肝病患者鼻内镜术后鼻腔填塞物的选择及疗效

The selection and efficacy of nasal packing after endoscopic sinus surgery in patients with liver disease

目的比较4种填塞材料在肝病患者鼻内镜术后的鼻腔填塞效果,指导临床选择合理的鼻腔填塞物。方法选择凡士林纱条、碘仿纱条、膨胀海绵(Merocel)、SPIGGLE高膨胀止血棉4种填塞物,分别用于4组鼻内镜术后患者。对填塞期和抽取期出血量、填塞期鼻腔舒适度进行比较。结果 SPIGGLE高膨胀止血棉组患者填塞期不适度最小,17.7%的患者出现明显头痛,仅1.5%的患者达+++;碘仿纱条组不适度最高,100%的患者出现明显头痛,81.8%的患者达到+++,4组间差异有统计学意义(P<0.05)。填塞期渗血量,组间差异均有统计学意义(P<0.05),碘仿纱条组和凡士林纱条组出血量明显少于膨胀海绵组及SPIGGLE高膨胀止血棉组。凝血功能异常患者头痛在碘仿纱条组最高,81.8%的患者达到+++。填塞期及抽取期碘仿纱条组出血量最少,均为9.1%达到+++,与其他组比较差异有统计学意义(P<0.05)。结论肝病患者鼻内镜手术时,凝血功能正常患者使用SPIGGLE高膨胀止血棉具有较好的止血效果,有凝血功能异常的肝病患者应选择碘仿纱条。

Objective To compare the nasal packing effect of four kinds of nasal packing materials in endoscopic sinus surgery in patients with liver disease. Methods Four kinds of stuffing, including vaseline gauze, iodoform gauze,expanded sponge（Merocel） and SPIGGLE high expansion hemostatic cotton, were used in four groups of patients after nasal endoscopic surgery. The bleeding volume during the postoperative filling period and extraction period and the comfort of the nasal cavity during the filling period were compared. Results SPIGGLE group had the least discomfort in filling period, 17.7% of the patients had obvious headache, only 1.5% of the patients reached ＋ ＋ ＋. In iodoform gauze group,100% of the patients had significant headache, and 81.8% of the patients reached ＋ ＋ ＋. The difference was statistically significant between the four groups（P〈0.05）. The difference of blood leakage in the filling period was statistically significant（P〈0.05）. Iodoform gauze group and vaseline gauze group had less bleeding than the Merocel group and SPIGGLE group. For patients with abnormal coagulation function, headache was the most obvious in the iodoform gauze group,81.8% of the patients reached ＋ ＋ ＋. The bleeding in filling period and extraction period of iodoform gauze group was the least, only 9.1% of the patients reached ＋ ＋ ＋, which had statistically significant difference compared with other groups（P〈0.05）. Conclusion In endoscopic sinus surgery for patients with liver diseases, SPIGGLE has good hemostatic effect in patients with normal coagulation function, but for patients with coagulopathy should choose iodoform gauze.