Đang chuẩn bị liên kết để tải về tài liệu:
Sinusitis From Microbiology to Management - part 6

Khi được hệ thống, làm giảm lưu thông của basophil, bạch cầu ái toan, và số lượng đơn nhân 20% của mức bình thường (19). Họ có nhiều hiệu ứng phản ứng viêm trong CRS. Chúng ức chế sự bài tiết của yếu tố tăng trưởng và trung gian của phát triển tế bào viêm | Chronic Rhinosinusitis 223 Corticosteroids are powerful anti-inflammatory agents that affect both the number and function of inflammatory cells. When given systemically they reduce circulation of basophil eosinophil and monocyte counts to 20 of normal 19 . They have multiple effects on the inflammatory response in CRS. They inhibit the secretion of growth factors and mediators of inflammatory cell proliferation the release of arachidonic acid metabolites the accumulation of neutrophils in the affected tissues decrease vascular permeability and thin mucus by inhibiting glycoprotein secretion from submucosal glands 20 . When used in a topical form nasal steroid sprays have been shown to be safe and effective in alleviating the symptoms of allergic rhinitis 21 . Their use in patients with CRS is important in decreasing the size of nasal polyps and diminishing sinomucosal edema 22 . There are no set guidelines for the duration of their use and side effects from long-term use are unknown. Anecdotally patients with allergic rhinitis and nasal polyps use steroid sprays for many years with little side effects. Studies involving the use of oral steroids in the treatment of CRS were not done frequently. These agents represent some of our most effective medications as they have been shown to decrease the size of nasal polyps diminish mucosal edema and promote drainage of obstructed sinus ostia 23 24 . Some patients with significant and recurrent polyps are maintained on a daily dose of systemic steroids. This can be deleterious to the patients overall health because of significant side effects. Prolonged oral steroid use may result in muscle wasting and osteoporosis. Bone density scans should be considered in patients on long-term therapy. Extended use may also result in hypertension redistribution of body fat stores and may even induce long-lasting suppression of ACTH production which can result in anterior pituitary and adrenal cortical atrophy. Because of these harmful .