嗅觉训练治疗嗅觉障碍的临床疗效和影响因素分析  

Efficacy and associated factors of olfactory training in the treatment of olfactory dysfunction

作　　者：闫晓光 高星 孙智甫 郭怡辰[1] 姚淋尹[1] 刘佳[1] 肖伟[2,3] 吕倩雯 魏永祥 Yan Xiaoguang;Gao Xing;Sun Zhifu;Guo Yichen;Yao Linyin;Liu Jia;Xiao Wei;Lyu Qianwen;Wei Yongxiang(Department of Otorhinolaryngology Head and Neck Surgery,Belling Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Otorhinolaryngology Head and Neck Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]首都医科大学附属北京安贞医院耳鼻咽喉头颈外科,100029 [2]武汉大学中南医院耳鼻咽喉头颈外科,430071 [3]北京安贞医院

出　　处：《中华耳鼻咽喉头颈外科杂志》2018年第11期815-819,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金项目(81670903);北京市医管局“登峰”人才培养计划(DFL20150602);上气道功能障碍相关心血管疾病研究北京市重点实验室(BZ0377)。

摘　　要：目的 探讨嗅觉训练治疗嗅觉障碍的临床疗效及其影响因素.方法 2016年11月至2017年5月就诊于首都医科大学附属北京安贞医院的86例嗅觉障碍患者纳入本前瞻性研究,其中上呼吸道感染后嗅觉障碍患者49例,外伤性嗅觉障碍患者37例.入选时收集患者临床资料,包括性别、年龄、体质量指数(BMI)、病程、烟酒史、2型糖尿病等慢性病史、焦虑视觉模拟量表(VAS)评分.采用嗅觉训练治疗16周,并于治疗前后行Sniffin'Sticks嗅觉测试,气味察觉阈、气味辨别能力和气味识别能力3项测试的得分总和组成TDI综合评分(composite threshold-discrimination-identification score,TDI).采用SPSS 23.0软件对结果进行配对t检验、单因素及多因素Logistic回归分析.结果共80例患者完成治疗方案,其中上呼吸道感染后嗅觉障碍患者46例,外伤性嗅觉障碍患者34例.治疗后TDI得分较治疗前升高,差异有统计学意义[(18.3±8.6)分比(13.6±7.4)分,t=-6.158,P<0.05].治疗总体有效率40.0%(32/80).上呼吸道感染后嗅觉障碍治疗有效率45.7%(21/46),外伤性嗅觉障碍治疗有效率32.4%(11/34),二者差异无统计学意义(χ^2=1.441,P=0.230).Logistic回归分析显示,病程是影响嗅觉训练疗效的因素(OR=0.881,95%CI:0.799~0.973,P=0.012),初发症状到开始嗅觉训练时间间隔≤1年的患者治疗有效率为50.9%(29/57).结论 16周的嗅觉训练可有效治疗上呼吸道感染后和外伤性嗅觉障碍;早期进行嗅觉训练可取得更好的治疗效果.Objective To explore the clinical effects and the influence factors of olfactory training in the treatment of olfactory dysfunction.Methods A total of 86 patients with olfactory dysfunction (4.9 post-infectious and 37 post-traumatic)in Beijing Anzhen Hospital during Dec 2016 to May 2017 were recruited in this prospective study.The clinical data of patients were analyzed,including gender,age,body mass index (BMI),course of disease,smoking history,drinking history,diabetes history,hypertension history,hyperlipidemia history,and anxiety visual analogue score (VAS).All patients were treated with olfactory training for 16 weeks,and all of them underwent Sniffin'Sticks olfactory test before and after treatment,which was evaluated by composite threshold-discrimination-identification score (TDI).SPSS 23.0 software,paired t test and univariate and multivariate Logistic regression analysis were used to analyze the data.Results Eighty patients received treatment,including 46 post-infectious olfactory dysfunction and 34 post-traumatic olfactory dysfunction.After olfactory training,the total scores of TDI increased with statistically significant (18.3±8.6vs 13.6±7.4,t =-6.158,P <0.05).The overall efficacy was 40% (32/80).The effective rate were 45.7%(21/46)in post-infectious olfactory dysfunction and 32.4%(11/ 34)in post-traumatic olfactory dysfunction respectively,with no statistically significant difference (χ^2= 1.441,P =0.230).Logistic regression analysis showed that the course of disease was an influence factor in the clinical curative effect (OR =0.881,95%CI:0.799-0.973,P =0.012).In patients with less than a year of olfactory dysfunction,the olfactory function improved obviously with the efficiency of 50.9%(29/ 57).Conclusion Sixteen weeks of olfactory training provides a significant therapeutic effect on the postinfectious and post-traumatic olfactory dysfunction,and the olfactory training can achieve better therapeutic effects at the early stage.

关 键 词：嗅觉障碍 嗅觉训练 治疗结果 

分 类 号：R765.63[医药卫生—耳鼻咽喉科]