allergy/rhinology

过敏 / 鼻学
  • 文章类型: Journal Article
    目的:慢性鼻窦炎(CRS)是一种广泛流行的疾病,然而,根据性别的严重程度需要进一步研究。文献显示,人群中哮喘和过敏性气道疾病的严重程度存在性别差异。这些发现指出了这种差异的潜在荷尔蒙原因,但是没有研究表明性别在CRS伴鼻息肉(CRSwNP)中的作用。这项研究的目的是研究美国性别与CRSwNP严重程度的关系。
    方法:本研究基于OPTINOSE数据库中的NAVIGATEI和NAVIGATEII随机对照试验的181名参与者收集的数据进行。参与者根据气道相关合并症的性别控制进行分析,包括哮喘病史,种族,和种族。SNOT-22评分被评估为CRS的生活质量结果指标。使用多元线性回归确定性别与SNOT-22评分之间的关联。
    结果:有81名女性和100名男性参与者。女性的SNOT-22得分明显较高。女性报告的SNOT-22平均得分为53.8±16.5,男性为46.8±18.8。在调整后的回归中,性别与SNOT-22评分的相关性接近但未达到显著性(β:-4.97;95%CI:-10.68-0.73;p=0.09)。
    结论:平均而言,与男性相比,女性的CRSwNP表现更严重,调整后的关联接近统计意义。进一步研究,可能将激素视为发病机理的原因,需要更好地阐明性别在CRSwNP中的作用。
    OBJECTIVE: Chronic rhinosinusitis (CRS) is a widely prevalent condition, however its degree of severity according to sex requires further study. The literature shows that sex-based differences exist in the severity of asthma and allergic airway disease in the population. These findings point to a potential hormonal cause for this difference, but there is no study suggesting the role of sex in CRS with nasal polyps (CRSwNP). The purpose of this study was to examine the association of sex and CRSwNP severity in the United States.
    METHODS: This study was conducted on data gathered from 181 participants in the NAVIGATE I and NAVIGATE II randomized control trials within the OPTINOSE database. Participants were analyzed based on sex controlling for airway-related comorbidities, including history of asthma, race, and ethnicity. SNOT-22 scores were assessed as a quality-of-life outcome measure for CRS. The association between sex and SNOT-22 scores was determined using multiple linear regression.
    RESULTS: There were 81 female and 100 male participants. SNOT-22 scores were significantly higher in females. The average reported SNOT-22 score was 53.8 ± 16.5 in females and 46.8 ± 18.8 in males. On adjusted regression, the association of sex and SNOT-22 scores approached but didn\'t reach significance (β: -4.97; 95 % CI: -10.68-0.73; p = 0.09).
    CONCLUSIONS: On average, females had more severe manifestations of CRSwNP in comparison to males, with the adjusted association approaching statistical significance. Further studies, potentially looking at hormones as a cause of pathogenesis, are needed to better elucidate the role of sex in CRSwNP.
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  • 文章类型: Case Reports
    急性侵袭性真菌性鼻窦炎(AIFS)通常表现为侵袭性真菌感染,可在免疫受损患者的鼻窦中传播。尽管有AIFS在免疫能力方面的报道,非糖尿病患者,这是非常罕见的,其背后的真正机制是未知的。三十八岁有免疫能力,非糖尿病女性在三级护理中心接受了慢性鼻-鼻窦炎伴鼻息肉的双侧ESS,并在术后进行了AIFS.患者接受了简单的ESS,用含有曲安奈德的泡沫填充,并在类固醇冲洗剂和泼尼松锥度上排出。手术病理显示左侧定植,具有与霉菌瘤一致的非侵袭性真菌成分。她在术后第11天出现头痛和左侧眶后疼痛。她左鼻腔的培养物生长了根霉,MRI显示有证据表明左蝶骨粘膜有侵袭性真菌感染,左眼眶以眼尖为中心的炎症变化。她开始使用两性霉素,并进行了左侧清创术,并进行了活检,证实了血管侵袭性真菌病。她的左眼视力恶化至20/800,并接受了经皮球后注射两性霉素B治疗。经过稳定的间隔成像后,她长期服用抗真菌剂。广泛的免疫检查并不显著。我们描述了一个有免疫能力的患者,该患者在CRS鼻窦手术后发展为AIFS,并且可能是局部免疫抑制和手术后创伤的结果。喉镜,2024.
    Acute invasive fungal sinusitis (AIFS) classically presents as an aggressive fungal infection that can spread beyond its origin in the sinuses in immunocompromised patients. Although there have been reports of AIFS in immunocompetent, non-diabetic patients, it is extremely rare and the true mechanism behind it is unknown. A thirty-eight year old immunocompetent, non-diabetic woman underwent bilateral ESS for chronic rhinosinusitis with nasal polyps at a tertiary care center and post-operatively developed AIFS. Patient underwent uncomplicated ESS, was packed with foam containing triamcinolone and discharged on steroid rinses and a prednisone taper. Surgical pathology demonstrated left-sided colonization with non-invasive fungal elements consistent with a mycetoma. She presented on post-operative Day 11 with headache and left-sided retro-orbital pain. A culture of her left nasal cavity grew Rhizopus spp and MRI demonstrated evidence of invasive fungal infection of left sphenoid mucosa as well as inflammatory changes in the left orbit centered at the orbital apex. She was started on amphotericin and underwent a left-sided debridement with biopsies which demonstrated angioinvasive fungal disease. Her vision in her left eye worsened to 20/800 and she was treated with transcutaneous retrobulbar injection of amphotericin B. After stable interval imaging she was discharged on a long-term course of antifungals. Extensive immunologic work-up was unremarkable. We describe a case of an immunocompetent patient who developed AIFS after sinus surgery for CRS and a mycetoma likely as a result of local immune suppression and post-surgical trauma. Laryngoscope, 2024.
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  • 文章类型: Journal Article
    目的:鼻内镜下内侧上颌窦炎(EMM)是一种有效的干预措施,适用于既往中肠吻合后的顽固性上颌窦炎患者。难治性上颌窦炎的病理生理学尚未完全了解。我们旨在确定结构化组织病理学(SHP)的趋势,以更好地了解组织结构变化如何导致难治性鼻窦炎和粘液纤毛清除受损。
    方法:包括所有接受EMM或标准上颌窦造口术治疗各种形式的顽固性上颌窦炎的患者。进行回顾性图表审查以收集人口统计信息,疾病特征,合并症条件,文化数据,和SHP报告。对SHP变量进行卡方和逻辑回归分析。
    结果:纳入了41例接受EMM的患者和464例接受上颌吻合的患者。平均而言,EMM队列年龄更大10岁(60.9岁vs.51.1年;p=0.001),并且更经常有既往鼻窦手术史(73.2%vs.40.9%;p<0.001)。EMM患者的纤维化发生率较高(34.1%vs.15.1%,p=0.002),在控制之前的鼻窦手术和鼻息肉病时,这仍然具有统计学意义(p=0.001)。铜绿假单胞菌阳性培养物(38.2%vs.5.6%,p<0.001)和凝固酶阴性葡萄球菌(47.1%vs.23.5%,p=0.003)在EMM组中更为普遍。
    结论:在需要EMM的患者中,假单胞菌和凝固酶阴性葡萄球菌的纤维化和细菌感染更为普遍。这可能导致顽固性上颌窦炎患者粘液纤毛清除受损的多因素病因。
    方法:3喉镜,2024.
    OBJECTIVE: Endoscopic medial maxillectomy (EMM) is an effective intervention for patients with recalcitrant maxillary sinusitis after previous middle meatal antrostomy. The pathophysiology of refractory maxillary sinusitis is incompletely understood. We aim to identify trends in structured histopathology (SHP) to better understand how tissue architecture changes contribute to refractory sinusitis and impaired mucociliary clearance.
    METHODS: All patients who underwent EMM or standard maxillary antrostomy for recalcitrant maxillary sinusitis of various forms were included. Retrospective chart review was conducted to collect information on demographics, disease characteristics, comorbid conditions, culture data, and SHP reports. Chi-squared and logistic regression analyses were performed for SHP variables.
    RESULTS: Forty-one patients who underwent EMM and 464 patients who underwent maxillary antrostomy were included. On average, the EMM cohort was 10 years older (60.9 years vs. 51.1 years; p = 0.001) and more often had a history of prior sinus procedures (73.2% vs. 40.9%; p < 0.001). EMM patients had higher rates of fibrosis (34.1% vs. 15.1%, p = 0.002), and this remained statistically significant when controlling for prior sinus procedures and nasal polyposis (p = 0.001). Cultures positive for pseudomonas aeruginosa (38.2% vs. 5.6%, p < 0.001) and coagulase negative staphylococcus (47.1% vs. 23.5%, p = 0.003) were more prevalent in the EMM group.
    CONCLUSIONS: Fibrosis and bacterial infections with Pseudomonas and coagulase negative Staphylococcus were more prevalent in patients requiring EMM. This may contribute to the multifactorial etiology of impaired mucociliary clearance in patients with recalcitrant maxillary sinusitis.
    METHODS: 3 Laryngoscope, 134:2646-2652, 2024.
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  • 文章类型: Journal Article
    目的:结构化组织病理学(SHP)是一种分析鼻窦组织以表征慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)的内型的方法。过敏性真菌性鼻-鼻窦炎(AFRS)与CRSwNP的某些内型共有几个特征。我们的目的是比较AFRS和嗜酸性粒细胞CRSwNP的组织病理学,以进一步了解它们是否完全是单独的内生型或疾病实体。
    方法:对接受内窥镜鼻窦手术的AFRS和CRSwNP患者进行回顾性回顾。收集了人口统计数据,合并症,主观和客观严重程度评分,和13个变量SHP报告。包括每个高倍视野(eCRSwNP)>10个嗜酸性粒细胞的CRSwNP患者。采用卡方检验和t检验进行统计分析。
    结果:共确定了29例AFRS和108例eCRSwNP患者。AFRS患者更年轻,更常见的是黑人。症状严重程度评分(SNOT-22,Lund-MacKay,和Lund-Kennedy)在小组之间是统一的。AFRS患者的Charcot-Leyden晶体发生率较高(41.4%vs.10.2%;p<0.001)。严重程度的炎症,嗜酸性粒细胞炎症占优势,嗜酸性粒细胞聚集体,上皮下水肿,基底膜增厚在两组中都很常见,两组之间的比率无统计学差异。化生,溃疡,纤维化,增生/乳头状改变率低(<30%),组间相似。
    结论:eCRSwNP和AFRS的SHP高度一致,这表明AFRS总体上是CRSwNP的严重亚型,而不是单独的疾病实体。这也为AFRS属于CRSwNP的内生谱提供了依据。
    方法:3喉镜,2023年。
    OBJECTIVE: Structured histopathology (SHP) is a method of analyzing sinonasal tissue to characterize endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP). Allergic fungal rhinosinusitis (AFRS) shares several features with certain endotypes of CRSwNP. Our objective was to compare the histopathology of AFRS and eosinophilic CRSwNP to further understand whether they are separate endotypes or disease entities altogether.
    METHODS: A retrospective review of AFRS and CRSwNP patients undergoing endoscopic sinus surgery was performed. Data were collected on demographics, comorbidities, subjective and objective severity scores, and 13-variable SHP reports. CRSwNP patients with >10 eosinophils per high-power field (eCRSwNP) were included. Chi-squared and t-tests were used for statistical analysis.
    RESULTS: A total of 29 AFRS and 108 eCRSwNP patients were identified. AFRS patients were younger and more often Black. Symptom severity scores (SNOT-22, Lund-MacKay, and Lund-Kennedy) were uniform between groups. AFRS patients had a higher rate of Charcot-Leyden crystals (41.4% vs. 10.2%; p < 0.001). Severe degree of inflammation, eosinophilic inflammatory predominance, eosinophil aggregates, subepithelial edema, and basement membrane thickening were common in both groups, and their rates were not statistically significantly different between groups. Metaplasia, ulceration, fibrosis, and hyperplastic/papillary change rates were low (<30%) and similar between groups.
    CONCLUSIONS: The SHP of eCRSwNP and AFRS are highly consistent, which suggests AFRS is a severe subtype of CRSwNP overall rather than a separate disease entity. This also lends credence to AFRS belonging on the endotypic spectrum of CRSwNP.
    METHODS: 3 Laryngoscope, 134:2617-2621, 2024.
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  • 文章类型: Case Reports
    鼻窦淋巴瘤是一种罕见的临床实体。三种主要亚型表现出不同的临床模式和治疗结果。我们报告了第一例B细胞淋巴瘤患者,没有任何鼻腔手术史,外伤或吸毒,他给我们中心做了鼻中隔穿孔.喉镜,133:2871-2873,2023年。
    Sinonasal lymphoma is a rare clinical entity. Three main subtypes exhibit different clinical patterns and treatment outcomes. We report the first case of a B-cell lymphoma in a patient without any previous history of nasal surgery, trauma or drug use, who presented to our center with a nasal septal perforation. Laryngoscope, 133:2871-2873, 2023.
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  • 文章类型: Journal Article
    UNASSIGNED:为了确定鼻内药物治疗(每日鼻内皮质类固醇和/或抗组胺药,和鼻腔盐水冲洗[NSI]),过敏性鼻炎(AR)。
    UNASSIGNED:患者从一个学术三级护理鼻科和变态反应诊所招募。在初次访问后和/或治疗后4-6周进行半结构化访谈。转录访谈使用扎根理论进行了分析,归纳方法阐明有关患者坚持AR治疗的主题。
    未经批准:共有32名患者(12名男性,20名女性;年龄22-78岁)参加了(初次访问时有7名,七个在后续访问中,两者均为18)。内存触发器,例如将鼻腔常规与现有的日常活动或药物联系起来,被患者确定为在初次和随访时对依从性最有帮助的策略。与NSI相关的后勤障碍(凌乱,需要时间,等。)是后续讨论中最常见的概念。患者根据经历的副作用或感知的疗效修改了方案。
    UNASSIGNED:记忆触发有助于患者坚持鼻部常规。与NSI相关的后勤障碍可以阻止使用。医疗保健提供者应在患者咨询期间解决这两个概念。结合这些概念的基于微动的干预措施可能有助于提高对AR治疗的依从性。
    未经评估:2.
    UNASSIGNED: To determine the facilitators of and barriers to adherence to use of intranasal pharmacotherapy (daily intranasal corticosteroids and/or antihistamine, and nasal saline irrigation [NSI]), for allergic rhinitis (AR).
    UNASSIGNED: Patients were recruited from an academic tertiary care rhinology and allergy clinic. Semi-structured interviews were conducted after the initial visit and/or 4-6 weeks following treatment. Transcribed interviews were analyzed using a grounded theory, inductive approach to elucidate themes regarding patient adherence to AR treatment.
    UNASSIGNED: A total of 32 patients (12 male, 20 female; age 22-78) participated (seven at initial visit, seven at follow-up visit, and 18 at both). Memory triggers, such as linking nasal routine to existing daily activities or medications, were identified by patients as the most helpful strategy for adherence at initial and follow-up visits. Logistical obstacles related to NSI (messy, takes time, etc.) was the most common concept discussed at follow-up. Patients modified the regimen based on side effects experienced or perceived efficacy.
    UNASSIGNED: Memory triggers help patients adhere to nasal routines. Logistical obstacles related to NSI can deter from use. Health care providers should address both concepts during patient counseling. Nudge-based interventions that incorporate these concepts may help improve adherence to AR treatment.
    UNASSIGNED: 2.
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  • 文章类型: Journal Article
    目的:鼻窦粘膜上的细菌生物膜,尤其是金黄色葡萄球菌的生物膜,与慢性鼻窦炎(CRS)的严重程度和顽固性有关。很少,如果有的话,适用于鼻腔鼻窦应用的抗生物膜剂可用于解决此问题。Nasodine®鼻喷雾剂(Nasodine)是一种基于0.5%聚维酮碘的制剂,已开发用于鼻窦应用。我们研究了Nasodine的抗生物膜功效,以确定它是否可能是治疗生物膜相关CRS的候选药物。
    方法:使用疾病控制中心生物膜反应器在体外培养金黄色葡萄球菌ATCC6538的生物膜。完整的生物膜通过浸入0.9%盐水(对照)进行处理,半浓度Nasodine,或完全浓度的Nasodine持续5分钟至6小时。将进一步的生物膜细胞分散到悬浮液中,然后处理30秒至5分钟。然后通过培养和计数菌落来计数存活细菌,并将活细菌的log10减少量与对照进行了比较。
    结果:Nasodine显示出时间和浓度依赖性细菌对完整生物膜的杀伤作用。用短暂的5分钟的暴露观察到来自完整生物膜的活细菌的统计学显著减少。Nasodine在1分钟内始终根除分散的生物膜。
    结论:Nasodine在体外对金黄色葡萄球菌ATCC6538的生物膜具有高度活性。完整生物膜结构的存在阻碍了生物膜杀伤。
    背景:在慢性鼻窦炎(CRS)中,被称为生物膜的细菌群落与更严重的炎症有关。一种名为Nasodine的基于碘的鼻喷雾剂在暴露6小时后几乎完全根除了细菌生物膜。Nasodine可用于治疗CRS。喉镜,2023年。
    Bacterial biofilms on the sinonasal mucosa, especially biofilms of Staphylococcus aureus, are associated with greater severity and recalcitrance of chronic rhinosinusitis (CRS). There are few, if any, antibiofilm agents suitable for sinonasal application available for the management of this problem. Nasodine® Nasal Spray (Nasodine) is a 0.5% povidone-iodine-based formulation that has been developed for sinonasal application. We investigated the antibiofilm efficacy of Nasodine to determine whether it may be a candidate for the treatment of biofilm-associated CRS.
    Biofilms of S. aureus ATCC 6538 were grown in vitro using the Centers for Disease Control biofilm reactor. Intact biofilms were treated by immersion in 0.9% saline (control), half concentration Nasodine, or full concentration Nasodine for between 5 min and 6 h. Further biofilm cells were dispersed into suspension then treated for between 30 s and 5 min. Surviving bacteria were then enumerated by culture and counting colonies, and the log10 reduction in viable bacteria was compared with control.
    Nasodine demonstrated time and concentration-dependent bacterial killing against intact biofilm. Statistically significant reductions in viable bacteria from intact biofilms were seen with exposures as brief as 5 min. Nasodine consistently eradicated dispersed biofilm within 1 min.
    Nasodine is highly active against biofilms of S. aureus ATCC 6538 in vitro. Biofilm killing is impeded by the presence of the intact biofilm structure.
    In chronic rhinosinusitis (CRS), bacterial communities called biofilms are associated with more severe inflammation. An iodine-based nasal spray called Nasodine almost completely eradicates bacterial biofilms after 6 h of exposure. Nasodine may be useful for treating CRS. Laryngoscope, 133:2490-2495, 2023.
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  • 文章类型: Journal Article
    目的:描述我们在手术时活动性感染的单侧慢性鼻-鼻窦炎(CRS)患者术后使用抗生素的经验,并评估该人群术后常规抗生素给药的必要性。
    方法:本回顾性图表回顾分析了2013年11月至2019年9月在三级护理中心接受内窥镜鼻窦手术治疗单侧化脓性CRS的所有患者的病历,这些患者未开常规术后抗生素。记录直到窦腔正常化的持续时间以及是否最终为持续性感染体征和症状开了抗生素。分析患者特征和发现以确定任何评估参数是否与术后抗生素的需要相关。
    结果:69名患者被纳入研究。33例(47.8%)在术后期间不需要抗生素。接受抗生素治疗的患者的平均窦性正常化时间为8.1周(1-24周),未接受抗生素治疗的患者为5.7周(1-16周)(P=0.066)。在单变量或多变量分析中,没有评估变量与抗生素使用相关。
    结论:对于本系列中近一半的单侧化脓性CRS患者,术后不需要使用抗生素使感染的窦腔正常化。需要进一步的研究来更好地描述哪些患者将从术后抗生素中受益。
    方法:四级。
    OBJECTIVE: To describe our experience with the use of postoperative antibiotics in the management of unilateral chronic rhinosinusitis (CRS) patients with active infection at the time of surgery, and to evaluate the need for routine postoperative antibiotic administration in this population.
    METHODS: This retrospective chart review analyzed the medical records of all patients who underwent endoscopic sinus surgery for unilateral purulent CRS between November 2013 and September 2019 at a tertiary care center and who were not prescribed routine postoperative antibiotics. Duration of time until normalization of sinus cavities and whether antibiotics were ultimately prescribed for persistent infectious signs and symptoms were recorded. Patient characteristics and findings were analyzed to determine if any of the evaluated parameters were associated with the need for postoperative antibiotics.
    RESULTS: Sixty-nine patients were included in the study. Thirty-three (47.8%) did not require antibiotics during the postoperative period. The average time to sinus normalization was 8.1 weeks (range 1-24 weeks) for patients who received antibiotics and 5.7 weeks (range 1-16 weeks) for those who did not receive antibiotics (P = .066). No evaluated variables were associated with antibiotic use on univariate or multivariate analysis.
    CONCLUSIONS: Postoperative antibiotics were not necessary to normalize infected sinus cavities for nearly half of patients with unilateral purulent CRS in this series. Further studies are needed to better delineate which patients would derive benefit from postoperative antibiotics.
    METHODS: Level IV.
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  • 文章类型: Journal Article
    目的:系统回顾文献以评估适应症,安全,以及DrafIIb手术的疗效,并评估支架和皮瓣等技术因素的附加优势。
    方法:直到2019年7月在Medline和Cochrane数据库上发表的文章。
    方法:在根据2018年PRISMA指南进行系统评价后,1533篇文章中的26篇被纳入并审查了DrafIIb的适应症;手术技术;皮瓣的使用,支架,移植物,或丝裂霉素;手术期间和手术后的并发症;成功率或复发率。
    结果:DrafIIb的主要适应症是慢性额部鼻-鼻窦炎(61.82%)。术后通畅率为87.85%。当应用皮瓣/移植物时,率为93.5%,但它们的附加值没有统计学意义。支架可以是翻修手术的替代方案。治疗除慢性鼻窦炎以外的额叶病变也令人满意。安全性与DrafIII相当:未报告围手术期并发症,术后仅少数(0.2%的病例中有眼睑瘀斑和眶周蜂窝织炎,在1.55%的不足)。
    结论:正确指示时,DrafIIb正面钻孔是一种安全高效的正面病理治疗手术技术,效率和安全性可与DrafIII相媲美,当不需要双边方法时,使其成为有效的选择。需要更多的研究来确认襟翼的附加值,移植物,和支架。
    OBJECTIVE: To systematically review the literature to evaluate the indications, safety, and efficacy of the Draf IIb procedure and to evaluate the added advantages of technical factors such as stents and flaps.
    METHODS: Articles published until July 2019 on Medline and Cochrane databases.
    METHODS: After a systematic review based on the 2018 PRISMA guidelines was conducted, 26 of 1533 articles were included and reviewed for indications of Draf IIb; surgical technique; use of flaps, stents, grafts, or mitomycin; complications during and after surgery; and success or recurrence rate.
    RESULTS: The main indication for Draf IIb was chronic frontal rhinosinusitis (61.82%). The postoperative patency rate was 87.85%. When flaps/grafts were applied, the rate was 93.5%, but their added value was not statistically significant. Stents could be an alternative for revision surgery. Treating frontal pathologies other than chronic rhinosinusitis was also satisfying. Safety was comparable to Draf III: no perioperative complications were reported, only a few postoperative ones (eyelid ecchymosis and periorbital cellulitis in 0.2% of the cases, hyposmia in 1.55%).
    CONCLUSIONS: When properly indicated, Draf IIb frontal drilling is a safe and highly effective surgical technique for frontal pathology treatment, with efficiency and safety comparable to the Draf III, making it a valid option when a bilateral approach is not needed. More studies are required to confirm the added values of flaps, grafts, and stents.
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  • 文章类型: Journal Article
    目的:功能性内窥镜鼻窦手术(FESS)后的疼痛和镇痛需求差异很大。这项研究旨在量化常规FESS后的疼痛,并确定最常用的疼痛管理方案。
    方法:回顾性图表回顾了2017年10月至2019年5月接受FESS的100例患者。患者前瞻性地完成了每日疼痛日记,并报告了分类为无疼痛的疼痛水平(0)。轻度(1-3),中等(4-7),或严重(8-10)。患者被归类为麻醉品,非麻醉品,组合,或没有基于类型的镇痛药使用。
    结果:纳入69例患者。大多数患者在前5个POD期间报告轻度(39%)或无痛(28%)。平均POD1疼痛评分为3.98,随随后的POD而降低。在POD1上,37%使用阿片类药物(n=37),32%使用非阿片类药物(n=32),22%使用组合(n=22),9%没有使用止痛药(n=9)。在任何给定的一天,前5个POD中使用的平均麻醉药数为2粒。年龄与报告的POD1疼痛评分呈负相关(P=.003),术前使用类固醇治疗鼻窦息肉患者与较低的POD1疼痛评分相关(P=.03)。
    结论:即使在POD1上,大多数患者经历了轻度或无疼痛,这随着每个POD而减少。FESS术后患者严重过量使用麻醉药,未充分利用。在FESS之后,我们提倡耳鼻喉科医生更明智的处方习惯,并强调依赖非麻醉剂替代品,如对乙酰氨基酚或NSAIDS,以减少术后期间的麻醉剂使用和滥用。
    方法:4.
    OBJECTIVE: Pain and analgesic requirements after functional endoscopic sinus surgery (FESS) vary widely. This study aims to quantify pain after routine FESS and determine the most commonly used pain management regimen.
    METHODS: Retrospective chart review of 100 patients who underwent FESS from Oct 2017 to May 2019. Patients prospectively completed a daily pain diary and reported pain levels that were categorized into no pain (0), mild (1-3), moderate (4-7), or severe (8-10). Patients were categorized into narcotics, non-narcotics, combination, or none based on type of analgesic used.
    RESULTS: Sixty-nine patients were included. Majority of patients reported either mild (39%) or no pain (28%) during the first 5 PODs. Mean POD1 pain score was 3.98, which decreased with each subsequent POD. On POD1, 37% used opioids (n = 37), 32% used non-opioids (n = 32), 22% used a combination (n = 22), and 9% used no pain meds (n = 9). Mean number of narcotic pills used within the first 5 PODs was 2 pills on any given day. Age was inversely associated with reported POD1 pain scores (P = .003) and use of preoperative steroids in patients with sinonasal polyposis was associated with lower POD1 pain scores (P = .03).
    CONCLUSIONS: Even on POD1, majority of patients experienced either mild or no pain, and this decreases with each POD. Narcotics are grossly overprescribed and underutilized by patients postoperatively after FESS. We advocate for more judicious prescribing habits of narcotics by Otolaryngologists after FESS, and emphasize relying on non-narcotic alternatives like Acetaminophen or NSAIDS to diminish narcotic use and abuse in the postoperative period.
    METHODS: 4.
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