不同温度生理盐水鼻腔冲洗对变应性鼻炎的治疗作用  

Treatment of allergic rhinitis with normal saline nasal irrigation at different temperature

作　　者：蔺林[1] 严文洪[1] 赵霞[1] 

机构地区：[1]复旦大学附属华山医院耳鼻咽喉头颈外科,上海200040

出　　处：《中华耳鼻咽喉头颈外科杂志》2014年第2期109-114,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：上海市卫生局科研课题计划项目（20114145）

摘　　要：目的 研究不同温度的生理盐水鼻腔冲洗对变应性鼻炎（allergic rhinitis,AR）的影响,探讨鼻腔冲洗的恰当温度.方法 将AR患者60例,以随机数字表法平均分为3组,分别以15 ℃C、25℃、40℃生理盐水进行鼻腔冲洗,健康对照组20例不予特殊干预.采用视觉模拟量表评分（visualanalogue scale,VAS）评估流涕、打喷嚏、鼻塞、鼻痒等鼻部症状的改变,采用酶联免疫吸附试验检测各组鼻腔冲洗液中组织胺、白三烯C4（leukotriene C4,LTC4）、屋尘螨D1特异性IgE（specific IgE,sIgE）和嗜酸粒细胞阳离子蛋白（eosinophil cationic protein,ECP）含量的改变.以GraphPad Prism 5统计软件进行数据分析.结果 15℃和25℃生理盐水鼻腔冲洗组流涕、打喷嚏、鼻塞、鼻痒等鼻部症状VAS评分、鼻腔冲洗液中组织胺、LTC4、屋尘螨D1 sIgE、ECP含量治疗前后差异无统计学意义（P值均＞0.05）.40℃生理盐水鼻腔冲洗组治疗前打喷嚏、鼻塞VAS评分分别为（6.118±0.410）、（5.765±0.442）分,治疗后分别为（3.765±0.291）、（3.529±0.365）分,差异有统计学意义（t=4.678,P＜0.001;t =3.901,P＜O.01）;鼻腔冲洗液中组织胺、LTC4含量治疗前分别为（21.78±0.62）、（17.43 0.67） ng/ml,治疗后分别为（18.82 ±0.52）、（13.14±0.59） ng/ml,差异有统计学意义（t =3.632,P＜0.001;t =4.79,P＜0.001）;治疗前后流涕（t=2.02,P=0.051）、鼻痒（t=1.984,P=0.056）的VAS评分和鼻腔冲洗液中sIgE（t=1.891,P=0.066）、ECP（t=2.021,P=O.05）含量差异无统计学意义.40℃与25℃生理盐水鼻腔冲洗组相比,打喷嚏、鼻塞VAS评分差异有统计学意义（t=2.060,P=0.048;t=2.053,P=0.048）;鼻腔冲洗液中组织胺、LTC4含量差异有统计学意义（t=2.078,P=0.045;t =2.149,P=0.038）;而流涕、鼻痒VAS评分和鼻腔冲洗液中sIgE、ECP含量差异均无统计学意义（P值均＞0.05）.结论 40℃生理盐水鼻腔冲洗可以明显改善患者打喷嚏和鼻塞�Objective To investigate the influence of normal saline nasal irrigation with different temperature on allergic rhinitis （AR） and to confirm the appropriate temperature of nasal irrigation.Methods Sixty patients with AR were randomly divided into 3 groups（according to random number table） and received 15 ℃,25 ℃ or 40 ℃ normal saline nasal irrigation respectively,and 20 healthy controls received no treatment.Visual analogue scale （VAS） was used to assess the symptoms among the control group and the various intervention groups and the enzyme linked immunosorbent assay （ELISA） was applied to detect the contents of histamine,leukotriene C4 （LTC4）,house dust mite D1 specific IgE （sIgE） and eosinophil cationic protein （ECP） among the control group and the various intervention groups.GraphPad Prism 5 software was used to analyze the data.Results There was no statistical difference between 15 ℃ normal saline nasal irrigation group and 25 ℃ normal saline nasal irrigation group.Pre-intervention and postintervention whether in VAS scores of rhinorrhea,sneezing,nasal obstruction and nasal pruritis or in contents of histamine,LTC4,sIgE and ECP showed no difference （all P ＞ 0.05）.However,the symptoms of sneezing （VAS score：6.118 ± 0.410） and nasal obstruction （VAS score：5.765 ± 0.442） were reduced （sneezing VAS score：3.765 ± 0.291 ; nasal obstruction VAS score：3.529 ± 0.365）.The difference was significant （t =4.678,P ＜ 0.001 ; t =3.901,P ＜ 0.O1）.The contents of histamine [（21.78 ± 0.62） ng/ ml] and LTC4 （17.43 ± 0.67 ng/ml） were also decreased after intervention of 40 ℃C normal saline nasal irrigation [histamine content：（18.82 ± 0.52） ng/ml; LTC4 content：（13.14 ± 0.59） ng/ml].The difference was significant （t =3.632,P ＜ 0.001 ; t =4.79,P ＜ 0.001）.Nonetheless,there were no statistical differences in VAS scores of rhinorrhea （t =2.02,P =0.051） and nasal pruritis （t =1.984,P =0.056） and in contents of sIgE （t =1

关 键 词：温度 氯化钠 等渗溶液 鼻炎 变应性 常年性 鼻炎 变应性 季节性 治疗结果 灌洗 

分 类 号：R765.21[医药卫生—耳鼻咽喉科]