鼻内镜术后患者应用纳吸棉填塞鼻腔的效果

目的探讨鼻内镜术后患者应用纳吸棉填塞鼻腔的效果。方法将162例手术患者按患者意愿分为试验组和对照组,试验组术后以纳吸棉填塞鼻腔,对照组术后以凡士林纱条填塞鼻腔,观察两组患者术后鼻部胀痛、鼻腔出血量、睡眠时间、饮食状况、住院天数情况的差异。结果试验组患者术后疼痛、出血、睡眠及食欲情况均显著好于对照组(均P<0.05)。结论鼻内镜术后应用纳吸棉填塞鼻腔治疗能更有效地缓解患者术后疼痛、减少出血,延长睡眠时间和促进患者食欲,减少了患者术后的痛苦,值得临床推广。     

Effects of Nasopore Packing on Dacryocystorhinostomy

Purpose

To investigate the effects of placement of the absorbable packing material Nasopore at the anastomosis site of newly formed mucosal flaps on postoperative re-bleeding, discomfort, and on the success rate of dacryocystorhinostomy (DCR).

Methods

A review of the medical records of patients with primary acquired nasolacrimal duct obstruction that underwent external or endonasal DCR by a single surgeon was performed. The degree of re-bleeding, discomfort, and postoperative results, including anatomical success, functional success and postoperative nasal findings such as granulation, synechiae, and membrane formation were compared in patients whose anastomosis site was packed with either Nasopore or Merocel, a non-absorbable packing material.

Results

A total of 77 patients (101 eyes) were included. Of the 101 eyes, 30 were packed with Nasopore, while 71 were packed with Merocel. The Nasopore group showed significantly better results than the Merocel group in the degree of re-bleeding and the level of patient discomfort (p = 0.000, 0.039, respectively; Pearson''s chi-square test), whereas there were no statistically significant differences between the two groups in postoperative anatomical and functional success (p > 0.05).

Conclusions

Nasopore significantly reduced postoperative nasal re-bleeding and patient discomfort during the early post-surgical period, but failed to show an effect on the postoperative anatomical and functional success of DCR.     

Nasopore鼻腔局部联合注射血凝酶在鼻内镜术后止血效果的观察

目的：采用双盲随机对照临床试验比较功能性鼻内镜术后术腔Nasopore联合注射血凝酶和Naso-pore联合生理盐水鼻腔填塞的止血效果。方法：选择确诊为慢性鼻一鼻窦炎需行功能性鼻内镜手术患者68例,随机分为实验组40例和对照组28例。实验组术后给予Nasopore＋注射血凝酶填塞（注射血凝酶均使用1 U,使用前将其溶解于0．5ml生理盐水中）,术毕将溶解有注射血凝酶的生理盐水注入已填入鼻腔的Nasopore中;对照组术后给予纳吸绵填塞,术毕将0．5ml生理盐水注入已填入鼻腔的Nasopore中。通过患者术后VAS评分比较两组在功能性鼻内镜手术后出血效果的差异。结果：对照组术后6h鼻出血VAS评分分别与同组术后1、2、3d比较,差异有统计学意义（P〈O．05）;实验组术后6h的鼻出血VAS评分分别与同时段对照组比较,差异有统计学意义（P％0．05）。结论：功能性鼻内镜手术后使用Nasopore作为鼻腔填塞物联合局部使用注射血凝酶,可以有效减少术后6h内的出血。     

慢性中耳炎术后纳吸棉填塞术腔33例

目的比较慢性中耳炎术后,分别采用纳吸棉与碘仿纱条填塞术腔的不同效果。方法单耳发病的慢性化脓性胆脂瘤型中耳炎患者60例(耳),均采用开放式的改良乳突根治术及耳甲腔成形术,两组患者一般临床资料比较,差异无统计学意义(P>0.05)。术后按本人意愿,分为观察组和对照组,观察组33例(耳),术后采用纳吸棉填塞术腔;对照组27例(耳),术后采用碘仿纱条填塞术腔。比较两组患者术后并发症发生率,24 h耳痛程度,48 h内睡眠时间,术后2周取出耳部填塞物时术腔出血率。结果观察组术后并发症发生率9.1%,对照组为33.3%,两组比较差异有统计学意义(P<0.05)。术后24 h观察组耳痛程度Ⅰ级32例(耳),Ⅱ级1例(耳);对照组Ⅰ级22例(耳),Ⅱ级5例(耳),P<0.05。观察组患者术后48 h内平均睡眠时间为(15.61±0.93)h,对照组为(12.44±1.31)h,P<0.05。术后2周观察组取出耳部填塞物时出血率为6.1%,对照组为29.2%,P<0.05。结论慢性中耳炎术后采用纳吸棉填塞术腔,并发症发生率相对较低,能减轻术后疼痛、延长睡眠时间、减少创面二次损伤。     

Steroid vs. antibiotic impregnated absorbable nasal packing for wound healing after endoscopic sinus surgery: a randomized,double blind,placebo-controlled study

IntroductionEndoscopic sinus surgery can lead to crusting or synechiae formation, which can affect the healing process.ObjectiveThe aim of our study was to compare the influence of steroid versus antibiotic versus saline solution impregnated absorbable nasal spacers on postoperative wound healing and patient satisfaction.MethodsEighty patients, 33 women and 47 men, were enrolled in this study. At the end of the surgery, two pieces of 4 cm biodegradable material were applied in each ethmoid cavity. One of them was impregnated with saline solution, while the second one with steroid, or with antibiotic.ResultsWe observed statistically significant differences in the Lund–Kennedy score between the control and both treatment groups: for the Antibiotic-group on days 10 and 30 (p = 0.009; p = 0.009) and for the Steroid-group on day 90 (p = 0.008). The extended endoscopic appearance of nasal mucosa indicated statistically significant differences in crust formation on day 10 comparing the steroid and control dressing (p = 0.025), in secretion type on days 10 and 30 comparing the antibiotic and control dressing (p = 0.003; p = 0.016) and additionally for steroid and control on day 90 (p = 0.046). On Day 90 we observed statistically significant differences in the absence of mucosal edema in the S-group compared to controls (p = 0.007).ConclusionsThe results of this study reveal the significant positive influence of steroid- and antibiotic-impregnated biodegradable nasal packing on the postoperative healing process and patient satisfaction compared to the saline soaked dressing.