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指南专题：变应性鼻炎如何诊断与治疗？答案在这里！

2017-03-13 MedSci MedSci原创

变应性鼻炎过敏性鼻炎
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最是一年春好处，阳春三月正是外出春游赏花的好时节。然而，对于过敏性鼻炎的患者来说，却是一年中最无法言说的痛：整日顶着通红的鼻头，不停打着喷嚏，擦着鼻涕，“赏春”变成了“伤春”! 每到现在的这个季节，门诊的过敏性鼻炎患者会激增，大多数患者都是外出时吸入过敏源所导致的季节性过敏性鼻炎。过敏性鼻炎又称变应性鼻炎，它的发生需要同时具备三个条件，即特应性个体(过敏体质的人)、过敏源(主要包括花粉、植物毛絮

最是一年春好处，阳春三月正是外出春游赏花的好时节。然而，对于过敏性鼻炎的患者来说，却是一年中最无法言说的痛：整日顶着通红的鼻头，不停打着喷嚏，擦着鼻涕，“赏春”变成了“伤春”!
每到现在的这个季节，门诊的过敏性鼻炎患者会激增，大多数患者都是外出时吸入过敏源所导致的季节性过敏性鼻炎。过敏性鼻炎又称变应性鼻炎，它的发生需要同时具备三个条件，即特应性个体(过敏体质的人)、过敏源(主要包括花粉、植物毛絮、螨虫、动物皮毛、真菌等)以及两者相遇。

这些不是小编今天分享的重点，重点是如何治疗！
一、药物治疗
1、局部使用糖皮质激素
AGAR2015强烈推荐鼻用糖皮质激素，包括成人与儿童(≥2岁)。
2、抗组胺药
有鼻用和口服两类，适用于轻中度患者，季节性、常年性、一过性的患者均可酌情选择使用。口服一从性较好，起效快还便宜；鼻用的费用较高，味道差、镇静作用明显、需用剂量大、致鼻出血等局部不良反应的缺点，5岁以下儿童禁用！
3、白三烯受体拮抗剂：
由于肺炎高且效果不如抗组胺药，所以临床上不推荐将口服白三烯受体拮抗剂作为治疗过敏性鼻炎的一线用药。
4、肥大细胞膜稳定剂
该类药属于色酮类化合物，包括色甘酸钠、尼多酸钠、四唑色酮、奈多罗米哪、吡嘧司特钾和曲尼司特等。色甘酸钠和曲尼司特临床较常用，对缓解儿童和成人过敏性鼻炎的喷嚏、流涕和鼻痒有一定效果。
5、减充血剂
减充鼻剂为α肾上腺素能受体激动剂，目前常用的药物有0.05%羟甲唑啉和0.05%赛洛唑啉鼻喷剂，可快速缓解鼻塞，但对其他症状无效。减充血剂要严格控制使用次数及疗程，一般每天喷鼻2次，没测1-3喷/次，连续用药不超过7天。
6、抗胆碱药
常用药物为异丙托溴铵，主要用于减少鼻分泌物，对鼻痒、鼻塞、喷嚏无明显效果。0.03%异丙托溴铵每天喷鼻2-3次，每侧1-2喷/次，一般喷鼻后15-30min即可发挥作用，持续时间4-8小时。
7、中药
中草药对改善常年性、持续性的过敏性鼻部症状有效，且安全性良好。目前提倡辨证论治，但循证医学证据尚不充足。
二、鼻腔冲洗
鼻腔盐水冲洗是一种安全、方便、廉价的治疗方法，通常用于鼻腔和鼻窦炎性疾病的辅助治疗。
三、免疫治疗
药物治疗不能有效控制症状，无论是否进行环境控制，均推荐免疫治疗(皮下或舌下)。不足之处在于，费用高、可能发生全身及局部不良反应、处置频率高、疼痛、起效慢，仍利大于弊，并发难治性哮喘者不推荐使用。
四、外科手术
伴有鼻腔阻塞、下鼻甲肥大且药物治疗无效的患者可选择下鼻甲切除术。缺点：手术风险较高。
主要手术方式：
（1）下鼻甲成形术
（2）翼管神经切除术
（3）鼻后神经切断术
参考指南（点击可下载）：
相关视频课程（点击可查看）： 

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    2017-05-12 108807375_62823137

    #专题#

    0

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    2017-07-06 木头人524

    #诊断与治疗#

    0

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    2017-03-21 往日如昨

    鼻腔盐水冲洗是一种安全、方便、廉价的治疗方法，通常用于鼻腔和鼻窦炎性疾病的辅助治疗。

    0

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    2017-03-15 七九九八

    继续努力

    0

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    2017-03-15 fmq_28614553

    #变应性鼻炎#

    0

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    2017-03-14 七九九八

    继续努力，加油加油

    0

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    2017-03-14 刘煜

    学习了谢谢分享

    0

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    2017-03-13 1ddf0692m34(暂无匿称)

    值得学习

    0

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    2017-03-13 Chongyang Zhang

    签到学习了很多。

    0

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