【作者】 翟性友；

【导师】 邱宝珊；

【作者基本信息】 广州中医药大学 ， 中医五官科学， 2007， 硕士

【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。更多还原

【Abstract】 [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.更多还原