精准填塞、传统填塞及无填塞在鼻内镜下电凝治疗难治性鼻出血中的临床疗效

Clinical effect of precise packing, traditional packing and no packing in the treatment of refractory epistaxis under nasal endoscopy

目的比较使用精准填塞、传统填塞及无填塞等三种填塞方式在鼻内镜下电凝治疗难治性鼻出血中的临床疗效。方法对150例难治性鼻出血患者行鼻内镜下电凝止血术,随机分精准填塞组、传统填塞组及无填塞组等三组,每组各50例,比较三组术后的临床指标。结果无填塞组、精准填塞组患鼻窦炎、分泌性中耳炎等并发症及疼痛评分分别低于传统填塞组,差异均有统计学意义(P<0.05),无填塞组与精准填塞组之间差异无统计学意义(P>0.05);三组患者鼻腔粘连、一次性治愈率比较,差异均无统计学意义(P>0.05)。无填塞组、精准填塞组患者中伴高血压患者再出血率分别高于传统填塞组,差异均有统计学意义(P<0.05),无填塞组与精准填塞组之间差异无统计学意义(P>0.05)。结论传统填塞给患者造成很大痛苦,电凝止血术后尽量避免传统填塞。精准填塞既不造成患者疼痛,又增加一次性治愈率的保险系数,建议电凝止血后采用明胶海绵行精准填塞。伴有高血压及全身系统疾病的患者再出血率与术后三种填塞方式有关,建议伴高血压的鼻出血患者电凝后一定要行传统鼻腔填塞。

Objective To compare the clinical efficacy of three kinds of packing methods including precise packing, traditional packing and no packing in the treatment of refractory epistaxis under nasal endoscopy. Methods 150 patients with refractory epistaxis underwent endoscopic electrocoagulation hemostasis surgery. The patients were randomly divided into precise packing group; traditional packing group and no stuffing group,with 50 cases in each group.The postoperative clinical indicators between three groups were compared and analyzed. Results The complications including sinusitis and secretory otitis media and pain scores of the no stuffing group and precise packing group were lower than those of the traditional packing group,and the difference was statistically significant （P〈0.05）. There was no signif- icant difference between the non-stuffing group and the precision packing group （P〉0.05）. There was no significant dif- ference in the nasal adhesions and the one-time cure rate in the three groups （P〉0.05）. The rebleeding rate of patients with hypertension in no-packing group and precision-packing group was higher than that in traditional packing group, and the difference was statistically significant （P〈0.05）. There was no significant difference between the no-stuff group and the precision packing group（P〉0.05）. Conclusion Traditional stuffing causes great pain to the patient, and the traditional packing should be avoided after electrocoagulation to the greatest extent. Accurate packing does not cause the patient＇s pain, and increases the insurance coefficient of one-time cure rate, thus the use of gelatin sponge for accurate packing is recommended after electrocoagulation. The rebleeding rate of patients accompanied by high blood pressure and systemic disease is related to the three packing ways after surgery. It is recommended that in epistaxis patients with high blood pressure should undergo the traditional nasal packing after electrocoagulation.