Kominsky Evan, Liu Katherine Y, Ninan Sen, Arrighi-Allisan Annie, Filimonov Andrey, Kidwai Sarah, Morton Kathryn, Saini Alok T, Spock Todd, Del Signore Anthony, Govindaraj Satish, Iloreta Alfred Marc
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Am J Otolaryngol. 2022 Jul-Aug;43(4):103476. doi: 10.1016/j.amjoto.2022.103476. Epub 2022 May 4.
Preoperative corticosteroids have been shown to improve surgical visibility and intraoperative blood loss for chronic rhinosinusitis with nasal polyposis (CRSwNP) patients undergoing endoscopic sinus surgery (ESS). However, there is no consensus on the optimal dosing regimen.
A randomized, controlled trial was conducted to compare low, medium, and high dose corticosteroids prior to ESS. Patients with CRSwNP refractory to medical management were randomized to low (N = 8), medium (N = 10), or high (N = 5) dosing regimens of corticosteroids prior to ESS. Baseline disease severity was measured with the 22-item Sino-nasal Outcome Test and Lund-Mackay scores. Modified Lund-Kennedy endoscopic scores (MLKES) were measured at baseline and after corticosteroid treatment. Intraoperative parameters were measured including Boezaart surgical visibility score, intraoperative blood loss, and operative time.
Medium dose corticosteroids demonstrated a superior surgical visibility score to low dose and comparable results to high dose, but these results were not significant (p = 0.33). No significant difference was observed between groups for total blood loss (p = 0.15), operative time (p = 0.87), or change in MLKES (p = 0.27).
Current recommendations include the use of preoperative corticosteroids in patients with CRSwNP undergoing ESS, but there is no consensus on dose or duration. We did not find a statistically significant difference in surgical field visibility, intraoperative blood loss, or operative time between different dosing regimens. Further studies are needed to evaluate the efficacy of a low-dose preoperative regimen with the goal of reducing cumulative patient exposure to systemic corticosteroids.
术前使用皮质类固醇已被证明可改善接受鼻内镜鼻窦手术（ESS）的慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者的手术视野和术中失血情况。然而，关于最佳给药方案尚无共识。
进行了一项随机对照试验，以比较ESS术前低、中、高剂量皮质类固醇的效果。药物治疗无效的CRSwNP患者在ESS术前被随机分为低剂量（N = 8）、中剂量（N = 10）或高剂量（N = 5）皮质类固醇给药方案组。采用22项鼻鼻窦结局测试和Lund-Mackay评分评估基线疾病严重程度。在基线和皮质类固醇治疗后测量改良Lund-Kennedy内镜评分（MLKES）。测量术中参数，包括Boezaart手术视野评分、术中失血和手术时间。
中剂量皮质类固醇的手术视野评分优于低剂量，与高剂量相当，但这些结果无统计学意义（p = 0.33）。各组之间在总失血量（p = 0.15）、手术时间（p = 0.87）或MLKES变化（p = 0.27）方面未观察到显著差异。
目前的建议包括对接受ESS的CRSwNP患者使用术前皮质类固醇，但在剂量或疗程方面尚无共识。我们未发现不同给药方案在手术视野清晰度、术中失血或手术时间方面存在统计学显著差异。需要进一步研究以评估低剂量术前给药方案的疗效，目标是减少患者累积接触全身皮质类固醇的剂量。
