鼻中隔鼻成形术及其与健康结局的相关性：一项关于功能与心理社会结局的前瞻性队列研究

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中文摘要

背景： 鼻中隔鼻成形术通常用于解决功能性鼻阻塞和美学问题。虽然功能结局已得到充分证实，但功能改善与心理社会健康之间的关系仍不完全清楚。
方法： 开展了一项前瞻性观察性队列研究，纳入150例连续符合条件并同意接受鼻中隔鼻成形术的成年患者，手术在一家三级转诊中心进行。使用鼻阻塞症状评估（NOSE）量表、压力评估问卷以及世界卫生组织生活质量工具（WHOQOL-BREF）在术前和术后6个月评估患者报告结局。采用Wilcoxon符号秩检验分析评分变化，并使用Spearman秩相关系数评估功能结局与心理社会结局之间的关联。
结果： 所有患者均完成了随访。平均NOSE评分从67.4 ± 18.2显著改善至21.6 ± 16.9（p < 0.001），平均降低45.8分，超过了既定的临床相关性阈值。约82%的患者实现了具有临床意义的改善。在大多数情绪和社会领域观察到感知压力显著降低（p < 0.05），而认知领域未见显著变化。WHOQOL-BREF分析显示，在生理、心理和社会领域有显著改善（p < 0.001），效应量为中到大，而环境领域变化极小。NOSE评分改善与心理生活质量结局之间观察到中等程度关联（r = 0.50，p < 0.05）。
结论： 鼻中隔鼻成形术与6个月时鼻阻塞及多项心理社会结局的显著改善相关。功能改善与心理幸福感增强呈中等程度关联。这些发现应被解释为关联而非因果关系，因为观察性设计无法完全控制潜在混杂因素，包括基线心理社会状态、手术指征、患者期望、美学满意度以及手术特异性因素。

英文摘要

BACKGROUND: Septorhinoplasty is commonly performed to address functional nasal obstruction and aesthetic concerns. While functional outcomes are well established, the relationship between functional improvement and psychosocial well-being remains incompletely understood.
METHODS: A prospective observational cohort study was conducted including 150 consecutive eligible and consenting adult patients undergoing septorhinoplasty at a tertiary referral centre. Patient-reported outcomes were assessed preoperatively and at 6 months postoperatively using the Nasal Obstruction Symptom Evaluation (NOSE) scale, a stress assessment questionnaire, and the World Health Organization Quality of Life instrument (WHOQOL-BREF). Changes in scores were analysed using the Wilcoxon signed-rank test, and associations between functional and psychosocial outcomes were assessed using Spearman's rank correlation coefficient.
RESULTS: All patients completed follow-up. The mean NOSE score improved significantly from 67.4 ± 18.2 to 21.6 ± 16.9 (p < 0.001), representing a mean reduction of 45.8 points that exceeded established thresholds for clinical relevance. Approximately 82% of patients achieved clinically meaningful improvement. Significant reductions in perceived stress were observed across most emotional and social domains (p < 0.05), while cognitive domains showed no significant change. WHOQOL-BREF analysis demonstrated significant improvements in the physical, psychological, and social domains (p < 0.001), with moderate-to-large effect sizes, whereas the environmental domain showed minimal change. A moderate association was observed between improvement in NOSE scores and psychological quality-of-life outcomes (r = 0.50, p < 0.05).
CONCLUSIONS: Septorhinoplasty was associated with significant improvements in nasal obstruction and multiple psychosocial outcomes at 6 months. Functional improvement was moderately associated with enhanced psychological well-being. These findings should be interpreted as associations rather than causal effects, because the observational design could not fully control for potential confounders, including baseline psychosocial status, surgical indication, patient expectations, aesthetic satisfaction, and procedure-specific factors.