Lima Adriano Damasceno, Giffoni Rodolfo Baptista, Arguelles-Hernandez Julieta, Santos Gabriele, Sena Victor L J C, Aguiar Ricardo S, Cruz Marcelo L S, Dalmaschio Maria E P, Nakanishi Marcio
Universidade de Brasília (UnB), Divisão de Pós-Graduação em Ciências Médicas, Brasília, DF, Brazil.
Universidade Estadual de Feira de Santana, Departamento de Saúde, Feira de Santana, BA, Brazil.
Braz J Otorhinolaryngol. 2025 Jan-Feb;91(1):101517. doi: 10.1016/j.bjorl.2024.101517. Epub 2024 Nov 5.
This study aimed to clarify the impact of hypertonic solutions on various outcomes, including persistence or reduction of nasal crusts, polypoid edema, and postoperative inflammatory symptoms.
We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for studies comparing hypertonic with isotonic saline irrigation after FESS in adult patients with Chronic Rhinosinusitis (CRS). Outcomes were polypoid mucosa, nasal crusts, and variation from the baseline of Sino-Nasal Outcome Test (SNOT) 20/22 and Visual Analog Scale (VAS). For statistical analysis, we used RevMan 5.4.1, and assessed heterogeneity with I statistics.
We included a total of 479 patients from 7 studies. In the hypertonic saline group, there was a reduction in the nasal crust Risk Ratio (RR) (RR = 0.65; 95% CI 0.49 to 0.87; p = 0.004; I = 0%) after 30-45 days and severe crusts at 14-21 days (RR = 0.59; 95% CI 0.38 to 0.91; p = 0.02; I = 0%). Additionally, the persistence of polypoid mucosa was lower in the intervention arm (RR = 0.53; 95% CI 0.43 to 0.65; p < 0.00001; I = 0%) after 14-21 days. In the symptomatic evaluation hypertonic saline group showed an improvement in postoperative symptoms by a VAS Mean Difference (MD) (MD = -5; 95% CI -5.77 to -4.24; p < 0.00001; I = 0%) and a SNOT 20/22 Standard Mean Difference (SMD) (SMD = -1.65; 95% CI -2.7 to -0.61; p = 0.002; I = 93%) reduction from baseline in 30-45 days after the surgery.
Hypertonic saline showed a superior improvement in postoperative evaluation by means of nasal crusting, mucosal healing aspect, and nasal inflammatory symptoms compared with isotonic saline irrigation.
本研究旨在阐明高渗溶液对各种结果的影响，包括鼻痂的持续存在或减少、息肉样水肿和术后炎症症状。
我们检索了PubMed、Embase和Cochrane对照试验中央注册库，以查找比较成人慢性鼻窦炎（CRS）患者功能性内镜鼻窦手术（FESS）后高渗盐水与等渗盐水冲洗的研究。结果指标为息肉样黏膜、鼻痂，以及鼻窦结局测试（SNOT）20/22和视觉模拟量表（VAS）相对于基线的变化。对于统计分析，我们使用RevMan 5.4.1，并通过I统计量评估异质性。
我们共纳入了来自7项研究的479例患者。在高渗盐水组中，30 - 45天后鼻痂风险比（RR）降低（RR = 0.65；95%置信区间0.49至0.87；p = 0.004；I = 0%），14 - 21天时严重鼻痂的风险比（RR = 0.59；95%置信区间0.38至0.91；p = 0.02；I = 0%）。此外，干预组在14 - 21天后息肉样黏膜的持续存在率较低（RR = 0.53；95%置信区间0.43至0.65；p < 0.00001；I = 0%）。在症状评估中，高渗盐水组术后症状通过VAS平均差（MD）得到改善（MD = -5；95%置信区间 -5.77至 -4.24；p < 0.00001；I = 0%），并且在术后30 - 45天SNOT 20/22标准平均差（SMD）从基线降低（SMD = -1.65；95%置信区间 -2.7至 -0.61；p = 0.002；I = 93%）。
与等渗盐水冲洗相比，高渗盐水在术后评估中在鼻痂形成、黏膜愈合方面和鼻炎症症状方面显示出更优的改善效果。
