦术后中药“通窍洗剂”术腔冲洗的临床疗效研究

发布时间：2018-07-03 05:38

本文选题：慢性鼻-鼻窦炎 + 鼻息肉　；参考：《福建中医药大学》2010年硕士论文

【摘要】： 目的：对慢性鼻-鼻窦炎患者采用功能性鼻内镜手术,术后以生理盐水冲洗术腔为对照组,观察术后“通窍洗剂”术腔冲洗在临床症状、体征改善程度,记录术腔清洁时间、术腔上皮化时间,反映本方对鼻内镜术后患者黏膜炎症恢复的治疗作用,客观评价本方对慢性鼻-鼻窦炎术后患者的疗效和安全性,并通过研究中药“通窍洗剂”对患者鼻黏膜中超氧化物歧化酶活性(SOD)和丙二醛(MDA)变化的影响,讨论慢性鼻-鼻窦炎、鼻息肉的发病机制。方法：符合纳入标准、均接受功能性鼻内镜鼻窦手术的慢性鼻-鼻窦炎患者54例,按照入院的先后次序,依照随机对照的原则分为A组(治疗组),B组(对照组)。术后治疗组以“通窍洗剂”冲洗术腔,对照组以生理盐水冲洗术腔,所有的患者均采用Messerklinger术式。分别记录患者治疗前及治疗12周鼻塞、鼻漏、嗅觉障碍、头面部疼痛不适等症状程度的改变；治疗12周内鼻内镜观察鼻腔黏膜的转归愈合情况；治疗前、治疗12周在鼻内镜下取患者鼻道窦口周围黏膜,观察术后鼻黏膜超氧化物歧化酶(SOD)活性与丙二醛(MDA)表达情况。经统计学分析处理,评判其疗效。结果：两组的性别、年龄、病程等一般资料经统计学处理无显著性差异,具有可比性。①两组症状积分比较,治疗12周后,自身治疗前后症状总分对照分别经配对t检验,两组治疗比较(P0.001),具有显著性差异；两组间症状总评分采用t检验,t=-4.538,P0.05,认为两种治疗后总分差异有统计学意义,两组各项症状积分比较,采用t检验,鼻塞、鼻漏、头面部疼痛方面积分比较均有显著性差异,嗅觉障碍方面比较无显著性差异；两组术腔体征积分比较,在治疗后2周、4周无明显差异,治疗12周积分经t检验,t值为-3.200,P0.05,说明两组有显著性差异；两组术腔清洁时间经t检验,t值为-2.324,P0.05,有显著性差异。说明中药通窍洗剂比生理盐水术腔冲洗更能发挥清洁术腔的作用,达到术腔清洁的目的,以利于促进下一步的术腔黏膜上皮化；两组术腔上皮化时间经t检验,t值为-2.015,P0.05,具有显著性差异,说明中药通窍洗剂术腔清洗比生理盐水术腔冲洗能更有效地促进和加速术腔黏膜上皮化；②治疗12周,两组鼻腔黏膜组织超氧化物歧化酶(SOD)活性经成组t检验,t值2.345,P0.05,有显著性差异。两组鼻腔黏膜组织MDA含量经成组t检验,t值-17.559,P0.01,有显著性差异,说明中药“通窍洗剂”起到纠正氧自由基代谢或紊乱的作用。结论：①中药“通窍洗剂”术腔清洗比生理盐水冲洗鼻腔更能有效地促进和加速术腔黏膜上皮化,“通窍洗剂”可以提高功能性鼻内镜治疗慢性鼻-鼻窦炎、鼻息肉的手术疗效,是安全有效的中药制剂；②慢性鼻-鼻窦炎病人清除自由基能力下降,脂质过氧化反应活跃,自由基代谢紊乱可能在慢性鼻-鼻窦炎的发病机制中起重要作用。
[Abstract]:Objective: to observe the improvement of clinical symptoms and signs in patients with chronic rhinosinusitis by functional endoscopic sinus surgery. The time of epithelialization of the operative cavity reflects the therapeutic effect of our prescription on the recovery of mucosal inflammation in patients with nasal endoscopy, and objectively evaluates the efficacy and safety of the prescription in patients with chronic rhinosinusitis after surgery. By studying the effect of Tongqiao lotion on the changes of superoxide dismutase (SOD) and malondialdehyde (MDA) in nasal mucosa, the pathogenesis of chronic rhinosinusitis and nasal polyps was discussed. Methods: 54 patients with chronic rhinosinusitis underwent functional endoscopic sinus surgery were divided into group A (treatment group) and group B (control group) according to the order of admission and the principle of randomized control. The treatment group was irrigated with Tongqiao lotion and the control group with normal saline. All the patients were treated with Messerklinger. The symptoms of nasal obstruction, rhinorrhea, olfactory disorder, head and facial pain and discomfort were recorded before and after 12 weeks of treatment. After 12 weeks of treatment, the mucosa around the nasal sinus orifice was taken under nasal endoscope to observe the activity of superoxide dismutase (SOD) and the expression of malondialdehyde (MDA) in nasal mucosa. The curative effect was evaluated by statistical analysis. Results: there was no significant difference in sex, age and course of disease between the two groups, but there was no significant difference between the two groups after 12 weeks of treatment. After 12 weeks of treatment, the total scores of symptoms before and after treatment were compared by paired t test. There was significant difference between the two groups (P0.001), the total score of symptoms between the two groups was t test -4.538% P0.05, the result showed that the total scores of the two groups after treatment were statistically significant, the scores of symptoms of the two groups were compared with t test, nasal obstruction, rhinorrhea, and rhinorrhea. There were significant differences in the scores of head and face pain, but no significant differences in olfactory disorders, and there was no significant difference between the two groups in the scores of signs and signs 2 weeks after treatment, 4 weeks after treatment, and 4 weeks after treatment, there was no significant difference between the two groups. After 12 weeks of treatment, the t value of the two groups was -3.200 t test, which indicated that there was a significant difference between the two groups, and the t value of the two groups was -2.324% P0.05, there was significant difference in the cleaning time of the two groups. The results showed that Tongqiao lotion could play a more important role in cleaning the cavity than that of normal saline in order to promote the mucosal epithelization in the next step. The time of epithelization of the two groups was significantly different by t test (t = -2.015, P 0.05), which indicated that the washing of the cavity of Tongqiao lotion was more effective than that of saline in promoting and accelerating the treatment of 12 weeks of mucosal epithelialization. The activity of superoxide dismutase (SOD) in nasal mucosa of the two groups was significantly different by t test. The content of MDA in nasal mucosal tissue of the two groups was significantly different by t test (P 0.01), indicating that Tongqiao lotion could correct the metabolism or disorder of oxygen free radical. Conclusion "Tongqiao lotion" can promote and accelerate mucosal epithelization more effectively than normal saline washing. "Tongqiao lotion" can improve functional nasal endoscopy in the treatment of chronic rhinosinusitis. The surgical effect of nasal polyps is a safe and effective traditional Chinese medicine preparation for chronic rhinosinusitis patients with decreased ability to scavenge free radicals and active lipid peroxidation. Free radical metabolic disorder may play an important role in the pathogenesis of chronic rhinosinusitis.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R765.4

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