鼻内镜下不同止血填塞材料的选择及生物相容性

Selection and biocompatibility of different hemostatic packing materials in nasal endoscopic surgery

背景:鼻腔填塞是治疗鼻出血和防止鼻腔鼻窦术后出血粘连或再狭窄的重要措施。目前国内外应用的鼻腔填塞材料多种多样,哪一种材料更适合填塞鼻腔,填塞材料能在鼻腔留置多长时间,还没有一个公认的标准。目的:综合分析鼻内镜下术后应用不同止血材料的现状及研究进展,揭示其各自的特点及应用前景。方法:应用计算机检索CNKI和PubMed数据库中1998-01/2008-12关于医用生物敷料的文章,在标题和摘要中以"鼻腔;止血敷料;明胶海绵;纱布;藻酸钙敷料"为检索词进行检索。选择文章内容与创伤修复相关,同一领域文献则选择近期发表或发表在权威杂志文章。初检得到124篇文献,中文82篇,英文42篇,根据纳入标准选择22篇文章进行分析。结果与结论:不同填塞材料各具优点,也各有其局限性。术后应该针对各类鼻腔手术方式,范围、大小,出血性质不同,可根据患者的具体情况,结合不同止血材料的生物学特性,选择不同材料实行混合填塞和重点填塞。如何既能快速固定、有效止血,又可以减轻或避免止血后对鼻腔造成的不利影响,加快伤口愈合、减轻伤痛是鼻腔微创止血和材料填充亟待解决的难题。

BACKGROUND： Nasal packing is the major management to treat epistaxis and to prevent the hemorrhage, adhesion or restenosis in nasal cavity and paranasal sinuses after surgery. The applied nasal packing materials at home and abroad are various; there is no accepted standard concerning which material is more suitable for the nasal packing or how long the indwelling packing material should be retained in the nasal cavity. OBJECTIVE： To comprehensively analysis the present situation and research progression of the applications of different hemostatic materials after nasal endoscopic surgery; to reveal the characteristics and application prospects of each material. METHODS： A computer-based online search of CNKI and PubMed databases （1998-01/2008-12） was performed for the articles related to medical bio-bressing with the key words of ＂nasal cavity＂, ＂hemostatic dressing＂, ＂gelatin sponge＂, ＂gauze＂ and ＂calcium alginate dressing＂ in the titles and abstracts. Articles related to wound healing were selected; as to the identical field, articles published recently or in the authoritative magazines were selected. A total of 124 articles were collected in the initial search, 82 of them were in Chinese while 42 of them were in English. A total of 22 articles were retained according to the inclusion criteria. RESULTS AND CONCLUSION： Different packing materials have their own advantages and limitations. The packing materials for mixed packing and key packing after surgery should be selected based on the operative method, range, size and hemorrhagic property of different nasal cavity surgeries as well as the patient＇s specific situation and the biological characteristics of different hemostatic materials. The difficult problems that need to solve urgently in the hemostasis and material filing of the minimally invasive nasal cavity surgeries are how to fixe quickly and stop bleeding effectively as well as reduce or prevent the adverse effects to the nasal cavity after hemostasis; and how to accelerate wound healing and ease the pain.