Lal Devyani, Jategaonkar Ameya A, Borish Larry, Chambliss Linda R, Gnagi Sharon H, Hwang Peter H, Rank Matthew A, Stankiewicz James A, Lund Valerie J
Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, AZ, USA.
University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA.
Rhinology. 2016 Jun;54(2):99-104. doi: 10.4193/Rhino15.228.
Management of rhinosinusitis during pregnancy requires special considerations.
The systematic review was conducted using MEDLINE and EMBASE databases and relevant search terms. Title, abstract and full manuscript review were conducted by two authors independently. A multispecialty panel with expertise in management of Rhinological disorders, Allergy-Immunology, and Obstetrics-Gynecology was invited to review the systematic review. Recommendations were sought on use of following for CRS management during pregnancy: oral corticosteroids; antibiotics; leukotrienes; topical corticosteroid spray/irrigations/drops; aspirin desensitization; elective surgery for CRS with polyps prior to planned pregnancy; vaginal birth versus planned Caesarian for skull base erosions/ prior CSF rhinorrhea.
Eighty-eight manuscripts underwent full review after screening 3052 abstracts. No relevant level 1, 2, or 3 studies were found. Expert panel recommendations for rhinosinusitis management during pregnancy included continuing nasal corticosteroid sprays for CRS maintenance, using pregnancy-safe antibiotics for acute rhinosinusitis and CRS exacerbations, and discontinuing aspirin desensitization for aspirin exacerbated respiratory disease. The manuscript presents detailed recommendations.
The lack of evidence pertinent to managing rhinosinusitis during pregnancy warrants future trials. Expert recommendations constitute the current best available evidence.
孕期鼻窦炎的管理需要特殊考量。
使用MEDLINE和EMBASE数据库及相关检索词进行系统综述。由两位作者独立进行标题、摘要和全文审查。邀请了一个在鼻科疾病管理、过敏免疫和妇产科方面具有专业知识的多学科小组来审查该系统综述。就孕期CRS管理中以下各项的使用征求建议：口服糖皮质激素；抗生素；白三烯；局部糖皮质激素喷雾/冲洗/滴剂；阿司匹林脱敏；计划怀孕前对伴有息肉的CRS进行择期手术；对于颅底侵蚀/既往脑脊液鼻漏，阴道分娩与计划剖宫产的选择。
在筛选了3052篇摘要后，对88篇手稿进行了全文审查。未发现相关的1级、2级或3级研究。专家小组对孕期鼻窦炎管理的建议包括：继续使用鼻用糖皮质激素喷雾维持CRS治疗，对急性鼻窦炎和CRS加重期使用妊娠安全的抗生素，以及对阿司匹林加重的呼吸道疾病停止阿司匹林脱敏治疗。本文给出了详细建议。
缺乏与孕期鼻窦炎管理相关的证据，这使得未来有必要进行试验。专家建议构成了当前可获得的最佳证据。
