Assiri Kholood, Alroqi Ahmad, Alromaih Saud, Alzarei Ali
Rhinology and Skull Base Surgery Consultant, Otorhinolaryngology, Head and Neck Surgery, King Faisal Medical City, P.O Box 10031, Abha, 61431 Saudi Arabia.
Rhinology and Skull Base Surgery Consultant, Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia.
Indian J Otolaryngol Head Neck Surg. 2022 Dec;74(Suppl 3):4612-4622. doi: 10.1007/s12070-021-02888-z. Epub 2021 Oct 6.
There is limited knowledge in the literature and lack of clear protocols among practitioners regarding preoperative steroids administration for patients undergoing endoscopic sinus surgery (ESS). This study aimed to identify the practice patterns of rhinologists in Saudi Arabia as well as systematically review all health-related evidence regarding the use of preoperative steroids for ESS. A previously used questionnaire was modified and distributed in Saudi Arabia among rhinologists who finished their residency training. It entailed questions about their qualifications and preoperative steroids use, preferred regimen, and possible benefits. Also, a systematic literature review using four major databases was conducted to build a scoping view of the current evidence. A total of 94 subjects responded to the mailed survey. Of them, 72(76.6%) used preoperative steroids; 40 subjects believed that there is a strong supporting evidence while 32 reported that there is no solid evidence. The commonest indication was chronic rhinosinusitis with nasal polyp followed by allergic fungal rhinosinusitis. More than half of subjects (54.2%) preferred medium-dose prednisone (30-40 mg/day). A considerable number believed that steroids decreased surgical bleeding (n = 57, 79.2%), improved surgical field visualization (77.8%), decreased surgical time (77.8%), and decreased mucosal inflammation (61.1%). Thirteen studies including 1028 patients were eligible for the systematic review. Only three studies reported a statistically significant effect of steroids in reducing intraoperative hemorrhage, while only two studies revealed that steroids significantly improved surgical field quality. In two studies, steroids showed a significant effect in reducing eosinophil infiltration. There is a major number of rhinology experts using preoperative steroids for patients undergoing ESS but there is a wide variation among their practice patterns. The current potential advantages of steroids need to be supported by further large randomized clinical trials to establish clear guidelines.
文献中关于接受鼻内镜鼻窦手术（ESS）患者术前使用类固醇的知识有限，从业者之间也缺乏明确的方案。本研究旨在确定沙特阿拉伯鼻科医生的实践模式，并系统回顾所有与术前使用类固醇进行ESS相关的健康证据。一份先前使用的问卷经过修改后在沙特阿拉伯分发给完成住院医师培训的鼻科医生。问卷包含有关他们的资质、术前类固醇使用情况、首选方案以及可能的益处等问题。此外，还使用四个主要数据库进行了系统的文献综述，以构建当前证据的概述。共有94名受试者回复了邮寄调查。其中，72名（76.6%）使用术前类固醇；40名受试者认为有强有力的支持证据，而32名报告称没有确凿证据。最常见的适应症是慢性鼻窦炎伴鼻息肉，其次是变应性真菌性鼻窦炎。超过一半的受试者（54.2%）首选中等剂量泼尼松（30 - 40毫克/天）。相当一部分人认为类固醇可减少手术出血（n = 57，79.2%）、改善手术视野清晰度（77.8%）、缩短手术时间（77.8%）以及减轻黏膜炎症（61.1%）。13项研究（包括1028名患者）符合系统综述的条件。只有三项研究报告类固醇在减少术中出血方面有统计学显著效果，而只有两项研究表明类固醇显著改善了手术视野质量。在两项研究中，类固醇在减少嗜酸性粒细胞浸润方面显示出显著效果。有大量鼻科专家对接受ESS的患者使用术前类固醇，但他们的实践模式差异很大。类固醇目前的潜在优势需要进一步的大型随机临床试验来支持，以建立明确的指南。
