局部糖皮质激素在耳鼻咽喉科疾病术后的疗效观察
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摘要
目的:通过比较局部糖皮质激素(本实验主要研究布地奈德)与全身糖皮质激素(以地塞米松为例)在耳鼻喉疾病术后治疗的效果,探讨局部糖皮质激素在耳鼻喉科疾病术后的治疗作用。
方法:1、选取乳突病变切除术加鼓室成形术后患者34例(36耳),随机分为三组,即布地奈德(普米克令舒)组、地塞米松组及对照组。术后第十二日抽出耳内纱条,布地奈德组用布地奈德(普米克令舒)2ml混合抗菌素滴剂(氧氟沙星)换药,地塞米松组用地塞米松5mg混合同种剂量抗菌素滴剂换药,对照组则单纯应用抗菌素滴剂换药。比较三组患者干耳时间。2、选取患有双侧慢性鼻窦炎鼻息肉且两侧病情基本相似的患者34例,经内镜鼻窦手术后进行同体对照观察,随机选取左侧鼻窦做为布地奈德组,右侧鼻窦为地塞米松组。术后48小时抽出鼻腔内止血棉棒,分别用布地奈德及地塞米松进行定期内镜下处理,观察患者两侧鼻窦粘膜上皮化过程。3、选取阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者40例,所有患者均在全麻下行UPPP术。术后将患者随机分为两组,一组为布地奈德组,一组为地塞米松组,分别用布地奈德混合庆大霉素及地塞米松混合庆大霉素进行雾化吸入,观察两组患者的咽痛、术腔肿胀的消失时间及住院时间。4、选取声带息肉患者30例,声带小结患者18例。患者均由同一术者在全麻下或者局麻下行声带息肉或声带小结切除术,术后将患者随机分为两组,即布地奈德组和地塞米松组,分别用布地奈德混合庆大霉素及地塞米松混合庆大霉素雾化吸入,观察两组患者喉部不适、声嘶症状消失时间及住院时间。
结果:1.对照组患者平均干耳时间为术后26天,地塞米松组平均干耳时间为21天,布地奈德组干耳时间较前两组均短,平均为17天,三组患者干耳时间经比较有统计学意义(P＜0.05)。2.布地奈德组治愈率及好转率均较地塞米松组高,平均上皮化时间为42天,地塞米松组平均上皮化时间为50天,两组比较有统计学差异(P＜0.05)。3.布地奈德组的咽痛、水肿消失时间及住院时间均较地塞米松组短,经统计学处理后,差别有显著性(P＜0.05)。4.布地奈德组的喉部不适、声嘶消失时间及住院时间也较地塞米松组短,统计学处理后,差别有显著性(P＜0.05)。
结论:1、局部应用糖皮质激素可有效的减轻慢性化脓性中耳炎、慢性鼻窦炎鼻息肉、OSAHS及声带息肉、声带小结术后的炎症反应。
2、局部糖皮质激素比全身性糖皮质激素更能有效的控制局部炎症反应,值得广泛推广。
Objective:By comparing the local glucocorticoids(in this experiment was budeson-ide) and systemic corticosteroids(dexamethasone for example) in chronic suppurative otitis media,chronic sinusitis and nasal polyps,OSAHS and vocal cord polyp,vocal nodules Observeing the efficacy of local glucocorticoid at the treatment of postoperative diseases.
Methods:From our hospital patients:
1.Selecting 34 cases(36 ears) patients with mastoid lesion excision and tympanoplasty, they were randomly divided into three groups,budesonide(Pulmicort) group, dexamethasone group and control group.Taking the ear gauze off when the 12 day after operations,budesonide group was changed the dressing with Pulmicort Respules(1mg) which mixed antibiotic drops 10ml(Ofloxacin),once a day.Dexamethasone group was changed the dressing with dexamethasone 5mg which mixed the same antibiotic drip,the control group was simply changed dressing with antibiotic drops.Observing and comparing the time of no exudation of wound in three groups of patients.
2.Selecting 34 cases patients with chronic sinusitis and nasal polyps of bilateral and similar conditions on both sides,all patients were selected the left side as budesonide group,the right was the dexamethasone group,They were the initial surgery patients,according to the scope of lesions,location and severity,respectively,they were implemented by the same technique of functional endoscopic sinus surgery,all patients were extracted nasal swab and stopped bleeding with packing in the first two days.In the 7 days,all patients were contracted the nasal mucosa with 1%ephedrine cotton,other conventional treatments were same.Cleaning the sinus weekly and when endoscopic sinus inspections,budesonide group was sprayed budesonide to the surface of mucosa in the sinus,dexamethasone group was sprayed dexamethasone insteadly.
3.Selecting the sleep apnea-hypopnea syndrome(OSAHS) patients 28 cases,the patients were randomly divided into two groups,one group for the budesonide group,another was dexamethasone group,they were experienced the same operations(UPPP).After operations,budesonide group was inhalated with Gentamicin 8~u and 2ml Pulmicort Respules,1 times a day,7 days.Dexamethasone group was inhalated with the same volume of Gentamicin and dexamethasone 5mg,1 times a day,7 days.More than the same treatment,patients were observed the disappearrance time of pharynxgodynia,edema and length of stay in hospital.
4.Selecting 30 cases patients with vocal cord polyp,18 cases patients with vocal nodules.The patients were randomly divided into two groups,namely budesonide group and dexamethasone group,All patients undered polyps or vocal nodules surgery after operations,budesonide group was inhalated Gentamicin 8~u and 2ml Pulmicort Respules,1 times a day,7 days.Dexamethasone group was inhalated with the same volume of Gentamicin and dexamethasone 5rag,1 times a day,7 days.The two groups were observed the time of throat discomfort,hoarseness symptom and length of stay in hospital.
Results:
1.The average time to do ear after operations of the patients of Control group was 26.09±5.38 days,the dexamethasone group was 21.5±5.16 days after operations,the time to do ears of budesonide group was shorter than the previous two groups,it was 17.76±3.37 days.Comparing three groups and fouding that they were statistically significant(P＜0.05).
2.Budesonide group:The process of epithelial more quickly than dexamethasone group,all patients after topial treatment and integrated treatment were cured for 97.05%,improved 2.94%,and the average time of epithelization was 42.82 days.
Dexamethasone group:The process of epithelial in budesonide group extened than Budesonide group.The cure rate was 94.1 percent and the improvement was 5.88%,the average time for epithelization was 50.03 days.Comparing the two groups and fouding that they were statistically significant(P＜0.05).
3.The two groups showed:
The disappeared time of pharyngodynia,edema,and length of stay in hospital of the patients in the budesonide group were shorter than dexamethasone group.The disappeared time of pharyngodynia of budesonide group was about 8.4 days,edema disappeared time was about 8.1 days,hospitalization time was 10.3 days.The disappearance of time of pharyngodynia of dexamethasone group:was 11.0 days,edema disappearance time was 11.35 days,hospitalization time was 13.35 days.After statistical analysis,the two groups were significant differences.(P ＜0.05)
4.The disappeared time of throat discomfort,hoarseness and length of stay in hospital of budesonide group were shorter than dexamethasone group,the disappearance time of throat discomfort of budesonide group was about 5.21 days,hoarseness disappeared was about 7.21 days,hospitalization time was 7.46 days;The disappearance time of throat discomfort of dexamethasone group was about 9.5 days,hoarseness disappearance time was11.0 days, hospitalization time was 10.0 days.After statistical analysis,the two groups were significant differences.(P＜0.05).
Conclusion:
1.Topical application of glucocorticoids may be effective to reduce the inflammatory response of chronic suppurative otitis media,chronic sinusitis and nasal polyps,OSAHS and vocal cord polyp,vocal nodules which after.operations.
2.Topical glucocorticoid are more effective in the control of local inflammatory response than systemic glucocorticoids,it could be used widely.
方法:1、选取乳突病变切除术加鼓室成形术后患者34例(36耳),随机分为三组,即布地奈德(普米克令舒)组、地塞米松组及对照组。术后第十二日抽出耳内纱条,布地奈德组用布地奈德(普米克令舒)2ml混合抗菌素滴剂(氧氟沙星)换药,地塞米松组用地塞米松5mg混合同种剂量抗菌素滴剂换药,对照组则单纯应用抗菌素滴剂换药。比较三组患者干耳时间。2、选取患有双侧慢性鼻窦炎鼻息肉且两侧病情基本相似的患者34例,经内镜鼻窦手术后进行同体对照观察,随机选取左侧鼻窦做为布地奈德组,右侧鼻窦为地塞米松组。术后48小时抽出鼻腔内止血棉棒,分别用布地奈德及地塞米松进行定期内镜下处理,观察患者两侧鼻窦粘膜上皮化过程。3、选取阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者40例,所有患者均在全麻下行UPPP术。术后将患者随机分为两组,一组为布地奈德组,一组为地塞米松组,分别用布地奈德混合庆大霉素及地塞米松混合庆大霉素进行雾化吸入,观察两组患者的咽痛、术腔肿胀的消失时间及住院时间。4、选取声带息肉患者30例,声带小结患者18例。患者均由同一术者在全麻下或者局麻下行声带息肉或声带小结切除术,术后将患者随机分为两组,即布地奈德组和地塞米松组,分别用布地奈德混合庆大霉素及地塞米松混合庆大霉素雾化吸入,观察两组患者喉部不适、声嘶症状消失时间及住院时间。
结果:1.对照组患者平均干耳时间为术后26天,地塞米松组平均干耳时间为21天,布地奈德组干耳时间较前两组均短,平均为17天,三组患者干耳时间经比较有统计学意义(P＜0.05)。2.布地奈德组治愈率及好转率均较地塞米松组高,平均上皮化时间为42天,地塞米松组平均上皮化时间为50天,两组比较有统计学差异(P＜0.05)。3.布地奈德组的咽痛、水肿消失时间及住院时间均较地塞米松组短,经统计学处理后,差别有显著性(P＜0.05)。4.布地奈德组的喉部不适、声嘶消失时间及住院时间也较地塞米松组短,统计学处理后,差别有显著性(P＜0.05)。
结论:1、局部应用糖皮质激素可有效的减轻慢性化脓性中耳炎、慢性鼻窦炎鼻息肉、OSAHS及声带息肉、声带小结术后的炎症反应。
2、局部糖皮质激素比全身性糖皮质激素更能有效的控制局部炎症反应,值得广泛推广。
Objective:By comparing the local glucocorticoids(in this experiment was budeson-ide) and systemic corticosteroids(dexamethasone for example) in chronic suppurative otitis media,chronic sinusitis and nasal polyps,OSAHS and vocal cord polyp,vocal nodules Observeing the efficacy of local glucocorticoid at the treatment of postoperative diseases.
Methods:From our hospital patients:
1.Selecting 34 cases(36 ears) patients with mastoid lesion excision and tympanoplasty, they were randomly divided into three groups,budesonide(Pulmicort) group, dexamethasone group and control group.Taking the ear gauze off when the 12 day after operations,budesonide group was changed the dressing with Pulmicort Respules(1mg) which mixed antibiotic drops 10ml(Ofloxacin),once a day.Dexamethasone group was changed the dressing with dexamethasone 5mg which mixed the same antibiotic drip,the control group was simply changed dressing with antibiotic drops.Observing and comparing the time of no exudation of wound in three groups of patients.
2.Selecting 34 cases patients with chronic sinusitis and nasal polyps of bilateral and similar conditions on both sides,all patients were selected the left side as budesonide group,the right was the dexamethasone group,They were the initial surgery patients,according to the scope of lesions,location and severity,respectively,they were implemented by the same technique of functional endoscopic sinus surgery,all patients were extracted nasal swab and stopped bleeding with packing in the first two days.In the 7 days,all patients were contracted the nasal mucosa with 1%ephedrine cotton,other conventional treatments were same.Cleaning the sinus weekly and when endoscopic sinus inspections,budesonide group was sprayed budesonide to the surface of mucosa in the sinus,dexamethasone group was sprayed dexamethasone insteadly.
3.Selecting the sleep apnea-hypopnea syndrome(OSAHS) patients 28 cases,the patients were randomly divided into two groups,one group for the budesonide group,another was dexamethasone group,they were experienced the same operations(UPPP).After operations,budesonide group was inhalated with Gentamicin 8~u and 2ml Pulmicort Respules,1 times a day,7 days.Dexamethasone group was inhalated with the same volume of Gentamicin and dexamethasone 5mg,1 times a day,7 days.More than the same treatment,patients were observed the disappearrance time of pharynxgodynia,edema and length of stay in hospital.
4.Selecting 30 cases patients with vocal cord polyp,18 cases patients with vocal nodules.The patients were randomly divided into two groups,namely budesonide group and dexamethasone group,All patients undered polyps or vocal nodules surgery after operations,budesonide group was inhalated Gentamicin 8~u and 2ml Pulmicort Respules,1 times a day,7 days.Dexamethasone group was inhalated with the same volume of Gentamicin and dexamethasone 5rag,1 times a day,7 days.The two groups were observed the time of throat discomfort,hoarseness symptom and length of stay in hospital.
Results:
1.The average time to do ear after operations of the patients of Control group was 26.09±5.38 days,the dexamethasone group was 21.5±5.16 days after operations,the time to do ears of budesonide group was shorter than the previous two groups,it was 17.76±3.37 days.Comparing three groups and fouding that they were statistically significant(P＜0.05).
2.Budesonide group:The process of epithelial more quickly than dexamethasone group,all patients after topial treatment and integrated treatment were cured for 97.05%,improved 2.94%,and the average time of epithelization was 42.82 days.
Dexamethasone group:The process of epithelial in budesonide group extened than Budesonide group.The cure rate was 94.1 percent and the improvement was 5.88%,the average time for epithelization was 50.03 days.Comparing the two groups and fouding that they were statistically significant(P＜0.05).
3.The two groups showed:
The disappeared time of pharyngodynia,edema,and length of stay in hospital of the patients in the budesonide group were shorter than dexamethasone group.The disappeared time of pharyngodynia of budesonide group was about 8.4 days,edema disappeared time was about 8.1 days,hospitalization time was 10.3 days.The disappearance of time of pharyngodynia of dexamethasone group:was 11.0 days,edema disappearance time was 11.35 days,hospitalization time was 13.35 days.After statistical analysis,the two groups were significant differences.(P ＜0.05)
4.The disappeared time of throat discomfort,hoarseness and length of stay in hospital of budesonide group were shorter than dexamethasone group,the disappearance time of throat discomfort of budesonide group was about 5.21 days,hoarseness disappeared was about 7.21 days,hospitalization time was 7.46 days;The disappearance time of throat discomfort of dexamethasone group was about 9.5 days,hoarseness disappearance time was11.0 days, hospitalization time was 10.0 days.After statistical analysis,the two groups were significant differences.(P＜0.05).
Conclusion:
1.Topical application of glucocorticoids may be effective to reduce the inflammatory response of chronic suppurative otitis media,chronic sinusitis and nasal polyps,OSAHS and vocal cord polyp,vocal nodules which after.operations.
2.Topical glucocorticoid are more effective in the control of local inflammatory response than systemic glucocorticoids,it could be used widely.
引文
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