初次与再次手术鼻-鼻窦炎鼻息肉患者的生存质量调查  

Investigation on quality of life in patients suffering from rhinosinusitis with nasal polyps after primary and revision endoscopic sinus surgery

作　　者：陶源[1] 陆兴[1] 曾沛英[1] 

机构地区：[1]北京大学深圳医院耳鼻咽喉科,广东深圳518036

出　　处：《中国耳鼻咽喉颅底外科杂志》2017年第3期251-255,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的采用针对性的量表对慢性鼻-鼻窦炎鼻息肉手术患者的生存质量进行评估,评价初次与再次鼻-鼻窦炎鼻息肉手术患者术后各个测定时点的生存质量状况。方法通过视觉模拟量表(visual analog scale,VAS)、鼻腔鼻窦结局测量20条(sino-nasal outcome test-20,SNOT-20)等症状及QOL量表,及鼻内镜检查量化评估评分法(Lund-Kennedy评分法)对30例慢性鼻-鼻窦炎鼻息肉再次手术(revision endoscopic sinus surgery,RESS)患者术前和术后1年进行随访,与40例慢性鼻-鼻窦炎鼻息肉初次手术(primary ESS,PESS)患者术后的评分结果进行比较。结果两组患者均进行鼻内镜手术治疗,1年后VAS总体症状评分,SNOT-20量表的20个条目总分与5大条目的总分等指标均明显好转(P<0.05),术后鼻内镜评分亦明显改善(P<0.05);两组术后的SNOT-20量表条目总分指标横向对比差异无统计学意义(P>0.05);术前影响患者最大的五个问题分别是:需要擤鼻涕、鼻涕倒流、流脓鼻涕、头昏、夜间睡眠质量不好。术后相应问题均有改善,但是相比较初发组鼻-鼻窦炎鼻息肉患者术后,再次手术组鼻-鼻窦炎鼻息肉患者组术后"忧虑"条目的情况有明显差异。结论不论对于初次还是再次手术患者来说,鼻内镜手术是一个可重复进行、能显著缓解症状、提高生存质量的有效治疗方式。经过手术后,需要擤鼻涕、鼻涕倒流、流脓鼻涕的症状有待进一步解决,对于复发再次手术组鼻-鼻窦炎鼻息肉患者出现的对于鼻内镜手术患者"忧虑"的情况,应该进行有针对性的病情解释和心理疏导工作。Objective To explore the quality of life （QOL） in patients suffering from chronic rhinosinusitis with nasal polyps after primary endoscopic sinus surgery （PESS） and revision endoscopic sinus surgery （HESS）. Methods A prospective trial was conducted to survey the QOL of 30 patients treated with RESS and 40 with PESS. All the patients were evaluated by visual analog scale （VAS）, item-20 sino-nasal outcome test （SNOT-20）, Lund-Kennedy staging system before operation （as the baseline ） and 12 months after operation. Results The total scores of SNOT-20 and 5 most important items in SNOT-20 and Lund-Kennedy scores of the patients in both groups at 12 months after surgery were less than those of their baselines respectively（ all P 〈0.05 ）. At that time, the difference of SNOT-20 scores between the PESS group and the RESS group was statistically insignificant （ P 〉 0.05 ）. The 5 items most frequently reported as important before operation were ＂Need to blow nose＂ , ＂Postnasal discharge＂ , ＂Thick nasal discharge＂, ＂Dizziness＂ and ＂Lack of a good night＇ s sleep＂ in both groups. At 12 months after surgery, ＂Frustrated/restless/irritable＂ became one of the 5 most important items in the PESS group while ＂sad＂ in the HESS group. Conclusions As a therapeutic means that can be adopted repeatedly, relief clinical symptoms significantly and improve QOL, endoscopic sinus surgery is effective for both primary and recurrent chronic rhinosinusitis. The problems of ＂ sad＂ and ＂ Frustrated/restless/irritable＂ should be sufficiently emphasized in clinical treatment.

关 键 词：鼻-鼻窦炎 鼻息肉 生存质量 修正手术 SNOT-20 

分 类 号：R765.25[医药卫生—耳鼻咽喉科]