The Clinical Significance Of Preoperative Pulmonary Function And Fractional Exhaled Nitric Oxide Testing In Patients With Chronic Sinusitis

Objective:To explore the clinical significance of lung function and fractional exhaled nitric oxide in patients with chronic sinusitis with or without polyps who denied bronchial asthma and planned to undergo endoscopic sinus surgery.Methods:One hundred and seventy-one patients with CRS in our hospital were recruited in this study.All patients accepted lung function and fractional exhaled nitric oxide?FeNO?test before surgery:Screening for asthma;Patients with asthma or FeNO abnormalities underwent standardized drug therapy before surgery until lung function was close to normal.All patients were accepted surgery after satisfactory evaluation by respiratory and anesthesiologists;All patients underwent endotracheal intubation combined with anesthesia.Asthma and non-asthmatic patients with abnormal FeNO were treated with penehyclidine hydrochloride or atropine before anesthesia.SPO₂,Ppeak and PETCO₂ were monitored and recorded during surgery.Postoperative symptoms of wheezing,shortness of breath,chest tightness and cough were also observed and recorded after operation.Results:1.Of the 171 patients,105 were patients with chronic sinusitis with nasal polyps?CRSwNP?and 66 with chronic sinusitis without nasal polyps?CRSsNP?.10 cases were diagnosed as bronchial asthma,with a positive rate of 5.85%.9 cases had positive results in bronchodilation test,and one case had negative rate of peak expiratory flow?PEF?improvement of 40.4%.One cases were mild asthma,six cases were moderate asthma,three cases were severe asthma;The average FeNO of 10 patients was 47.7ppb,of which9 patients'FeNO was over 25 ppb;The mean FeNO of 38 cases with normal pulmonary function was over 25 ppb,of which 12 cases'FeNO were over 50ppb;2.The FEV1%and FEF22-75%of CRSwNP were lower than those of CRSsNP,and the difference was statistically significant?P<0.05?.There was no significant difference in FEV1/FVC and PEF between the two groups?P>0.05?.3.One hundred and seventy-one patients successfully completed the operation,whose intraopertive anesthesia monitor showed that SPO₂ were greater than 95%,Ppeak were less than 35cmH₂O,PETCO₂ were greater than 35mmHg;4.Mild dyspnea occurred in a patient diagnosed as asthma the next morning after surgery.The auscultation was scattered in the wheezing sound,and the symptoms were relieved 10 minutes after inhalation of bronchodilator.All patients were discharged smoothly.Conclusion:1.CRS and bronchial asthma often exist at the same time and routinely screen for asthma before surgery should be encouraged.2.Routine screening for lung function and FeNO and standardized perioperative treatment in patients with chronic sinusitis before nasal endoscopy have a preventive effect on acute exacerbation of bronchial asthma.3.Strengthening multidisciplinary cooperation with respiratory and anesthesia has certain clinical value.