瑞纳凝胶对比膨胀海绵用于鼻腔填塞的Meta分析

A Meta-analysis compare rapid rhino with merocel for nasal packing

目的:评价鼻腔填塞材料瑞纳凝胶和膨胀海绵在临床应用时的疗效及不良反应。方法:检索PubMed、EMBASE、Cochrane Library、CBM、CNKI、VIP、万方等数据库,并追查所有纳入研究的参考文献。纳入应用瑞纳凝胶和膨胀海绵作为鼻腔填塞材料的随机对照试验,采用Cochrane评价手册5.1的质量评价标准进行评价,用RevMan5.1软件进行分析数据。结果:最终纳入4个随机对照试验,包括115例患者。Meta分析显示:瑞纳凝胶与膨胀海绵对比,在填塞时引起的疼痛感较轻微[MD=1.37,95%CI(0.13,2.60),P<0.05],在移除时引起的疼痛感亦较轻微[MD=2.88,95%CI(2.34,3.41),P<0.01]。填塞后1h瑞纳凝胶引起的胀痛感较轻微[MD=0.91,95%CI(0.58,1.23),P<0.01],填塞后6h瑞纳凝胶引起的胀痛感亦较轻微[MD=1.15,95%CI(0.75,1.55),P<0.01]。移除瑞纳凝胶时出血量较移除膨胀海绵时少[MD=0.26,95%CI(0.12,0.39),P<0.01],在填塞和移除时瑞纳凝胶均较膨胀海绵容易。而在控制出血的有效率方面,2种材料差异无统计学意义[OR=1.00,95%CI(0.38,2.61),P>0.05]。结论:瑞纳凝胶在应用的时候引起的疼痛感,胀痛感,填塞和移除时引起的出血均较膨胀海绵轻微。在鼻出血和鼻腔术后的应用中可以减轻患者的痛苦和负担,在控制出血的有效率方面,2种材料差异无统计学意义。

Objective： To assess the efficacy and adverse reaction of nasal packing materials Rapid Rhino and Merocel. Method： We searched the database PubMed, EMBASE, Cochrane Library, CBM, CNKI, VIP and WANFANG database on line by computer, and traced the related references. Randomized controlled trials（RCTs） of rapid rhino and merocel as nasal packing materials were included. The quality of the included documents was e- valuated by the criterion of Cochrane handbook 5.1. The coehrane collaboration＇s Revman 5.1 software was used for data analysis. Result： Four RCTs involving 115 patients were identified. Meta-analyses showed that Rapid Rhino produced significantly lower pain and discomfort during insert of pack[MD= 1. 37, 95%CI（0. 13, 2. 60）, P〈0.05], whereas less pain and discomfort during removal of pack [ MD = 2. 88, 95GCI（2. 34, 3.41）,P〈 0. 011. Rapid Rhino associated with a significantly slighter degree of fullness rised after insertion[MD= 1. 15, 95%]CI（0.75, 1.55）, P〈0.011, and the same situation happened after 6 hours[-MD=l. 15, 95%CI（0. 75, 1.55）, P〈0. 01]. Rapid rhino caused to less reactionary bleeding when pack removal[MD=0.26, 95GCI（0.12, 0.39） ,P〈0. 011, rapid rhino was easier for the heahhcare worker during insert and removal. There was no sig- nificant difference between two packs on the efficiency of hemostaticEOR= 1.00, 95 %CI（0. 38,2.61）, P〉0. 051. Conclusion：The application of Rapid Rhino causeed less pain and fullness, leadedto slighter bleed than Merocel when insertion and removal. There was no significant difference between two packs on the efficiency of hemostatic when used for epistaxis or after routine nasal surgery.