不同鼻腔填塞物用于慢性鼻窦炎鼻内镜术后临床观察

Clinical observation on different nasal cavity waddings used after endoscopic sinus surgery in chronic sinusitis

目的比较凡士林纱布、可溶性止血纱布、医用聚乙烯醇(PVA)绵三种鼻腔填塞方法用于慢性鼻窦炎鼻内镜术后疗效。方法设立凡士林纱布组、可溶性止血纱布组、医用PVA绵组进行对照研究,观察鼻窦炎内镜手术后填塞凡士林纱布、可溶性止血纱布、医用PVA绵三组患者术后4 h疼痛程度,术后48 h取出填塞物后止血效果及并发症。结果术后疼痛情况凡士林纱布组疼痛率为78.57%,可溶性止血纱布组疼痛率为47.62%,医用PVA绵组疼痛率为74.42%,可溶性止血纱布组与凡士林纱布组疼痛率比较,差异有统计学意义(P<0.01),凡士林纱布组与医用PVA绵组疼痛率比较,差异无统计学意义(P>0.05);术后止血效果凡士林纱布组出血率为47.62%,可溶性止血纱布组出血率为52.38%,医用PVA绵组出血率为25.58%,医用PVA绵组与可溶性止血纱布组出血率比较,差异有统计学意义(P<0.01),凡士林纱布组与可溶性止血纱布组出血率比较,差异无统计学意义(P>0.05);三组并发症均很少,症状轻,1个月后复查均恢复。结论术后疼痛可溶性止血纱布优于凡士林纱布和医用PVA绵。术后止血效果医用PVA绵优于凡士林纱布和可溶性止血纱布。综合患者痛苦及经济等多方面因素考虑,可溶性止血纱布止血效果确切、患者痛苦少、无严重并发症,是一种鼻窦术后窦口填塞的理想填塞物。

Objective To compare the curative effects of three kinds of nasal cavity waddings,vaseline gauze, soluble hemostatic gauze and medical PVA cotten,used after endoscopic sinus surgery in chronic sinusitis. Methods The vaseline gauze group ,the soluble hemostatic gauze group and the PVA medical cotton group were established for conducting the case-control study. Postoperative 4 h pain, hemostatic effect after removing nasal cavity wadding at postoperative 48 h and complications were observed in 3 groups. Results The postoperative pain rate was 78.57% in the three groups,47.62% in the soluble hempstatic gauze group and 74.42% in the PVA medical cotton group ,the difference between the soluble hemostatic gauze group and the vaseline gauze group showed statistical significance（P〈0.01 ） and the difference between the vaseline gauze group and the PVA medical cotton group had no statistical significance （P〉0.05）. The postoperative bleeding rate was 47.62% in the vaseline gauze group, 52.38% in the soluble hemostatic gauze group and 25.58% in the PVA medical cotton group, the difference between the PVA medical cotton group and the soluble hemostatic gauze group had statistical significance （P〈0.01）,while the difference between the vaseline gauze group and the soluble hemostatic gauze group had no statistical significance（P〉0.05）. The three groups had rare complications with slight symptoms,which recovered in postoprative 1 month follow up. Conclusion The soluble hemostatic gauze is superior to the vaseline gauze and the medical PVA cotton in postoperative analgesia. But the medical PVA cotton is superior to the vaseline gauze and the soluble hemostatie gauze in postoprative hemostasis. Taking many factors of pa- tient suffering and economic cost into comprehensive consideration,the soluble hemostatic gauze may be an ideal nasal cavity wadding with definite hemostasis effect,less pain and without severe complications after endoscopic sinus surgery.