长期局部给予激素联合小剂量克拉霉素在慢性鼻窦炎中治疗效果及与鼻息肉影响

劳国光??刘新建??田文浩??黄卓源

[摘要] 目的 探讨长期局部给予激素联合小剂量克拉霉素治疗慢性鼻窦炎临床疗效及合并有鼻息肉对疗效影响。 方法 选取2013年3月～2016年4月我院住院和门诊诊治慢性鼻窦炎患者105例作为研究对象，其中合并鼻息肉34例作为C组，将未合并鼻息肉患者71例随机分为A组36例和B组35例。B组给予糖皮质激素局部给药治疗，A组在B基础上给予小剂量克拉霉素治疗，C组切除鼻息肉后治疗同A组。比较三组患者症状改善情况及疗效。 结果 治疗前，三组患者鼻塞、嗅觉障碍及头痛症状评分比较，差异无统计学意义（P>0.05）；治疗后，B组患者鼻塞、嗅觉障碍及头痛症状评分均高于A、C两组，差异有统计学意义（P<0.05），A、C两组比较差异无统计学意义（P>0.05）。A、C两组治疗效果显著于B组，差异有统计学意义（P<0.05）；且A、C两组疗效比较差异无统计学意义（P>0.05）。 结论 长期局部给予激素联合小剂量克拉霉素治疗慢性鼻窦炎具有显著临床疗效，对于合并有鼻息肉患者疗效不受影响。

[关键词] 慢性鼻窦炎；鼻息肉；克拉霉素；糖皮质激素

[中图分类号] R765.9 [文献标識码] A [文章编号] 2095-0616（2017）12-45-03

Effects of long-term topically administered hormone combined with low-dose clarithromycin in the treatment of chronic sinusitis and nasal polyps

LAO Guoguang LIU Xinjian TIAN Wenhao HUANG Zhuoyuan

Department of ENT，Tangxia Hospital，Dongguan 523721，China

[Abstract] Objective To investigate the clinical efficacy of long-term topically administered hormone combined with low-dose clarithromycin in the treatment of chronic sinusitis and nasal polyps. Methods 105 patients with chronic sinusitis were selected as studying object，who were treated in our hospital and outpatient department from March 2013 to April 2016.34 patients with nasal polyps were treated as group C，and 71 patients without nasal polyps were randomly divided into group A （36 cases） and group B （35 cases）.Group B was given topical administration of glucocorticoid，and group A was given low-dose clarithromycin treatment on group B.Group C were removed nasal polyps and treated the same as the A group.The symptom improvement and curative effect were compared between the three groups. Results Before treatment，there was no significant difference in nasal obstruction，olfactory dysfunction and headache symptoms between the three groups （P>0.05）.After treatment， the scores of nasal obstruction，olfactory dysfunction and headache in group B were higher than that in the group A and the group C（P<0.05），and there was no significant difference between the group A and group C （P>0.05）.The effect of A and C in two groups was significantly higher than that in group B （P<0.05），and there was no significant difference between the two groups of A and C （P>0.05）. Conclusion Long-term topically administered hormone combined with low-dose clarithromycin in the treatment of chronic sinusitis has remarkable clinical effect，and has no effect on the curative effect of the patients with nasal polyps.

[Key words] Chronic sinusitis；Nasal polyps；Clarithromycin；Glucocorticoid

慢性鼻窦炎为多种因素引起非感性慢性鼻腔鼻黏膜炎症性疾病，具有病情反复、病史长等特点，对患者健康和生活质量造成严重影响。糖皮质激素为治疗慢性鼻窦炎首选方法，通过局部给药提高局部用药浓度减轻炎症反应，达到治疗效果。随着近年研究深入，相关报道指出长期小剂量克拉霉素在慢性鼻窦炎中治疗可协助提高临床疗效[1]。同时，由于长期慢性炎症刺激，部分慢性鼻窦炎患者常合并有鼻息肉，本次研究对局部给予糖皮质激素与小剂量克拉霉素联合在慢性鼻窦炎患者中治疗效果及鼻息肉是否对疗效造成影响进行分析，现报道如下。