射频消融治疗药物性鼻炎患者的下鼻甲肥大

文献信息

中文摘要

目的： 鼻气道阻塞常与下鼻甲肥大（ITH）相关，通常源于慢性炎症。药物性鼻炎（RM）是一种非过敏性鼻炎，常与长期使用鼻减充血剂有关。我们研究了射频消融辅助下鼻甲减容术（RFATR）作为RM的二线诊室治疗，重点关注其对停用减充血剂喷雾和生活质量（QoL）的影响。
方法： 在一家三级大学附属医疗中心进行的前瞻性队列研究。连续纳入因鼻气道阻塞和下鼻甲肥大（ITH）而接受下鼻甲射频消融术（RFATR）的成年患者。患者被分为两组：患有药物性鼻炎（RM）的患者和无RM的患者。主要结局指标为停止滥用鼻减充血剂、围手术期并发症以及患者报告的生活质量（QoL）问卷反应。
结果： 2016年3月至2023年3月期间在我们医疗中心接受RFA的256名患者中，有53名被诊断为患有RM。RM患者的平均年龄高于非RM患者，且合并症更多。与非RM患者相比，RM患者在RFATR术后He-NOSE问卷中取得了显著改善（术前和术后评分差异分别为11.9±5.8 vs. 5.7±6，p=0.002）。所有RM患者在RFATR后均停止了减充血剂喷雾的使用。并发症发生率和翻修需求均较低，组间无显著差异。
结论： RFATR是治疗RM的一种有效且安全的方法，可显著改善患者的生活质量并促进停用减充血剂喷雾。其微创性、易于实施以及与局部麻醉的兼容性使其成为戒除减充血剂喷雾滥用的可行选择，并具有潜在的长期益处。
证据等级： 根据2011年牛津循证医学中心，为3级证据。

英文摘要

OBJECTIVES: Nasal airway obstruction is commonly associated with Inferior Turbinate Hypertrophy (ITH), often stemming from chronic inflammation. Rhinitis Medicamentosa (RM), a type of non-allergic rhinitis, is frequently linked to prolonged use of nasal decongestants. We investigated Radiofrequency Ablation-assisted Turbinate Reduction (RFATR) as a second line in office treatment for RM, focusing upon its impact on decongestant spray cessation and Quality of Life (QoL).
METHODS: A prospective cohort study at a tertiary university-affiliated medical center. Consecutive adult patients with nasal airway obstruction and Inferior Turbinate Hypertrophy (ITH) who underwent Radiofrequency Ablation of the inferior Turbinates (RFATR). Patients were categorized into two groups: those with Rhinitis Medicamentosa (RM) and those without RM. The main outcome measures were cessation of nasal decongestant abuse, perioperative complications, and patient-reported responses to Quality-of-Life (QoL) questionnaires.
RESULTS: Fifty-three of the 256 patients who underwent RFA between March 2016 and March 2023 at our medical center were diagnosed as having RM. RM patients had a higher mean age and more comorbidities than non-RM patients. RM patients achieved significant improvements in He-NOSE questionnaires post-RFATR compared to non-RM patients (pre- and postoperative score difference of 11.9 ± 5.8 vs. 5.7 ± 6, respectively, p = 0.002). All RM patients ceased using decongestant spray use following RFATR. Complication rates and need for revision were low, with no significant group differences.
CONCLUSIONS: RFATR is an effective and safe treatment for RM, significantly improving patients' QoL and facilitating decongestant spray cessation. Its minimal invasiveness, ease of administration, and compatibility with local anaesthesia make it a viable option for ceasing decongestant spray abuse with potential long-term benefits.
LEVEL OF EVIDENCE: Level 3 evidence, according to the Oxford Centre for Evidence-Based Medicine 2011.