Graf P, Hallén H
Department of Otorhinolaryngology, Södersjukhust, Karolinska Institute,Stockholm, Sweden.
Laryngoscope. 1996 May;106(5 Pt 1):605-9. doi: 10.1097/00005537-199605000-00016.
A parallel, randomized, double-blind study was performed in 30 healthy subjects to investigate the effects on the nasal mucosa of a 1-month treatment with nasal sprays. Ten subjects received oxymetazoline nasal spray; 10 subjects used a nasal spray containing the preservative benzalkonium chloride, and the others were treated with a placebo nasal spray. The three variables that were studied --nasal mucosal swelling, symptom scores, and nasal reactivity-- were estimated by histamine challenge before and after 28 days of treatment. Rhinostereometry was used to measure nasal mucosal swelling and nasal reactivity. After 28 days of use, benzalkonium chloride spray alone induced an increase in nasal mucosal swelling. At the end of the month, the score for nasal stuffiness was significantly higher for the group treated with oxymetazoline than for those treated with benzalkonium chloride. Oxymetazoline nasal spray induced a pronounced increase in nasal reactivity, which was significantly greater than that induced in the placebo group. Long-term use of placebo and benzalkonium chloride nasal sprays also caused an increase in nasal reactivity, but not to the same extent as with the nasal sprays containing oxymetazoline. The authors concluded that long-term use of oxymetazoline induces a sensation of nasal stuffiness, which may be due to unconscious exaggeration of the degree of nasal stuffiness, induced nasal hyperreactivity, or a combination of both. These factors are probably the main reasons for the prolonged use of nasal decongestive sprays and the development of rhinitis medicamentosa. Benzalkonium chloride induces mucosal swelling, which explains why the presence of this preservative in a decongestant spray aggravates rhinitis medicamentosa.
对30名健康受试者进行了一项平行、随机、双盲研究，以调查鼻喷雾剂1个月治疗对鼻黏膜的影响。10名受试者使用羟甲唑啉鼻喷雾剂；10名受试者使用含有防腐剂苯扎氯铵的鼻喷雾剂，其余受试者用安慰剂鼻喷雾剂治疗。在治疗28天前后，通过组胺激发试验评估所研究的三个变量——鼻黏膜肿胀、症状评分和鼻反应性。使用鼻立体测量法测量鼻黏膜肿胀和鼻反应性。使用28天后，单独使用苯扎氯铵喷雾剂会导致鼻黏膜肿胀增加。在月末，使用羟甲唑啉治疗组的鼻阻塞评分显著高于使用苯扎氯铵治疗组。羟甲唑啉鼻喷雾剂会引起鼻反应性显著增加，且明显大于安慰剂组。长期使用安慰剂和苯扎氯铵鼻喷雾剂也会导致鼻反应性增加，但程度不如含有羟甲唑啉的鼻喷雾剂。作者得出结论，长期使用羟甲唑啉会引起鼻阻塞感，这可能是由于无意识地夸大了鼻阻塞程度、诱发鼻高反应性或两者兼而有之。这些因素可能是鼻减充血喷雾剂长期使用和药物性鼻炎发生的主要原因。苯扎氯铵会引起黏膜肿胀，这解释了减充血喷雾剂中这种防腐剂的存在会加重药物性鼻炎的原因。
