Kanjanawasee Dichapong, Seresirikachorn Kachorn, Chitsuthipakorn Wirach, Snidvongs Kornkiat
1 Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
2 Endoscopic Nasal and Sinus Surgery Excellent Center, Department of Otolaryngology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Am J Rhinol Allergy. 2018 Jul;32(4):269-279. doi: 10.1177/1945892418773566. Epub 2018 May 18.
Background Saline nasal lavage is one of the treatments of sinonasal diseases. Evidence from basic research favors hypertonic saline (HS) over isotonic saline (IS) for mucociliary clearance, but evidence from clinical studies is controversial. Conversely, HS may carry greater side effects. Objective To compare the effects of HS and IS nasal irrigation in treating sinonasal diseases. Methods Systematic search with Ovid MEDLINE, Scopus, PubMed, Google Scholar, and Manual additional sources was conducted. Randomized controlled trials comparing HS with IS nasal irrigation in treating any sinonasal diseases, including rhinitis and rhinosinusitis, were included. Data were pooled for meta-analyses. Outcomes were symptom scores, sinonasal outcome test (SNOT), and adverse events. Heterogeneity was explored by subgroup analyses. Results Nine studies (740 patients) were included. HS nasal irrigation brought greater benefits over IS in symptom reduction (standardized mean difference (SMD) -0.58; 95% confidence interval [CI]: -0.76, -0.40); however, no difference was shown in SNOT-20 improvement (mean difference 1.81; 95% CI: -0.68, 4.30). In subgroup analyses, effects favoring HS on symptoms were larger in 4 subgroups. These were (1) patients with rhinitis (SMD -1.09; 95% CI: -1.42, -0.76) compared with rhinosinusitis (SMD -0.37; 95% CI: -0.58, -0.15), P < .01; (2) patients under the age of 18 years (SMD -1.22; 95% CI: -1.53, -0.91) compared with patients over the age of 18 years (SMD -0.26; 95% CI: -0.49, -0.04), P < .01; (3) saline irrigation using high volume (SMD -0.89; 95% CI: -1.18, -0.60) compared with low volume (SMD -0.39; 95% CI: -0.62, -0.16), P < .01; and (4) saline irrigation with hypertonicity of <3% (SMD -1.09; 95% CI: -1.42, -0.76) and hypertonicity of 3%-5% (SMD -1.20; 95% CI: -1.61, -0.78) compared with hypertonicity of >5% (SMD 0.20; 95% CI: -0.15, 0.55), P < .01. Buffered saline and operative status did not have impact. HS brought greater minor adverse effects. No major adverse effects were reported. Conclusion HS improves symptoms over IS nasal irrigation in treating sinonasal diseases. There is no difference in disease-specific quality of life. However, HS brings greater minor side effects than IS.
背景 鼻腔盐水冲洗是鼻窦疾病的治疗方法之一。基础研究证据表明，在促进黏液纤毛清除方面，高渗盐水（HS）优于等渗盐水（IS），但临床研究证据存在争议。相反，高渗盐水可能会带来更多副作用。目的 比较高渗盐水和等渗盐水鼻腔冲洗治疗鼻窦疾病的效果。方法 通过Ovid MEDLINE、Scopus、PubMed、谷歌学术进行系统检索，并手动补充其他来源。纳入比较高渗盐水和等渗盐水鼻腔冲洗治疗包括鼻炎和鼻窦炎在内的任何鼻窦疾病的随机对照试验。汇总数据进行荟萃分析。观察指标为症状评分、鼻窦结局测试（SNOT）和不良事件。通过亚组分析探讨异质性。结果 纳入9项研究（740例患者）。高渗盐水鼻腔冲洗在减轻症状方面比等渗盐水更具优势（标准化均数差（SMD）-0.58；95%置信区间[CI]：-0.76，-0.40）；然而，在SNOT-20改善方面未显示出差异（均数差1.81；95%CI：-0.68，4.30）。在亚组分析中，高渗盐水在4个亚组中对症状的改善效果更显著。分别为：（1）鼻炎患者（SMD -1.09；95%CI：-1.42，-0.76）与鼻窦炎患者（SMD -0.37；95%CI：-0.58，-0.15）相比，P＜0.01；（2）18岁以下患者（SMD -1.22；95%CI：-1.53，-0.91）与18岁以上患者（SMD -0.26；95%CI：-0.49，-0.04）相比，P＜0.01；（3）大量盐水冲洗（SMD -0.89；95%CI：-1.18，-0.60）与少量盐水冲洗（SMD -0.39；95%CI：-0.62，-0.16）相比，P＜0.01；（4）高渗度＜3%的盐水冲洗（SMD -1.09；95%CI：-1.42，-0.76）和高渗度3%-5%的盐水冲洗（SMD -1.20；95%CI：-1.61，-0.78）与高渗度＞5%的盐水冲洗（SMD 0.20；95%CI：-0.15，0.55）相比，P＜0.01。缓冲盐水和手术状态无影响。高渗盐水带来更多轻微不良反应。未报告严重不良反应。结论 在治疗鼻窦疾病方面，高渗盐水鼻腔冲洗比等渗盐水鼻腔冲洗能更好地改善症状。在疾病特异性生活质量方面无差异。然而，高渗盐水比等渗盐水带来更多轻微副作用。
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