摘要
目的:观察长期小剂量大环内酯类药物联合鼻用糖皮质激素治疗慢性鼻-鼻窦炎(CRS)的疗效。方法:克拉霉素片0.25g口服,2次/d,2周后改为1次/d;曲安奈德喷雾剂喷鼻,1次/d。不伴鼻息肉的CRS患者26例给药时间12～28周,平均16.62周。伴鼻息肉的CRS患者30例,先在内镜下切除鼻息肉(手术前后用抗生素、激素5～7d),然后开始药物疗法。给药时间12～33周,平均20.03周。治疗前后采用Lund-Mackey鼻窦CT评分,主观症状自评治疗效果。结果:伴息肉组治疗后鼻窦CT平均得分2.83±1.86,显著低于治疗前(7.20±2.06,t=11.41,P<0.01);不伴息肉组治疗后鼻窦CT平均得分2.43±1.91,显著低于治疗前(6.23±1.88,t=12.86,P<0.01)。伴息肉组和不伴息肉组鼻窦CT评分疗效治愈率分别达到43.3%和50.0%。两组的自评疗效与鼻窦CT评分疗效比较无明显差异。结论:长期使用小剂量的克拉霉素联合鼻用糖皮质激素治疗CRS有效。鼻息肉多发和手术处理次数多的患者疗效相对较差。鼻息肉切除和围手术期集中使用大剂量抗生素、糖皮质激素有利于提高伴息肉的CRS患者药物疗法的疗效。
Objective：To observe the clinical treatment effectiveness of Clarithromycin combined with nasal glucocorticoids for chronic rhinosinusitis（CRS）.Method：Clarithromycin was 0.25 g a day（the first two weeks was 0.25 g twice a day）and topical Triamcinolone Acetonaide Acetate nasal spray was（220 μg/d） once a day.Fifty-six patients were enrolled in our research.Twenty-six patients of CRS without nasal polyps was treated for 12 to 28 weeks（average 16.62 weeks）.Thirty patients of CRS with nasal polyps was treated for 12 to 33 weeks（average 20.03 weeks）after polypectomy.The patients＇ symptom were evaluated through Sino-Nasal Outcome Test 20（SNOT-20）scale.Meanwhile sinus CT were evaluated by Lund-Mackey system before and after operation.Result：The score of CT scan was significantly decreased to 2.83±1.86（t=11.41,P0.01） in the CRS with nasal polyps group and to 2.43±1.91（t=12.86,P0.01） in the CRS without nasal polyps group after treatment.Recovery rate of CRS with nasal polyps group was 43.3% and of CRS without nasal polyps group was 50.0% with CT images.The self assessments of treatment efficiency was coincident with CT image in the two groups.Conclusion：The treatment with Long term use of low dosage oral macrolide Clarithromycin combined with nasal sterid on CRS was efficacy.Polypectomy,large dose antibiotic and sterid used in intraoperative period could significant improve the treatment efficiency of CRS with nasal polyps.
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2011年第8期360-363,共4页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词
克拉霉素
糖皮质激素
鼻窦炎
鼻息肉
Clarithromycin
glucocorticoids
sinusitis
nasal polyp
作者简介
通信作者：刘巨波（Email：entliu0503@163．com）
