鼻窦术后不同体位局部给药对额窦内药物滞留量影响的分析

Influence of head position on postoperative frontal sinus drug deposition

摘要:

目的通过对尸头标本鼻窦解剖及鼻内给药体位试验，分析额窦开放术后的最佳给药体位。方法新鲜尸头标本4个，均开放上颌窦、筛窦、蝶窦和额窦，使用荧光素钠溶液模拟糖皮质激素混悬液，分别在头正中位（upright）、头后伸位（mygind）和头低前倾位（praying to mecca）3个头位的情况下灌注荧光素钠溶液1 ml，观察3种给药体位下额隐窝及额窦内荧光素钠溶液聚集情况，分别评估3种体位荧光素钠溶液在额窦和额隐窝的浓度积分，并进行统计学分析。结果头正中位灌注荧光素钠溶液时溶液几乎完全无法到达额隐窝及额窦区域，头后伸位和头低前倾位两种体位下，荧光素钠溶液在额隐窝区域的量差别无统计学意义（P>0.05），而在额窦区域，头低前倾位时溶液的聚集量更大。结论头后伸位和头低前倾位是额窦开放术后鼻腔内局部应用糖皮质激素的合适给药体位，头低前倾位效果更佳。

关键词:慢性鼻－鼻窦炎|额窦|额隐窝|头位

Abstract:

ObjectiveTo evaluate the influence of various head positions on postoperative frontal sinus drug deposition.MethodsFull house surgery was performed in 4 fresh frozen cadaver heads. The glucocorticoid suspension was simulated by fluorescein sodium solution. One milliliter of fluorescein solution was dropped into the nasal sinuses in three different head positions respectively, and the fluorescein deposition was evaluated. The three head positions included head upright position, Mygind's position and prayingtoMecca position.ResultsThe fluorescein deposition was almost absent in upright head position. There was no difference of fluorescein concentration in frontal recess between Mygind' and prayingtoMecca head positions (P>0.05). In the frontal sinus, the concentration of fluorescein in prayingtoMecca head position was higher than that in Mygind's position.ConclusionThe Mygind's and the prayingtoMecca head positions are the optimal head positions regarding the delivery of topical medications to frontal recess, and the prayingtoMecca head position is the best.

Key words:Rhinosinusitis| chronic|Frontal sinus| Frontal recess|Head position