头孢克洛联合糖皮质激素治疗对慢性鼻-鼻窦炎术后鼻腔黏膜恢复及预后的影响

The impact of cefaclor combined with corticosteroid infiltration on nasal mucosa recovery and prognosis after surgery for chronic rhinosinusitis

摘要:

目的 探讨头孢克洛联合糖皮质激素浸润对慢性鼻-鼻窦炎患者术后鼻腔黏膜恢复及预后的影响。方法 选取2021年1月—2022年12月连云港市第二人民医院收治的96例慢性鼻-鼻窦炎患者，采用随机数字表法分为对照组和观察组，各48例。对照组采用常规鼻窦炎术后处理，观察组在对照组基础上给予头孢克洛联合糖皮质激素浸润治疗。比较两组患者的视觉模拟评分法（VAS）评分、鼻黏膜功能、鼻黏膜恢复情况、炎症水平、生活质量、并发症及预后情况。结果 观察组治疗后1个月流涕、鼻塞、鼻痒、喷嚏的VAS评分均低于对照组（P <0.05）；观察组治疗前与治疗后1个月流涕、鼻塞、鼻痒、喷嚏VAS评分的差值均高于对照组（P <0.05）。观察组治疗后1个月鼻腔黏液纤毛传输时间（MTT）低于对照组，鼻纤毛传输速率（MTR）高于对照组（P <0.05）；观察组治疗前与治疗后1个月MTT、MTR的差值高于对照组（P <0.05）。观察组治疗后3个月Lund-Mackay、Lund-Kennedy评分均低于对照组（P <0.05）；观察组治疗前与治疗后3个月Lund-Mackay、Lund-Kennedy评分的差值均高于对照组。观察组治疗后1个月肿瘤坏死因子-α（TNF-α）、干扰素γ（IFN-γ）、白细胞介素-5（IL-5）水平均低于对照组（P <0.05）；观察组治疗前与治疗后1个月TNF-α、IFN-γ、IL-5水平的差值均高于对照组（P <0.05）。观察组治疗后3个月汉化版鼻腔鼻窦结局测试22条（SNOT-22）量表各维度评分均低于对照组（P <0.05）；观察组治疗前与治疗后3个月SNOT-22量表各维度评分的差值均高于对照组（P <0.05）。观察组与对照组不良事件总发生率和复发率比较，差异均无统计学意义（P >0.05）。结论 头孢克洛联合糖皮质激素浸润治疗可有效改善慢性鼻-鼻窦炎术后患者的鼻黏膜纤毛功能、鼻黏膜功能和鼻黏膜恢复情况，降低炎症水平，对生活质量无显著影响，且具有较好的安全性。

Abstract:

Objective To explore the impact of cefaclor combined with corticosteroid infiltration on the recovery of nasal mucosa and prognosis in patients with chronic rhinosinusitis post-surgery.Methods Ninety-six patients with chronic rhinosinusitis treated at The Second People's Hospital of Lianyungang from January 2021 to December 2022 were selected and randomly divided into a control group (n = 48, receiving conventional post-sinus surgery care) and an observation group (n = 48, receiving additional cefaclor combined with corticosteroid infiltration on top of the conventional care). The outcomes compared between the two groups included Visual Analogue Scale (VAS) scores for rhinorrhea, nasal congestion, nasal itch, and sneezing; as well as mucociliary function, mucosal recovery, inflammation levels, quality of life, complications, and prognosis.Results At 1 month post-treatment, the observation group exhibited significantly lower VAS scores for rhinorrhea, nasal obstruction, nasal itching, and sneezing compared to the control group (P < 0.05). The differences in pre- and post-treatment VAS score reductions were also greater in the observation group. Nasal mucociliary clearance improved in the observation group, with shorter mucociliary transport time (MTT) and higher mucociliary transport rate (MTR) (P < 0.05). The Lund-Mackay and Lund-Kennedy scores at 3 months were significantly lower in the observation group (P < 0.05), with greater score reductions than the control group. Inflammatory markers (TNF-α, IFN-γ, IL-5) were significantly reduced in the observation group at 1 month (P < 0.05), with more pronounced decreases than the control group. The Sino-Nasal Outcome Test-22 (SNOT-22) scores at 3 months were significantly lower in the observation group across all domains (P < 0.05). No significant differences were observed in adverse events or recurrence rates between the two groups (P > 0.05).Conclusion The treatment involving cefaclor combined with corticosteroid infiltration effectively improved mucociliary function, mucosal function, and mucosal recovery in patients post-chronic rhinosinusitis surgery, reduced inflammation levels, and maintained good safety, without significantly impacting quality of life.