摘要目的 观察桉柠蒎肠溶软胶囊在慢性鼻窦炎围手术期中的应用效果.方法 行鼻内镜手术的576例慢性鼻窦炎患者,根据1997年海口诊断标准,其中Ⅰ型(不伴鼻息肉)318例(A组),Ⅱ～Ⅲ型(伴鼻息肉)258例(B组),再分别将每组患者按入院顺序编号,按照单、双号分入两组:治疗A组159例和对照A组159例,治疗B组129例和对照B组129例.治疗A组和治疗B组于术前开始服用桉柠蒎肠溶软胶囊,对照A组和对照B组不服用任何黏液促排剂.四组患者随访1年,通过视觉模拟量表(VAS)评分进行症状的主观评估,通过Lund-Kennedy内镜黏膜形态评分进行鼻腔黏膜变化与转归的客观评价,并对所得结果进行统计学分析.结果 VAS评分:治疗A组与对照A组比较,术后4,12,24周VAS评分差异有统计学意义[(9.56±5.23)分比(16.21±5.78)分、(6.24±4.05)分比(10.36±4.77)分、(5.08±3.35)分比(6.23±4.10)分](P＜0.05),术后48周VAS评分差异无统计学意义(P＞0.05);治疗B组与对照B组比较,术后4,12,24周VAS评分差异有统计学意义[(13.34±6.28)分比(17.62±5.98)分、(8.08±5.56)分比(12.59±5.70)分、(6.12±4.80)分比(8.79±5.04)分](P＜0.05),术后48周VAS评分差异无统计学意义(P＞0.05).Lund-Kennedy内镜黏膜形态评分:治疗A组与对照A组比较,术后4,12周评分差异有统计学意义[(3.44±1.96)分比(5.82±1.74)分、(3.03±1.87)分比(5.08±1.96)分](P＜0.05),术后24,48周评分差异无统计学意义(P＞0.05);治疗B组与对照B组比较,术后4,12,24周评分差异有统计学意义[(6.15±1.99)分比(7.52±2.04)分、(4.80±2.12)分比(6.92±1.57)分、(2.53±2.32)分比(4.12±1.72)分](P＜0.05),术后48周评分差异无统计学意义(P＞0.05).黏膜愈合情况:治疗A组治愈率98.11％ (156/159),对照A组治愈率87.42％ (139/159),两组比较差异有统计学意义(P＜0.05);治疗B组治愈率94.57％(122/129),对照B组治愈率79.84％ (103/129),两组比较差异有统计学意义(P＜0.05).且治疗A组和治疗B组愈合时间分别明显短于对照A组和对照B组[(9.62±1.12)周比(12.35±2.46)周和(13.37±1.84)周比(17.28±3.83)周],差异有统计学意义(P＜0.05).结论 围手术期应用桉柠蒎肠溶软胶囊的患者较未应用患者术腔干痂较少,易于清理,并且术后恢复时间短.黏液促排剂能明显改善术后黏膜分泌及上皮化,缩短术后换药时间,症状很快改善甚至消失,提高功能性鼻窦镜手术的成功率,具有良好的应用前景.

abstractsObjective To observe the application effect of the eucalyptol-limonene-pinene enteric soft capsule in chronic sinusitis during perioperative period.Methods Analyzed 576 cases of nasal endoscopic surgery for chronic sinusitis patients.According to diagnostic criteria (Haikou in 1997),patients with type Ⅰ (without nasal polyps) had 318 cases (group A),patients with type Ⅱ and Ⅲ (with nasal polyps) had 258 cases (group B).Then patients in each group were respectively numbered by hospitalized order.According to the single and double number,they were divided into two groups:treatment group A (159cases) and control group A (159 cases),treatment group B (129 cases) and control group B (129 cases).Patients in the treatment group A and B were treated with the eucalyptol-limonene-pinene enteric soft capsule before operation.Patients in the control group A and B were not taking any mucus cilium scavenger before operation.The follow-up was lasted for 1 year for four groups.Subjective symptoms were assessed by visual analog scale (VAS) score.The changes and outcomes of nasal mucosa were evaluated objectively by LundKennedy endoscopic mucosal morphology score.Then the results were analyzed statistically.Results VAS score:compared treatment group A with control group A,score differences were statistically significant in 4,12 and 24 weeks after operation [(9.56 ± 5.23) scores vs.(16.21 ± 5.78) scores,(6.24 ± 4.05) scores vs.(10.36 ±4.77) scores,(5.08 ± 3.35) scores vs.(6.23 ±4.10) scores](P＜ 0.05),but it was no significant difference in 48 weeks after operation (P ＞ 0.05) ; compared treatment group B with control group B,score differences were statistically significant in 4,12 and 24 weeks after operation [(13.34 ± 6.28) scores vs.(17.62 ±5.98) scores,(8.08 ±5.56) scores vs.(12.59 ±5.70) scores,(6.12 ±4.80) scores vs.(8.79 ± 5.04) scores](P＜ 0.05),but it was no significant difference in 48 weeks after operation (P＞ 0.05).LundKennedy endoscopic mucosal morphology score:the differences between treatment group A and control group A in 4 and 12 weeks after operation were statistically significant [(3.44 ± 1.96) scores vs.(5.82 ± 1.74)scores,(3.03 ± 1.87) scores vs.(5.08 ± 1.96) scores] (P ＜ 0.05),but no statistical significance in 24 and 48 weeks after operation (P ＞ 0.05) ; compared treatment group B with control group B,the scores in 4,12 and 24 weeks after operation were significantly different[(6.15 ± 1.99) scores vs.(7.52 ± 2.04) scores,(4.80 ± 2.12) scores vs.(6.92 ± 1.57) scores,(2.53 ± 2.32) scores vs.(4.12 ± 1.72) scores] (P ＜ 0.05),but no obvious difference in 48 weeks after operation (P ＞ 0.05).The cure rate of treatment group A was 98.11％ (156/159),control group A was 87.42％ (139/159),treatment group B was 94.57％ (122/129) and control group B was 79.84％ (103/129),there was significant difference on cure rate between treatment group and control group (P＜ 0.05).The mucosal healing's time in treatment group A and B were significantly shorter than those in control group A and B [(9.62 ± 1.12) weeks vs.(12.35 ± 2.46) weeks,(13.37 ± 1.84) weeks vs.(17.28 ± 3.83) weeks] (P ＜ 0.05).Conclusions These indicated that the dry scab in surgical cavity of patients with mucus cilium scavenger was less and easy to clean,and postoperative recovery time of patients was short.So the mucus cilium scavenger can obviously improve the secretion of mucosa and epithelial recovery,thus accelerate healing of the disease.It can also improve the success rate of functional endoscope sinus surgery,and may play a promising role in clinical application.