膨胀海绵和凡士林油纱条鼻腔填塞治疗鼻出血的随机对比试验

Expansion sponge versus vaseline gauze nasal packing in the treatment of nasal bleeding: A randomized comparative trial

为比较膨胀海绵和凡士林油纱条鼻腔填塞控制鼻出血的效果及组织相容性,将2004-03/2005-06上海中医药大学附属曙光医院耳鼻喉科收治较严重的鼻出血患者50例患者进行随机分组,分别采用膨胀海绵或油纱条进行鼻腔填塞止血处理,观察止血效果及有无鼻腔结硬痂、粘连和溃烂等材料宿主反应。结果显示48例采用填塞方法止血成功,两组各1例患者未能控制出血,最终采用鼻内镜下出血点电凝结合鼻腔藻酸钙辅料微填塞进行止血,在控制严重鼻出血的功效方面两组无差异。4周后鼻内镜下随访,2组均无鼻腔粘连和黏膜糜烂,膨胀海绵组1例、油纱条组3例表现为鼻腔少量结痂。提示膨胀海绵治疗严重鼻出血的效果与油纱条相似,组织相容性好,使用方便、简洁、容易鼻腔插入,对于简单措施不能控制的严重鼻出血,可选膨胀海绵鼻腔填塞来进行治疗。

The aim of this study was to compare the effects and histocompatibility of using the expansion sponge and the vaseline gauze nasal packing in the control of nasal bleeding. Fifty patients with severe epistaxis were enrolled from the Department of Otolaryngology in Shuguang Hospital, Shanghai University of Traditional Chinese Medicine between March 2004 and June 2005. They were divided into two groups at random, and differently treated with the expansion sponge and the vaseline gauze nasal packing for haemostasis. Then haemostasis efficacy and host response, such as scabbing of nasal cavity, adhesion and ulceration, were all observed. Results revealed that, 48 patients achieved successful haemostasis efficacy by the packing. One case failed in each group, then they were healed with electric coagulation plus calcium aiginate micro-packing on the bleeding point under nasal endoscope. No significant difference was found between the two groups in controlling severe nasal bleeding. All patients were followed up by nasal endoscope for 4 weeks, neither nasal adhesion nor mucous erosion was found in two groups. One case in the expansion sponge group and three cases in the vaseline gauze group developed nasal incrustation. It is indicated in this study that when nose bleeding can not be controlled by the simple haemostasis, expansion sponge nasal packing is a good method of haemostasis. Due to the superiority of convenience, concise, easy inserting into nasal cavity and decreasing suffering of the patients, expansion sponge nasal packing is applicable to nasal bleeding.