Effect Of Nasal Lavage With Azithromycin Solution On Mucosal Recovery After FESS Operation

Chronic nasal-sinusitis(chronic rhinosinusitis,CRS)is the common diseases of otolaryngology-head and neck surgery,is the sinus and nasal mucosa of chronic inflammation.Main symptoms is stuffy nose,stream sticking pus stuff,head facial pain and hyposmia or lose.The symptoms persists more than 12 weeks,influences the patient's quality of life.The standard drug-treatment is invalid.The endoscopic sinus surgery is preferred.The doctor clean the operative cavity for reducing the cavity adhesion,the formation of vesicles and polyps,maintaining the open-state drainage at sinus-mouth,accelerating the mucosal epithelium.Nasal irrigation can improve the ventilation and drainage of nasal cavity and sinuses,restore the protection function of mucosa.The mode of washing nasal is more in current,there is no unified standard.The large-ring lactone drugs has the effect of anti-inflammatory and immunomodulatory.The treatment of small dose,long-term large-ring drugs for chronic nasal sinusitis(CRS)had been recommended by European nose-sinusitis treatment opinions(EPOS 2007)as A class.But oral medication adherence is poor,patients often withdraw the drug to a slight improvement in symptoms,affecting the treatment effect.We used azithromycin solution for functional endoscopic sinus surgery patients postoperative nasal douche in the study,to find out the ways to promote more effective recovery of mucous membrane.Objective:In the treatment of chronic nasal-sinusitis approach,FESS is dominant,nasal lavage also play its proper synergy.This study was to observe the role of the azithromycin solution nasal lavage in patients with chronic nose sinusitis and the recovery of mucous membrane after FESS surgery,to evaluate its effectiveness,and to improve its ventilation and drainage of the nose,sinuses,to discuss the recovery of nasal sinus mucosa protection function,to improve the cure rate.The action mechanism of sinusitis were discussed,for expanding new approach for the treatment of nasal disease.Methods:We selected 60 patients with chronic snusitis surgery at February 2014 to June 2015 in our hospital by the functional nasal endoscopic surgical treatment,32 patients were male,and 28 patients were female.All enrolled patients are in line with the diagnostic criteria of Chinese medical association otolaryngology branch for chronic nasal sinusitis diagnosis and treatment guidelines(2012,Kunming)in.60 cases were randomly divided into A group(18cases,saline group),group B(20 cases,azithromycin lavage group),group C(22 cases,nasal spray hormone group).Lavaging nasal cavity for 1 month at the third day after operation,6 months of follow-up,we measured the nasal mucociliary transport rate(MTR),detected of eosinophil cationic protein in nasal secretions(ECP)and eosinophil chemotactic factor(eotaxin)concentration,observed the clinical symptoms and signs of improvement in patients,recorded the nasal cavity cleaning time and the epithelization time.Using Lund-Kennedy score,VAS score and SNOT-20 score,we statistically analysed of the recovery of the patients after operation,scientifically evaluated the effect of azithromycin solution nasal lavage for mucosal recovery in patients with chronic nasal-sinusitis.Result:1 The mucociliary transfer rate(MTR)of three groups has no significant difference before lavage(t = 1.25,P>0.05).At 1 month and 3 month after the operation,the group C is optimal,followed by group B,group A(t = 8.65,7.45,P<0.05,with significant difference).2 ECP concentrations of patients at 2,4,6,8,10 and 12 weeks after the operation is the most optimal in group C,followed by group B,group A(t = 4.23,5.11,6.28,7.43,8.66,9.01,P<0.05,with significant difference).The eotaxin concentration of patients at 2,4,6,8,10 and 12 weeks after the operation is the most optimal in group C,followed by group B,group A(t = 3.23,5.89,7.44,8.11,8.67,9.34,P<0.05,with significant difference).3 The preoperative symptoms of three groups has no significant differences(X2= 1.22,1.32,2.45,2.11,P>0.05).4 The number of clinical symptoms improving cases in the postoperative has significant difference at 1 month after the operation,group C is the most optimal,followed by group B,group A(X2= 5.66,7.12,6.88,9.16,P<0.05).At 3 month after the operation,group C is the most optimal,followed by group B,group A(t=7.11,6.23,6.56,9.21,P<0.05,with significant difference).5 Each group patients were followed up for 6 months Lund-Kennedy score,VAS score,SNOT-20 score more optimal in group C,followed by group B,group A(t = 5.12,6.31,7.56,P<0.05,with significant difference).Conclusion:1 Azithromycin solution nasal lavage can promote mucosal recovery,improve the patients' clinical symptoms and signs in patients after FESS.2 Azithromycin solution nasal lavage can increase nasal mucociliary transport rate of the patients,reduce the concentration of eosinophil cationic protein(ECP)and eosinophil chemotactic factor(eotaxin).