中国实用儿科杂志

中国实用儿科杂志

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药物联合鼻腔分泌物吸引治疗Ⅲ度腺样体肥大132例临床分析

  

  1. 1.福建医科大学附属福州儿童医院/福建省福州儿童医院耳鼻咽喉科，福建  福州  350005；2.国家儿童医学中心  复旦大学附属儿科医院耳鼻咽喉头颈外科，上海  200032
  • 出版日期:2021-08-06 发布日期:2021-09-09

Clinical analysis of drugs combined with nasal secretion suction in the treatment of adenoid hypertrophy of grade Ⅲ

  1. Department of Otolaryngology，Fuzhou Children’s Hospital of Fujian Province，Fuzhou  350005，China
  • Online:2021-08-06 Published:2021-09-09

摘要： 目的　探讨鼻用糖皮质激素、口服孟鲁司特联合鼻腔分泌物吸引治疗儿童Ⅲ度腺样体肥大的近期和远期疗效。方法　选择2017年6月至2019年12月间福建医科大学附属福州儿童医院/福建省福州儿童医院耳鼻咽喉科以电子鼻咽镜检查确诊的Ⅲ度腺样体肥大患儿132例，根据年龄分为两组，3～6岁为A组（低龄组），7～14岁为B组（高龄组），每组再随机分成2个亚组：A1、B1组（治疗组）采用鼻用糖皮质激素、口服孟鲁司特联合鼻腔分泌物吸引治疗，A2、B2组（对照组）仅采用鼻用糖皮质激素联合口服孟鲁司特治疗。各组均于治疗前、治疗3个月、12个月以视觉模拟量表（VAS）和电子鼻咽镜检查进行评估。结果　治疗组与对照组疗效比较：治疗3个月、12个月时，VAS症状评分及腺样体大小改变情况，A1组均优于A2组，B1组均优于B2组（P＜0.05）。低龄组与高龄组疗效比较：VAS症状评分方面，治疗3个月时A1组与B1组差异无统计学意义（P＞0.05），但于治疗12个月时B1组优于A1组（P＜0.05），而治疗3个月、12个月时B2组均优于A2组；腺样体大小改变情况方面，治疗3个月时，A1组与B1组、A2组与B2组，疗效差异均无统计学意义（P＞0.05），但在治疗12个月时，B1组优于A1组，B2组优于A2组（P＜0.05）。结论　鼻用糖皮质激素、口服孟鲁司特联合鼻腔分泌物吸引治疗儿童Ⅲ度腺样体肥大的近期疗效显著，但远期疗效因年龄差异而不同，7～14岁患儿疗效明显，可避免手术；而3～6岁患儿病情易反复，甚至腺样体继续增大，建议手术治疗，或作为该年龄段患儿手术禁忌期的暂时性治疗。

关键词: 腺样体肥大Ⅲ度, 儿童, 鼻用糖皮质激素, 鼻腔分泌物吸引

Abstract: Objective　To investigate the short-term and long-term efficacy of intranasal steroids and oral montelukast combined with nasal secretion suction in the treatment for children with adenoid hypertrophy of grade Ⅲ. Methods　A total of 132 children with adenoid hypertrophy of grade Ⅲ by electron-nasopharyngolaryngoscope from June 2017 to December 2019 were enrolled. They were divided into group A（3-6 years old） and group B（7-14 years old） by age and each group was randomly divided into two subgroups：A1 and B1 groups（treatment groups） were treated with intranasal steroids and oral montelukast combined with nasal secretion suction，while A2 and B2 groups（control groups） were only treated with intranasal steroids combined with oral montelukast. VAS symptom score and electronic nasopharyngoscopy were used to make asessments before treatment，3 months and 12 months after treatment. Results　The comparison of efficacy between the treatment groups and the control groups: in terms of VAS symptom score and adenoid size change，at 3 and 12 months after treatment，group A1 was better than group A2 and group B1 was better than group B2（P＜0.05）. The comparison of efficacy between younger groups and older groups：in terms of VAS symptom score，at 3 months after treatment，there was no significant difference between group A1 and group B1（P＞0.05），but at 12 months after treatment group B1 was better than group A1（P＜0.05），while group B2 was better than group A2 at 3 months and 12 months after treatment（P＜0.05）；in terms of adenoid size change，at 3 months after treatment，there was no significant difference between group A1 and group B1 or between group A2 and group B2（P＞0.05），but after 12 months of treatment，group B1 was better than group A1，and group B2 was better than group A2（P＜0.05）. Conclusion　Intranasal steroids and oral montelukast combined with nasal secretion suction in the treatment of children with adenoid hypertrophy of grade Ⅲ has a significant short-term efficacy，but the long-term efficacy varies by age，which is significant in children at 7-14 years old，reducing the need for surgery. The disease is likely to relapse in the children aged 3 to 6 years，and the adenoid hypertrophy keeps getting severe，so it is suggested to perform surgery，or it can be as a temporary treatment for children with operative contraindications.

Key words: adenoid hypertrophy of grade Ⅲ, child, intranasal steroids, nasal secretion suction therapy