4种不同填塞材料在鼻内镜术后填塞疗效中的应用观察

Effects of four different nasal packing materials after endoscopic sinus surgery

目的：探讨4种不同的填塞材料在鼻内镜术后填塞中的应用效果。方法：选取60例临床诊断为慢性鼻-鼻窦炎的患者,术前采用视觉模拟量表（VAS）、Lund-Kennedy鼻内镜检查评分系统、Lund-Mackay鼻窦CT评分系统进行鼻窦病变严重程度的评价,全部患者均行鼻内镜鼻窦手术,术后术腔根据情况分别置入纳西棉（16例）、膨胀海绵（16例）、凡士林纱条（16例）以及膨胀海绵合并凡士林纱条的混合填塞（12例）进行填塞止血,48~72h后取出填塞物,观察不同填塞材料在鼻内镜术后填塞应用中的止血效果,术后12h患者鼻腔胀痛及头痛程度,抽取鼻腔填塞物时的难易程度、患者的疼痛程度及鼻腔黏膜出血情况等,判断疗效。结果：纳西棉组填塞期与抽取时患者痛苦程度最小,抽取时难度小、出血量最少,与其他3组差异有统计学意义（P〈0.05）。膨胀海绵组患者填塞期出血量最多,与其他3组比较差异有统计学意义（P〈0.05）;凡士林纱条组患者填塞期与抽取时疼痛程度最高,与其他3组比较差异有统计学意义（P〈0.05）;膨胀海绵合并凡士林纱条组患者填塞期及抽取时的疼痛程度与膨胀海绵组比较差异无统计学意义（P〉0.05）,鼻腔填塞期出血量、抽取时难易程度及出血量与凡士林纱条组比较差异无统计学意义（P〉0.05）。结论：纳西棉作为一种新型高膨胀可吸收止血绵产品,用于鼻内镜术后术腔填塞具有止血效果好、填塞后鼻腔舒适度高、抽取时出血少等优点,同时实施个性化的不同材料的混合填塞能弥补其单独使用时的各种缺陷且临床效果较好,值得推广应用。

Objective：To investigate effects of four different types of nasal packs after endoscopic sinus surgery.Method：Sixty patients with chronic rhinosinusitis who underwent endoscopic sinus surgery were evaluated preoperatively using visual analog symptom scale,Lund-Kennedy endoscopy scoring scale,and Lund Mackay CT scoring scale.All patients received nasal packing after operative,and divided into four groups based on the nasal packs used：nasopore group（16cases）,merocel group（16cases）,vaseline gauze group（16cases）and merocel with vaseline gauze group（12cases）.All packs were removed 48 to 72hour after the surgery.Clinical effects of four nasal packs were evaluated based on following indexes：pain after twelve hours of nasal packing,bleeding during nasal packing,pain and bleeding during packing removal,difficulty of packing removal.Result：The lowest degree of forementioned five different indexes was found in Nasopore group,and was significantly different with other three groups（P〈0.05）,merocel produced the highest bleeding during nasal packing,which had significant difference with other three groups（P〈0.05）,vaseline gauze produced the highest pain during nasal packing and packing removal,which had significant difference with other three groups（P〈0.05）,merocel combined vaseline gauze had no significant difference with merocel on the pain during nasal packing and packing removal（P〉0.05）,and it had no significant difference with vaseline gauze on bleeding during nasal packing,bleeding upon packing removal and degree of difficulty or ease upon packing removal（P〉0.05）.Conclusion：As a new type of high expansion absorbable nasal packing products applied after FESS,nasopore has the advantages of good hemostatic effect,higher nasal comfort level,least bleeding upon packing removal and so on.At the same time,the implementation of personalized mixed nasal packing of different materials could make up for the various defects when used alone,gained better clinical effect and worthy of clinical popularization and application.