Balsalobre Leonardo, Pezato Rogerio, Mangussi-Gomes Joao, Gregorio Luciano, Haddad Fernanda Louise Martinho, Gregorio Luiz Carlos, Fujita Reginaldo
ENT Research Laboratory, Department of Otolaryngology and Head and Neck Surgery, Universidade Federal de São Paulo, SP, Brazil.
Int Arch Otorhinolaryngol. 2019 Apr;23(2):147-151. doi: 10.1055/s-0038-1676095. Epub 2019 Mar 7.
It has been hypothesized that increasing the interstitial hydrostatic pressure within the sinonasal mucosa of patients with nasal polyposis (NP) might decrease the size of nasal polyps. To evaluate the effects of positive airway pressure, delivered by a continuous positive airway pressure (CPAP) device, in patients with NP and in control subjects. Twelve patients with NP and 27 healthy subjects were exposed to CPAP (20 cm H2O) for 2 hours. Visual analog scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE) scale, acoustic rhinometry (AR), peak nasal inspiratory flow (PNIF) and nasal endoscopy (NE-Meltzer polyp grading system) were performed before and after the intervention, for all patients. The control group showed a significant worsening in nasal obstruction symptoms, as measured by VAS and NOSE ( < 0.01), and a significant decrease in nasal patency, as measured by the PNIF and AR ( < 0.01). For the NP group, VAS, NOSE, and AR did not differ significantly ( = 0.72, = 0.73, and = 0.17, respectively), but PNIF values worsened ( = 0.04) after exposure to CPAP. There was a statistically significant reduction in the nasal polyps' size ( = 0.04). Positive pressure worsened the nasal obstruction symptoms and decreased objective parameters of nasal patency in control subjects. In patients with NP, exposure to CPAP reduced the nasal polyps' size, and the nasal patency, as measured by PNIF. However, it had no significant effects in AR and in nasal obstruction symptoms.
有假说认为，增加鼻息肉（NP）患者鼻窦黏膜内的组织间液静水压可能会减小鼻息肉的大小。
为评估持续气道正压通气（CPAP）设备输送的气道正压对NP患者和对照受试者的影响。
12例NP患者和27名健康受试者接受了2小时的CPAP（20 cm H₂O）治疗。对所有患者在干预前后进行视觉模拟量表（VAS）、鼻阻塞症状评估（NOSE）量表、鼻声反射（AR）、最大吸气鼻腔气流（PNIF）和鼻内镜检查（NE-Meltzer息肉分级系统）。
对照组在VAS和NOSE测量中显示鼻阻塞症状显著恶化（<0.01），在PNIF和AR测量中显示鼻腔通畅度显著降低（<0.01）。对于NP组，VAS、NOSE和AR无显著差异（分别为=0.72、=0.73和=0.17），但在接受CPAP治疗后PNIF值恶化（=0.04）。鼻息肉大小有统计学意义的减小（=0.04）。
正压使对照受试者的鼻阻塞症状恶化，并降低了鼻腔通畅度的客观参数。在NP患者中，接受CPAP治疗可减小鼻息肉大小，并通过PNIF测量提高鼻腔通畅度。然而，它对AR和鼻阻塞症状没有显著影响。
