2种鼻腔填塞材料用于鼻腔填塞术后的临床观察

The clinical observation of two kinds of nasal packing materials for postoperative nasal packing

目的观察凡士林纱条和膨胀海绵(Merocel)用于鼻腔填塞术的临床效果。方法将78例鼻腔填塞患者按填塞材料不同分为凡士林纱条组40例和Merocel组38例。2组于24、48h后取出填塞物,评价其疗效。结果凡士林纱条组疼痛率和出血率分别为87.5%和95.0%高于Merocel组的47.4%和50.0%,差异均有统计学意义(P<0.01)。凡土林纱条组术日痰中带血8例,咽干15例,溢泪7例,耳堵塞感2例,纱条自后鼻孔掉入咽腔5例,鼻出血8例。Merocel填塞组需要加凡士林纱条增压才能止血6例,术日痰中带血或前鼻孔少量渗血12例,咽干5例,溢泪3例,耳堵塞感2例,并发鼻中隔血肿4例。术后7d鼻内镜检查凡士林纱条填塞组鼻黏膜擦伤9例(22.5%),肿胀21例(52.5%);Merocel组鼻黏膜擦伤2例(5.2%),肿胀13例(34.2%)。结论凡士林纱条填塞止血效果虽然好,但严重头痛患者难以接受,而且即使48h后取出再出血的机会仍很大。Merocel的疗效较凡士林纱条差,取出后有再出血的可能,但应用范围广且不良反应较少。鼻腔填塞时间不宜过长,应结合患者病情及填塞材料的种类决定。

Objective To observe the clinical evaluation vaseline gauze and Merocel for nasal packing.Methods 78 cases of nasal packing by packing material were divided into vaseline gauze group of 40 cases and Merocel group of 38 cases.24,48 hours after,stuffed out the packong to evaluate its efficacy.Results The pain and bleeding rats of vaseline gauze group were higher than that in Merocel group,the differences were statistically significant（87.5% and 95.0% vs 47.4% and 50.0%,P0.01）.In vaseline gauze group there were 8 cases of bloody sputum,throat in 15 cases,7 cases of epiphora,two cases of ear plug,gauze fall into the pharynx from the postnaris in 5 cases,8 cases of nasal bleeding.Merocel packing group needed to stop bleeding plus vaseline booster in 6 cases,surgery on bloody sputum or a small amount of bleeding from the anterior naris in 12 cases,throat in 5 cases,3 cases of epiphora,two cases of ear plug,septal hematoma in 4 cases.7d after endoscopic nasal examination vaseline gauze group grazed in 9 cases（22.5%）,swelling in 21 cases（52.5%）;Merocel group nasal abrasions in 2 patients（5.2%）,swelling in 13 cases（34.2%）.Conclusion Vaseline gauze to stop bleeding effect is good but difficult to accept patients with severe headache,and even if removed after 48h rebleeding and opportunities.The effective of Merocel is worse than vaseline worse,take out it rebleeding possibility,but it has wide range of applications and fewer adverse reactions.Nasal packing time is not too long,should be combine with patient condition and determine the types of packing materials.