五种鼻腔填塞材料的疗效分析及选择

目的回顾性比较分析5种填塞材料的疗效。方法将我科近年所使用的凡士林油纱布、藻酸钙纤维、膨胀海绵、吸收性明胶海绵和吸收性止血绫5种填塞材料分别用于鼻内镜或鼻窦术后鼻腔填塞(鼻腔填塞组)、中鼻道填塞(中鼻道填塞组)及鼻内镜检查出血点不明确的急诊鼻出血患者(急诊鼻出血组)。结果①鼻腔填塞组(238例):膨胀海绵最易引起头痛、鼻腔胀痛,其次是凡士林油纱布,藻酸钙纤维最次(P值均< 0．01);凡士林油纱布、膨胀海绵和藻酸钙纤维抽除难易度的差异均无统计学意义(P值均>0．05);凡士林油纱布抽除时较藻酸钙纤维易引起鼻腔出血(P<0．01),但以少量出血为主,膨胀海绵与凡士林油纱布、藻酸钙纤维的差异则无统计学意义(P值均>0．05);填塞材料抽除后,使用凡士林油纱布者鼻中隔血肿率为1．9％,显著低于膨胀海绵的17．3％及藻酸钙纤维的13．8％(P值均<0．01),而后两者间的差异无统计学意义(P> 0．05)。②中鼻道填塞组:藻酸钙纤维的抽除难度较吸收性止血绫、吸收性明胶海绵及吸收性止血绫 吸收性明胶海绵大(P值均<0．01),而后三者抽除难易度的差异无统计学意义(P值均>0．05)。③急诊鼻出血组;以膨胀海绵填塞均成功。结论凡士林油纱布为鼻中隔矫正术后较佳的填塞材料;膨胀海绵最适合鼻内镜检查未能确定出血部位的鼻腔后端及后鼻孔反复或中等量出血的急诊鼻出血患者,也可用于单纯下鼻甲术后填塞;藻酸钙纤维可用于各类鼻腔、鼻窦术后创面小、出血量少、只需短时填塞的患者,但填塞时需掌握技巧以防落入后鼻孔;吸收性止血绫包裹吸收性明胶海绵为中鼻道术后较佳的填塞材料。

Efficacy analysis and choice of five kinds of nasal packing materials

Objective To compare the efficacy of five nasal packing materials retrospectively for choosing the suitable packing material after endoscopic sinus surgery. Methods Application of Grassolind neutral, Sorbalgon, Merocel, Gelfoam, Absorbale stanching satin(ASS) and Gelfoam ASS after endoscopic sinus surgery was analyzed. Results Degree of difficulty in removal of the pack was not difficult among Grassolind neutral, Merocel and Sorbalgon(P > 0. 05);but headache, nasal pain were the most complain in Grassolind neutral, whereas those caused by Merocel and Sorbalgon were much lesser (P < 0. 01). Epistaxis easily occurred after removal of pack in case of Grassolind neutral and Sorbalgon(P < 0. 01), no significant difference demonstrated between Grassolind neutral and Meroce(P > 0. 05);Nasoseptal hematoma after removal occurred least with Grassolind neutral which was much lower than those of Merocel and Sorbalgon. Difficulty in removal of pack was most with Sorbalgon as comparing with the rest(P < 0. 01) , and no significant difference was present in the rest(P > 0. 05). Conclusions Traditional Vaseline gauze is the choice of packing material and reformed Vaseline gauze(Grassolind neutral)can be used for post-nasoseptal surgery. Merocel is the best packing material for epistaxis of posterior nasal cavity and internal nares and Sorbalgon can be used after endoscopic surgery, but having requirements of lesser wound surface and bleeding with short packing duration and prevention from falling into the posterior nares. Gelfoam ASS is best for middle meatus packing after endoscopic surgery.