慢性鼻窦炎—鼻息肉内窥镜术后中医辨证分型及疗效观察
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摘要
[目的]：观察中医药辨证治疗对慢性鼻窦炎—鼻息肉(Ⅱ型和Ⅲ型)鼻窦内窥镜手术后临床症状、体征和术腔清洁时间及上皮化时间等的改善情况，并且对其疗效做出初步评价，从中寻找辨证规律。
[方法]：将广州中医药大学第一附属医院耳鼻咽喉科从2006年6月至2007年2月间确诊为慢性鼻窦炎—鼻息肉住院患者52例(100侧)，按就诊单、双数顺序法分为治疗组26例(50侧)和对照组26例(50侧)。两组治疗方案均参考许庚等制定的围手术期治疗方案，治疗组术后加用中医药辨证治疗不少于8周。对照组出院后则不服用中药。中医辨证分为湿热蕴结型、脾虚湿困型。两组术后1～4周每周内窥镜复查1次，5～12周每月复查1～2次，记录其辨证类型、兼夹证型及术腔清洁情况、术腔上皮化时间，术后症状改善等。术后3个月参考1997海口标准，根据治疗前后症状、体征记分总和的改善百分率进行疗效评定。
[结果]：
1．治疗组在术腔清洁时间、囊泡持续时间及上皮化时间较之对照组有显著性差异(P＜0.05)。并且在术后临床症状改善以及局部体征内窥镜检查方面治疗组较之对照组有所提高(P＜0.05)。然而治疗组应用中医药辨证治疗在短期观察三个月内与对照组疗效无统计学差异(P＞0.05)，需要进一步远期随访观察。
2．各中医证型疗效比较：湿热蕴结型在两个中医证型中所占比例较高，为67.31％，脾虚湿困型，占32.69％。经卡方检验，两种证型疗效无差异(P＞0.05)。
3．术后气虚、夹瘀、夹湿持续时间的比较：治疗组气虚及夹湿、夹瘀持续时间短于对照组(P＜0.05)。
[结论]：
1．中医辨证治疗可减轻慢性鼻窦炎-鼻息肉(Ⅱ型和Ⅲ型)ESS术后全身症状及局部症状，促进术腔清洁及上皮化，中医药治疗显示出其整体治疗的优势。
2．治疗组和对照组在术后术腔恢复阶段的中医兼证变化具有一定的规律性。术后1～2周，多兼有气虚血瘀的体征，术腔基本清洁后，进入粘膜生长的活跃阶段，大多患者多兼有脾虚湿浊停聚之征，患者术后3个月与术前主要证型未见明显改变。两组患者术后气虚夹瘀、夹湿等兼证在持续时间上有长短之别，治疗组气虚夹瘀、夹湿持续时间较之对照组短。
[Objective]:
To observe the effect of chinese herbal medicine(CHM) therapy to chronic nasal sinusitis or nasal polyps (ⅡandⅢ)patients after endoscopic sinus surgery(ESS), improve the condition in the clinical symptom, physical sign、cleaning tiame and epithelization time in nasal cavity after ESS, put out preliminary assessment for its therapeutic effect and look for the regularity of the syndromes Differentiastion.
[Methods]:
52 (100 nasal and sinus cavities) chronic nasal sinusitis or nasal ployps in-patients from the first affiliated hospital of Guangzhou University of TCM were randomly allocated to treatment group(n=26, 50 nasal and sinus cavities)and control group(n=26, 50 nasal and sinus cavities) from 2006. 6 to 2007. 2. All the cases were administrated with the treatment plan refer to xu-geng's, herbal drug was add to treatment group post operation for at least 8 weeks, and control group without herbal drug. We summarized to 2 syndromes in these patients as followed: syndrome of damp and heat on the gallbladder、lung and spleen-stomach, syndrome of splenasthenic fluid-retention. endoscope examine was done each week during the first 4 weeks and each two or four weeks during the last after operation, and The TCM syndrome type, the clean of nasal and sinus cavity, mucosa edema, vesicles, granulation tissue, mini-polyps, fibrous hyperplasia, and complete epithelization etc was recorded. 3 month later the therapy effect was evaluated separately reference to the Haikou's standard in 1997, according to amendment percentage in pretherapy and post-treatment syndrome、physical sign sum scoring.
[Results]:
1. There were significant difference between the two groups(P＜0.05)on the time of the clean of nasal and sinus cavity, the lasting time of vesicles and mucosa edema, the time of complete epithelization(P＜0.05). And somewhat sublime between the two groups(P＜0.05)on the clinical symptom as well as nasal objective sign after splanchnoscopy, however, There were no statistics difference between the two groups(P＞0.05)on the curative effect during 3 months. This is to be followed-up visit and observation further.
2. The Curative effect between the 2 syndromes show that: the 2 syndromes of damp and heat on the gallbladder、lung and spleen-stomach was higher than syndrome of splenasthenic fluid-retention, is 67.31％and 32.69％respectively, carrid on the covariance, by x~2 test, the 2 syndromes show no different Curative effect(9＞0.05).
3. The time of the deficiency of vital energysubordinate、syndrome of blood stasis and the subordinate syndrome of excessive dampness in treatment group show that the lasting time was shorter than the control group(P＜0.05).
[Conclusions]:
1. Chinese herbal medicine(CHM) therapy may release the discomfort syndrome in region and the whole body, and promote the cleaning of nasal and sinus cavity, and complete epithelization, particularly in stageⅡandⅢ. Chinese herbal medicine(CHM) shows the advantage on its all round treatment.
2. We found some unvarying regularity of the syndrome changes in recovery phase of ESS between two groups. The first 2 weeks after operation most patients showed the deficiency of vital energy、subordinate syndromes of blood stasis and subordinate syndromes of moist; The stage of active mucous membrane regenerating, Most cases combining deficiency of vital energy with splenic asthenia, and did not change the main syndromes after the therapy 3 months late. There was statistic difference between the 2 groups on the days of the deficiency of vital energy、the subordinate syndrome of blood stasis stage and the subordinate syndrome of excessive dampness stage due to weekness of the spleen, treatment group showed the less time than the control group.
[方法]：将广州中医药大学第一附属医院耳鼻咽喉科从2006年6月至2007年2月间确诊为慢性鼻窦炎—鼻息肉住院患者52例(100侧)，按就诊单、双数顺序法分为治疗组26例(50侧)和对照组26例(50侧)。两组治疗方案均参考许庚等制定的围手术期治疗方案，治疗组术后加用中医药辨证治疗不少于8周。对照组出院后则不服用中药。中医辨证分为湿热蕴结型、脾虚湿困型。两组术后1～4周每周内窥镜复查1次，5～12周每月复查1～2次，记录其辨证类型、兼夹证型及术腔清洁情况、术腔上皮化时间，术后症状改善等。术后3个月参考1997海口标准，根据治疗前后症状、体征记分总和的改善百分率进行疗效评定。
[结果]：
1．治疗组在术腔清洁时间、囊泡持续时间及上皮化时间较之对照组有显著性差异(P＜0.05)。并且在术后临床症状改善以及局部体征内窥镜检查方面治疗组较之对照组有所提高(P＜0.05)。然而治疗组应用中医药辨证治疗在短期观察三个月内与对照组疗效无统计学差异(P＞0.05)，需要进一步远期随访观察。
2．各中医证型疗效比较：湿热蕴结型在两个中医证型中所占比例较高，为67.31％，脾虚湿困型，占32.69％。经卡方检验，两种证型疗效无差异(P＞0.05)。
3．术后气虚、夹瘀、夹湿持续时间的比较：治疗组气虚及夹湿、夹瘀持续时间短于对照组(P＜0.05)。
[结论]：
1．中医辨证治疗可减轻慢性鼻窦炎-鼻息肉(Ⅱ型和Ⅲ型)ESS术后全身症状及局部症状，促进术腔清洁及上皮化，中医药治疗显示出其整体治疗的优势。
2．治疗组和对照组在术后术腔恢复阶段的中医兼证变化具有一定的规律性。术后1～2周，多兼有气虚血瘀的体征，术腔基本清洁后，进入粘膜生长的活跃阶段，大多患者多兼有脾虚湿浊停聚之征，患者术后3个月与术前主要证型未见明显改变。两组患者术后气虚夹瘀、夹湿等兼证在持续时间上有长短之别，治疗组气虚夹瘀、夹湿持续时间较之对照组短。
[Objective]:
To observe the effect of chinese herbal medicine(CHM) therapy to chronic nasal sinusitis or nasal polyps (ⅡandⅢ)patients after endoscopic sinus surgery(ESS), improve the condition in the clinical symptom, physical sign、cleaning tiame and epithelization time in nasal cavity after ESS, put out preliminary assessment for its therapeutic effect and look for the regularity of the syndromes Differentiastion.
[Methods]:
52 (100 nasal and sinus cavities) chronic nasal sinusitis or nasal ployps in-patients from the first affiliated hospital of Guangzhou University of TCM were randomly allocated to treatment group(n=26, 50 nasal and sinus cavities)and control group(n=26, 50 nasal and sinus cavities) from 2006. 6 to 2007. 2. All the cases were administrated with the treatment plan refer to xu-geng's, herbal drug was add to treatment group post operation for at least 8 weeks, and control group without herbal drug. We summarized to 2 syndromes in these patients as followed: syndrome of damp and heat on the gallbladder、lung and spleen-stomach, syndrome of splenasthenic fluid-retention. endoscope examine was done each week during the first 4 weeks and each two or four weeks during the last after operation, and The TCM syndrome type, the clean of nasal and sinus cavity, mucosa edema, vesicles, granulation tissue, mini-polyps, fibrous hyperplasia, and complete epithelization etc was recorded. 3 month later the therapy effect was evaluated separately reference to the Haikou's standard in 1997, according to amendment percentage in pretherapy and post-treatment syndrome、physical sign sum scoring.
[Results]:
1. There were significant difference between the two groups(P＜0.05)on the time of the clean of nasal and sinus cavity, the lasting time of vesicles and mucosa edema, the time of complete epithelization(P＜0.05). And somewhat sublime between the two groups(P＜0.05)on the clinical symptom as well as nasal objective sign after splanchnoscopy, however, There were no statistics difference between the two groups(P＞0.05)on the curative effect during 3 months. This is to be followed-up visit and observation further.
2. The Curative effect between the 2 syndromes show that: the 2 syndromes of damp and heat on the gallbladder、lung and spleen-stomach was higher than syndrome of splenasthenic fluid-retention, is 67.31％and 32.69％respectively, carrid on the covariance, by x~2 test, the 2 syndromes show no different Curative effect(9＞0.05).
3. The time of the deficiency of vital energysubordinate、syndrome of blood stasis and the subordinate syndrome of excessive dampness in treatment group show that the lasting time was shorter than the control group(P＜0.05).
[Conclusions]:
1. Chinese herbal medicine(CHM) therapy may release the discomfort syndrome in region and the whole body, and promote the cleaning of nasal and sinus cavity, and complete epithelization, particularly in stageⅡandⅢ. Chinese herbal medicine(CHM) shows the advantage on its all round treatment.
2. We found some unvarying regularity of the syndrome changes in recovery phase of ESS between two groups. The first 2 weeks after operation most patients showed the deficiency of vital energy、subordinate syndromes of blood stasis and subordinate syndromes of moist; The stage of active mucous membrane regenerating, Most cases combining deficiency of vital energy with splenic asthenia, and did not change the main syndromes after the therapy 3 months late. There was statistic difference between the 2 groups on the days of the deficiency of vital energy、the subordinate syndrome of blood stasis stage and the subordinate syndrome of excessive dampness stage due to weekness of the spleen, treatment group showed the less time than the control group.
引文
[1]刘湘燕，韩德民，周兵．鼻一鼻窦解剖变异与慢性鼻窦炎的关系．中华耳鼻咽喉杂志．1998年03期．
[2]Bernstein JN, Gorfien J, Noble B. Role of allergy in nasal polyosis:areview, Otolaryngol Head Neck Surg, 1995, 113: ?24-?32.
[3]李渊．慢性鼻及鼻窦炎的预后及治疗中国医学文摘耳鼻咽喉科学2006，21(31)35—136．
[4]韩德民主编．鼻内窥镜外科学[M]．北京：人民卫生出版社，2001：186-187．
[5]王鸿，张罗，周兵等．慢性鼻窦炎鼻息肉与变应性因素相关性的探讨．中华耳鼻咽喉科杂志，2005年03期．
[6]韩德民，周兵．鼻内窥镜外科学[M]．北京：人民卫生出版社，2001：27-29．
[7]左可军，史剑波，许庚等慢性鼻窦炎的细菌学研究中华耳鼻咽喉头颈外科杂志，2005，40(7)：524—527．
[8] Dursun E, Bayiz U, Korkmaz H, et al. Follow-up results of 415 patients after endoscopic sinus surgery. Eur Arch Otorhinolaryngol, 1998,225:504-510.
[9]宋炳楠，蔡超等．鼻息肉的病因学研究．医学新进展中华名医论坛32-35
[10]冯海燕．复发性鼻息肉的综合治疗中国耳鼻咽喉颅底外科杂志，2005年01期(11卷)4142
[11]卜国玄，主编。耳鼻咽喉全书—鼻科学[M]。第2版．上海：上海科学技术出版社，2000．
[12]李华斌综述修正性内窥镜鼻窦手术[J]国外医学—耳鼻咽喉科学分册，2001，25(1)：75～76
[13]许昱，陶泽璋，吴玉珍．慢性鼻窦炎合并变应性鼻炎鼻内镜术后
疗效分析．变态反应世界百年中国五十年纪念论坛一论文汇编．2006-06-30，110．
[14]陈金辉，陶泽璋，孔勇刚等．全身应用激素对鼻息肉组织中NF-k Bp65及工KB α表达的影响国耳鼻咽喉-头颈外科，2005年01期
[15]殷晓东鼻内窥镜下手术治疗复发性鼻窦炎鼻息肉中国血液流 变学杂志12004；14(4)604—605
[16]吴崇华，郜一琼等探讨Ⅲ型慢性鼻窦炎鼻息肉的复发原因及综合治疗方法大理学院学报，2005年03期
[17]刘立中，梁传余．鼻内镜治疗慢性鼻窦炎鼻息肉术后术腔上皮修复过程中组织病理学观察临床耳鼻咽喉科杂志2005年10月第19卷第20期923-925
[18]杨国存，胡建文，曾一民鼻内窥镜手术治疗慢性鼻窦炎200例分析中国内镜杂志，2005年03期
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[25]陈俊杰林傧林建武通窍鼻炎片对慢性鼻窦炎、鼻息肉鼻内窥镜术后病例的临床疗效观察福建医药杂志，2005年02期
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[34]陈绿琦．鼻渊舒治疗鼻炎鼻窦炎疗效观察[J]．中国中西医结合耳鼻咽喉科杂志，200 1，12(9专刊)：23～24
[2]Bernstein JN, Gorfien J, Noble B. Role of allergy in nasal polyosis:areview, Otolaryngol Head Neck Surg, 1995, 113: ?24-?32.
[3]李渊．慢性鼻及鼻窦炎的预后及治疗中国医学文摘耳鼻咽喉科学2006，21(31)35—136．
[4]韩德民主编．鼻内窥镜外科学[M]．北京：人民卫生出版社，2001：186-187．
[5]王鸿，张罗，周兵等．慢性鼻窦炎鼻息肉与变应性因素相关性的探讨．中华耳鼻咽喉科杂志，2005年03期．
[6]韩德民，周兵．鼻内窥镜外科学[M]．北京：人民卫生出版社，2001：27-29．
[7]左可军，史剑波，许庚等慢性鼻窦炎的细菌学研究中华耳鼻咽喉头颈外科杂志，2005，40(7)：524—527．
[8] Dursun E, Bayiz U, Korkmaz H, et al. Follow-up results of 415 patients after endoscopic sinus surgery. Eur Arch Otorhinolaryngol, 1998,225:504-510.
[9]宋炳楠，蔡超等．鼻息肉的病因学研究．医学新进展中华名医论坛32-35
[10]冯海燕．复发性鼻息肉的综合治疗中国耳鼻咽喉颅底外科杂志，2005年01期(11卷)4142
[11]卜国玄，主编。耳鼻咽喉全书—鼻科学[M]。第2版．上海：上海科学技术出版社，2000．
[12]李华斌综述修正性内窥镜鼻窦手术[J]国外医学—耳鼻咽喉科学分册，2001，25(1)：75～76
[13]许昱，陶泽璋，吴玉珍．慢性鼻窦炎合并变应性鼻炎鼻内镜术后
疗效分析．变态反应世界百年中国五十年纪念论坛一论文汇编．2006-06-30，110．
[14]陈金辉，陶泽璋，孔勇刚等．全身应用激素对鼻息肉组织中NF-k Bp65及工KB α表达的影响国耳鼻咽喉-头颈外科，2005年01期
[15]殷晓东鼻内窥镜下手术治疗复发性鼻窦炎鼻息肉中国血液流 变学杂志12004；14(4)604—605
[16]吴崇华，郜一琼等探讨Ⅲ型慢性鼻窦炎鼻息肉的复发原因及综合治疗方法大理学院学报，2005年03期
[17]刘立中，梁传余．鼻内镜治疗慢性鼻窦炎鼻息肉术后术腔上皮修复过程中组织病理学观察临床耳鼻咽喉科杂志2005年10月第19卷第20期923-925
[18]杨国存，胡建文，曾一民鼻内窥镜手术治疗慢性鼻窦炎200例分析中国内镜杂志，2005年03期
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