一、結論
1. 本研究證實了 RSOM-31 確實為一簡便且有效評估慢性鼻竇 炎患者生活品質的工具，且中文版問卷之信度與英文版一樣 皆高於0.9 以上，因此建議可以作為慢性鼻竇炎治療介入的 療效評估工具，同時可作為醫療工作者之決策參考。另外，
RSOM-31 之使用相當簡便，回答時間亦很簡短，可於門診 間即可完成，因此可作為經常性的監測工具，一來可簡便評 估患者之治療成效，再者大量收集的資料亦能作為日後研究 的比較與參考。
2. 慢性鼻竇炎影響患者之生活品質確實是多方面的，尤以睡眠 及情緒上的影響最為嚴重。
3. 本研究收案之慢性鼻竇炎患者，其治療前鼻腔內之黴菌培養 率平均約為75.6%。
4. 本研究證實，在鼻沖洗液中加入 amphotericin B 沖洗鼻腔之 治療方法，確實為一安全且有效治療慢性鼻竇炎的方式，且 比單純使用生理食鹽水沖洗鼻腔，更能提升慢性鼻竇炎患者 之生活品質進步。
5. 不論實驗組或控制組，在沖洗治療一個月後，其臨床指標，
包括內視鏡疾病嚴重度及鼻腔內黴菌培養率，均無明顯變 化。
6. 由於本實驗只探討臨床療效部分，故從本研究結果並無法有 效推論或解釋黴菌在慢性鼻竇炎中之真正角色及致病機轉。
二、建議
1. 本研究雖然證實利用抗黴菌藥物 amphotericin B 沖洗鼻腔確 實為一安全且有效治療慢性鼻竇炎的方法，建議若其他治療 方式無效之慢性鼻竇炎患者，可嘗試利用amphotericin B 之 鼻沖洗液加以治療，但依目前本研究調配之治療濃度，其長 期累計之費用似乎過高，較不符成本效益，目前並不建議一 般慢性鼻竇炎患者常規使用。
2. 本研究證實，單純利用生理食鹽水沖洗鼻腔之方式（控制 組），不僅可作為治療慢性鼻竇炎之輔助療法，且單純使用 亦可增進患者之生活品質進步，對於不適合手術或不願接受 其他藥物治療的病患，可建議作為主要治療方式。
3. 雖然慢性鼻竇炎之真正致病機轉及黴菌的角色尚未完全釐 清，但由本實驗結果證實，抗黴菌藥物確實可有效治療病人
之症狀，建議臨床工作者及後續研究者可針對更基礎之分子 生物學及病理生理學，對慢性鼻竇炎及黴菌相關之致病機轉 加以深入研究，以早日釐清兩者之相關性。另外，亦可嘗試 不同濃度及途徑之抗黴菌藥物治療，以期達到臨床療效之餘
並能盡量減低治療成本。
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附錄一 英文版 RSOM-31
ID:
RHINOSINUSITIS OUTCOME MEASURE PRE-TREATMENT
Below you will find a list of symptoms, functional limitations, and emotional consequences of your rhinosinusitis. We would like to know more about these problems and would appreciate your answering the following questions to the best of your ability. There are no “right” or “wrong” answers, and only you can provide us with this information. Please rate your problems as they have been over the past two weeks. Thank you for your participation. Do not hesitate to ask our research assistant or other office staff members for assistance if necessary.Listed after the symptoms, functional limitations, and emotional consequences are two columns labeled Magnitude and Importance. Please refer to the following instructions and scales provided below to answer these questions.
Magnitude Scale Importance Scale
Sleep
25. Inconvenience of having to
Carry tissues/ handkerchief... ...0 1 2 3 4 5 ...1 2 3 4 26. Need to rub nose/eyes... ...0 1 2 3 4 5 ...1 2 3 4 27. Need to blow your nose
Repeatedly... ...0 1 2 3 4 5 ...1 2 3 4 28. Bad breath... ...0 1 2 3 4 5 ...1 2 3 4 Emotional Consequences
29. Frustrated, impatient, restless
Or irritable... ...0 1 2 3 4 5 ...1 2 3 4 30. Feeling depressed or sad... ...0 1 2 3 4 5 ...1 2 3 4 31. Embarrassed by your symptoms... ...0 1 2 3 4 5 ...1 2 3 4
Please feel free to add any additional comments below. Thank you for you participation.
ADDITIONAL COMMENTS:
附錄二 中文版 RSOM-31
11.眼睛腫脹、痠痛 0 1 2 3 4 5 1 2 3 4
作者簡傳
姓名：林 子 凱 性 別：男
生日：1972 年 01 月 11 日
學歷：中國醫藥大學醫務管理研究所碩士班（2004~2006 ）
中國醫藥大學醫學系畢業（1990-1997）
現職：嘉義榮民醫院耳鼻喉科主任 2005.10-迄今
嘉義榮民醫院耳鼻喉科主治醫師 2004.07-迄今
經歷：台大醫院實習醫師 1996.07-1997.06
海軍總部督察長室少尉軍醫官 1997.10-1999.06
台中榮民總醫院耳鼻喉部住院醫師及總醫師 1999.07-2003.06
台中榮民總醫院耳鼻喉部臨床研究員 2003.07-2004.06
國防大學國防醫學院臨床講師 2000.07-2005.07
參與學會：台灣醫學會
中華民國耳鼻喉科醫學會
台灣顏面整形重建外科醫學會