改良鼻内镜鼻窦手术联合中鼻甲切除术对难治性慢性鼻-鼻窦炎伴鼻息肉患者嗅觉功能及应激反应的影响
Effect of modified endoscopic sinus surgery combined with middle turbinate resection on olfactory function and stress response in patients with refractory chronic rhinosinusitis with nasal polyps.
作者信息
Su Bin, Han Qianqian, Xi Xiaoxin, Zhou Zining
机构信息
Department of Otorhinolaryngology Head and Neck Surgery, Tianjin 4th Central Hospital Tianjin 300140, China.
出版信息
Am J Transl Res. 2022 Feb 15;14(2):1279-1287. eCollection 2022.
OBJECTIVE
To investigate the effects of modified endoscopic sinus surgery combined with middle turbinate resection on olfactory function and stress response in patients with refractory chronic rhinosinusitis with nasal polyps (CRSwNP).
METHODS
We prospectively selected 92 patients with refractory CRSwNP who were treated in Tianjin 4th Central Hospital from June 2019 to June 2020 as the research subjects. According to the simple randomization of "flipping a coin", they were divided into the observation group (n=50) and the control group (n=42). The observation group was treated with modified endoscopic sinus surgery combined with middle turbinectomy and the control group underwent conventional surgery. The overall response rate, olfactory function, and stress responses of the two groups were compared.
RESULTS
A generalized linear model showed that the overall response rate at 2, 4, and 6 months after surgery in the observation group was higher than that in the control group (Wald group =4.301, Wald time =91.677, group =0.038, time <0.001). Repeated measurements of variance showed no significant differences in olfactory function scores before surgery (=0.485). After 2, 4, and 6 months, the olfactory function scores of the observation group were higher than those of the control group (<0.001). After surgery, patients in the observation group had lower Lund-Mackey, Lund-Kennedy, and SNOT-20 scores, and lower epinephrine (E), norepinephrine (NE), and cortisol (Cor) levels than those in the control group (all <0.001). The observation group had a significantly lower incidence of complications than the control group (10.00% vs. 28.57%, =5.226, =0.022).
CONCLUSION
Modified endoscopic sinus surgery combined with middle turbinate resection significantly improved the olfactory function and reduced the perioperative stress response of patients with CRSwNP.
目的
探讨改良鼻内镜鼻窦手术联合中鼻甲切除术对难治性慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者嗅觉功能及应激反应的影响。
方法
前瞻性选取2019年6月至2020年6月在天津市第四中心医院接受治疗的92例难治性CRSwNP患者作为研究对象。通过“抛硬币”简单随机化法将其分为观察组（n = 50）和对照组（n = 42）。观察组采用改良鼻内镜鼻窦手术联合中鼻甲切除术治疗，对照组行传统手术。比较两组的总有效率、嗅觉功能及应激反应。
结果
广义线性模型显示，观察组术后2、4、6个月的总有效率高于对照组（Wald组 = 4.301，Wald时间 = 91.677，组 = 0.038，时间 < 0.001）。重复测量方差分析显示，术前两组嗅觉功能评分无显著差异（ = 0.485）。术后2、4、6个月，观察组嗅觉功能评分高于对照组（< 0.001）。术后，观察组患者的Lund-Mackey、Lund-Kennedy及SNOT-20评分低于对照组，肾上腺素（E）、去甲肾上腺素（NE）及皮质醇（Cor）水平也低于对照组（均 < 0.001）。观察组并发症发生率显著低于对照组（10.00% 对 28.57%， = 5.226， = 0.022）。
结论
改良鼻内镜鼻窦手术联合中鼻甲切除术可显著改善CRSwNP患者的嗅觉功能，降低围手术期应激反应。
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