鼻内镜术后术腔硅胶扩张引流管应用

随着鼻内镜外科手术的广泛开展,术腔填塞物的科学选择和恰当使用越来越受到广大学者的重视[1～3]. 1 填塞物比较 近年来随着生物材料和技术的不断创新和进步,推出了多种各具特色的鼻腔填塞材料,如瑞纳凝胶快速止血材料(Gel-Knit)、膨胀海绵(Merocel)等.但无论是传统的凡士林纱条填塞方法,或是这些多来自国外价格较贵的专利产品,虽然都解决了术后术腔出血问题,但由于填塞物将鼻腔填满,影响术后通气,往往造成患者出现鼻塞、头痛、口干等不适症状.为解决这些问题,我们开发研制了不同规格的鼻腔扩张引流管作为鼻腔手术的填塞物[4],术后不但可以保证患者通气,还可以将鼻腔及鼻窦内的分泌物及渗血引流出来,减少术腔感染及术腔粘连的发生几率,且成本低廉,为患者解除了痛苦,并给术后的护理工作带来新的课题.     

鼻内镜手术后鼻腔填塞物的选择及效果比较

目的 前瞻性比较四种鼻腔填塞材料的疗效,指导临床选择合适的术后鼻内填塞物。方法 选择凡士林纱条、Merocel、瑞纳及硅胶管4组,采用视觉模拟评分法(visual analogue scale,VAS)评分和记录填塞期及抽取时病人的舒适程度、控制鼻出血的有效性和抽取填塞物的难易程度并进行比较。结果瑞纳组病人填塞期不适程度最小,与其他三组比较均有显著差异(P<0.01),抽取时的不适感也较小于凡士林纱条组以及硅胶管组(P<0.05);凡士林纱条术后当天渗血量少于其他组(P<0.05);瑞纳组抽取比较容易,相对凡士林纱条组以及硅胶管组有显著差异(P<0.0 1);抽取时凡士林纱条组渗血最多。结论鼻内镜手术时,应综合考虑手术范围、操作难易度、控制出血、减轻疼痛、有利愈合、确保效果等诸方面因素合理选用术后填塞物。瑞纳优势较为全面,可作为鼻内镜手术的常规填塞材料。     

Merocel高分子止血棉治疗鼻腔出血

目前鼻腔填塞仍是治疗鼻出血的重要方法.传统的填塞材料是凡士林油纱条,但鼻腔填塞后患者鼻部及头部胀痛明显、痛苦大,鼻腔黏膜局部损伤重、愈合慢.自2003年以来,我们用美国施美德公司产的Merocel高分子止血棉选择性地治疗各类鼻出血87例,效果良好,报道如下.     

低压止血气囊在鼻内镜手术中的应用

随着鼻内镜手术的广泛开展，鼻科手术的范围越来越大，术后鼻腔止血是手术成功的重要环节，而鼻腔及鼻窦手术术腔止血填充材料及方法一直为人们所关注。传统应用凡士林纱条填塞鼻腔、鼻窦，虽然经济适用，但填塞后患者鼻部胀痛及头痛反应较重，我们应用低压止血气囊作为鼻内镜手术后鼻腔填塞物，收到满意效果。     

凡士林纱带包裹膨胀海绵用于鼻出血84例的疗效观察

目的探讨凡士林纱带包裹膨胀海绵用于鼻出血的疗效。方法对84例鼻出血患者应用凡士林纱带包裹膨胀海绵填塞止血。结果3例填塞凡士林纱带包裹膨胀海绵后当时少量渗血（3．57％）,2例48h抽出后凡士林纱带包裹膨胀海绵再发出血（2．38％）,1例填塞凡士林纱带包裹膨胀海绵后失败。83例治愈（94．04％）。结论凡士林纱带包裹膨胀海绵是一种有效的鼻腔填塞材料,值得应用和推广。     

三种填塞材料在鼻内镜术后填塞中的临床效果分析

目的　探讨三种不同的填塞材料在在鼻内镜术后填塞中的临床效果。方法　选取60例鼻-鼻窦炎患者,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评价,全部行鼻内镜鼻窦手术,术后根据情况分别置入凡士林胶皮指套（20例）、膨胀海棉（20例）、凡士林纱条（20例）进行填塞止血,48小时后取出填塞物。观察不同填塞材料在鼻内镜术后填塞应用中的止血效果,抽取鼻腔填塞物时难易程度、患者疼痛程度及鼻腔黏膜出血情况等,判断疗效。结果　凡士林纱条胶皮指套填塞期与抽取时患者疼痛程度小,抽取时难度小、出血量少;膨胀海棉组患者填塞期出血量多;凡士林纱条组患者填塞期及抽取时疼痛程度高。结论　自制凡士林纱条外套胶皮指套填塞物,表面光滑,无刺激性,具有弹性、黏膜之间黏附性小,抽取时较容易,鼻腔清洁度佳,达到满意临床效果,材料来源容易,制作工艺简单,价格低廉,对基层医院有临床推广价值。     

不同鼻腔填塞物对鼻内镜术后伤口疼痛和止血效果的临床观察

鼻内镜手术是近年来鼻科学领域治疗慢性鼻窦炎的主要方法,术后止血常使用凡士林纱条填塞,时有渗血,拔纱条时出血多,填塞及抽取凡士林纱条病人痛苦大。我们通过观察采用凡士林纱条、胶原蛋白海绵、Merocel以及藻酸钙纤维4种填塞材料经鼻腔填塞的病人,通过对填塞期和抽取时病人的舒适程度、鼻出血量两个方面的观察,比较它们的痛苦程度和止血效果,报道如下。1资料与方法1.1临床资料本组病例为2003年6月~2005年6月在我院接受鼻内镜下鼻窦开放术的鼻窦炎病人,共67例,男43例,女24例;年龄17~69岁,平均33.2岁;所有病人均在局麻下接受手术,术前检查…     

Rhino凝胶止血材料用于鼻腔填塞的临床观察

目的：探讨Rhino凝胶止血材料在鼻腔、鼻窦术后及严重鼻出血的临床应用价值。方法：对传统的凡士林纱条和新型的凝胶止血材料进行鼻腔填塞的2组病例的临床资料进行回顾性分析，并对2种填塞方法在填塞期和抽取时患者的鼻腔疼痛和（或）头痛，控制出血的有效性和抽取填塞物的难易程度进行比较。结果：Rhino组在填塞期和抽取时患者鼻腔疼痛和（或）头痛比凡士林组轻（P〈0．01和P〈0．05）。填塞期24h出血量差异无统计学意义（P〉0．05），但在抽取时出血量差异有统计学意义（P〈0．01），抽取填塞物时，Rhino组比凡士林纱条组容易（P〈0．01）。结论：Rhino具有药物止血和压迫止血双重功能，是一种理想的鼻腔填塞物。     

Merocel高膨胀止血材料在鼻腔填塞中的选择应用

Merocel高膨胀止血材料比传统的填塞材料凡士林纱条在许多方面有明显优点，如填塞后鼻腔局部或头部疼痛减轻、抽除时出血量少、抽除后鼻腔黏膜反应轻等。但笔者在临床上发现它也有相对的不足，Merocel高膨胀止血材料对于明显的微小动脉出血，其压力相对不足，应用不当的话易引起渗血，     

功能性鼻内镜鼻窦手术后鼻腔处理方法的改进

目的探讨功能性鼻内镜鼻窦手术(FESS)后鼻腔处理的新方法及临床应用效果.方法随机将因慢性鼻窦炎鼻息肉行FESS的92例患者分为实验组和对照组,术毕两组均用凡士林纱条填塞鼻腔.实验组自术后第1天起间断性鼻腔滴抗生素注射液,术后第3至第5天取出填塞物.对照组于术后24～48h取出填塞物.比较两组患者在鼻腔填塞期间的头痛、鼻痛、咽部干燥感等主要临床症状以及抽取鼻腔填塞物后鼻出血,黏膜水肿充血或损伤状况.结果实验组上述指标的测定结果均优于对照组,两组差异有高度显著性(P＜0.01).结论FESS术中应用凡士林纱条填塞鼻腔后间断性鼻腔滴抗生素注射液可减轻鼻痛、头痛、咽部干燥感,减少鼻腔出血,黏膜水肿充血或损伤.     

藻酸钙敷料在鼻内镜术后术腔填塞效果的临床观察

目的 比较鼻内镜手术(endoscopic sinus surgery,ESS)后藻酸钙敷料(Sorbalgon(?)Tamponade Strips)与金霉素油纱条填塞术腔的效果,以寻求更好的鼻腔、鼻窦填塞材料。方法 对53例慢性鼻窦炎患者在鼻内镜手术后应用藻酸钙敷料随机填塞一侧鼻腔,金霉素油纱条填塞另一侧鼻腔作为对照。观察及评价填塞与抽取时,两侧鼻腔的出血量、疼痛及鼻粘膜水肿情况;并对两侧鼻粘膜进行光镜观察及比较。结果 应用藻酸钙敷料填塞止血效果好,填塞及抽取时出血少(P<0.01);鼻腔疼痛轻(P<0.01);术后鼻腔粘膜水肿轻(P<0.05)。填塞藻酸钙敷料的鼻腔,术后第三周鼻粘膜炎性细胞浸润程度与填塞金霉素油纱条的对照组比较差异无显著性(P>0.05)。结论 藻酸钙敷料是较理想的鼻腔手术后填塞止血材料。     

Nasal septal packing: which one?

The aim of this study was to investigate the effects of four different types of nasal packs on pain, nasal fullness and postoperative bleeding following septoplasty. Prospective randomised double blind study was conducted. The study group included 119 patients who underwent endonasal septoplasty under general anaesthesia. Four types of nasal packing materials were utilized: (1) Merocel standard 8-cm nasal dressing without airway, (2) Doyle Combo splint (DCS), (3) Merocel in a glove finger and (4) Vaseline gauze. All packs were removed at the 48th hour (±3?h) after the surgery. Three different variables were investigated following the surgical procedure: (1) pain, (2) nasal fullness and (3) bleeding after removal of the nasal packing material. DCS produced the greatest pain at the first and sixth postoperative hours. At the first postoperative day, the greatest pain score was reported for Merocel in the glove finger and the least for Merocel. The pain scores during the removal of the nasal packings were highest for Merocel and lowest for Merocel in the glove finger. DCS had the lowest nasal fullness score. Bleeding ratio was highest for Merocel, followed by Vaseline gauze, DCS and Merocel in the glove finger. Many different commercially available packing materials are presently used, each with inherent advantages and disadvantages. We evaluated the pain, nasal fullness and bleeding potential of four nasal packing materials and determined that Merocel had the highest pain potential during removal and the highest rate of bleeding following removal.     

Sorbalgon藻酸钙敷料填塞在2 013例鼻内镜术中的应用

目的:总结Sorbalgon藻酸钙敷料在鼻内镜术填塞中的应用效果,寻求更好的术腔填塞材料。方 法:2000年1月～2003年4月因慢性鼻窦炎、鼻息肉行鼻内镜手术的患者2013例,用Sorbalgon藻酸钙敷料作为 填塞材料,并与金霉素纱条填塞后的止血效果,鼻腔反应进行比较。结果:在鼻内镜术中应用Sorbalgon藻酸钙 敷料填塞止血效果好。与金霉素纱条相比,Sorbalgon敷料抽除时出血少,填塞后的鼻腔反应轻。Sorbalgon敷料 填塞时间不超过24h,无任何不良反应发生。结论:Sorbalgon藻酸钙敷料是一种更好的鼻内镜手术填塞材料。     

Sorbalgon藻酸钙敷料在功能性鼻内镜手术中的应用

目的：选择有效的鼻腔堵塞止血材料。方法：比较功能性鼻内镜手术凡士林纱条和Sorbalgon藻酸钙敷料鼻腔堵塞止血效果及堵塞后鼻腔反应情况。结果：应用Sorbalgon藻酸钙敷料止血效果好，头痛及鼻腔疼痛较轻，抽除堵塞物时鼻腔很少出血，术后鼻粘膜反应轻。结论：Sorbalgon藻酸钙敷料是一种良好的鼻腔，鼻窦手术后堵塞止血材料。     

Hemostasis in endoscopic sinus surgery using a specific gelatin-thrombin based agent (FloSeal)

The safety and efficacy of a new hemostatic sealant, based on a gel with collagen derived particles and topical thrombin (FloSeal, Fusion Medical Technologies, Inc. Fremont, CA) were assessed as an alternative to nasal packing for hemostasis in functional endoscopic sinus surgery. In a prospective clinical study of 50 patients undergoing bilateral endoscopic anterior ethmoidectomy, 2 ml FloSeal was used after surgery to stop bleeding. The results were compared to a control group of 50 patients with Merocel packing and showed that intraoperative hemostasis was rapid and equal in both groups. The main advantages of the new hemostatic sealant included a higher degree of comfort during postoperative nasal breathing and absence of complaints due to pressure or pain. There was only one case of postoperative bleeding on the 6th day, which required nasal packing. There were no more cases of stenoses or synechia in the ostiomeatal complex than were found in the Merocel group. No systemic side effects due to FloSeal were observed. This specific hemostatic sealant was shown to be a safe and efficacious alternative method for hemostasis in endoscopic sinus surgery with high patient satisfaction and an easy and fast mode of application.     

Merocel高膨胀海绵用于鼻出血

目的：探索更好的鼻腔填塞物。方法：比较传统的凡士林纱条与高膨胀海绵做为鼻腔填塞物的应用效果。结果：比较两组病人鼻腔填塞后24小时出血量，两者之间出血量无统计学差异（P＞0．05）。填塞时及取出时疼痛的程度，应用Merocel者明显较填塞凡士林纱条者轻，填塞期间的主要症状也较凡士林沙条组的病人轻。结论：Merocel高膨胀海绵是理想的鼻出血鼻腔填塞物。     

爱康肤银敷料用于鼻内镜术后填塞效果的临床观察

目的:比较鼻内镜手术后爱康肤银敷料(AquacelAg)与膨胀海绵填塞术腔的疗效,指导临床选择合适的术后填塞物。方法:对24例慢性鼻窦炎患者在鼻内镜术后应用爱康肤银敷料填塞右侧鼻腔(爱康肤银敷料组),并以膨胀海绵填塞左侧鼻腔作为对照(膨胀海绵组);观察、评价填塞期及抽取时两侧鼻腔的舒适程度及渗血量,并比较抽取的难易程度,及术后1周鼻黏膜水肿情况。结果:爱康肤银组填塞期与抽取时患者不适度比膨胀海绵组轻(P<0.01);填塞及抽取时2组出血量的差异无统计学意义(P>0.05);术后1周鼻黏膜水肿2组比较差异无统计学意义(P>0.05)。结论:爱康肤银敷料是一种良好的鼻内镜术后填塞材料。     

中药止血愈创鼻腔填塞油纱条临床应用

目的〓〖HTK〗利用中医中药理论,开发应用具有止血止痛、促进创伤愈合、放置时间长、使用经济、感觉舒适的中医药鼻腔填塞材料。〖HTW〗方法〓〖HTK〗选取中药组方,制取中药油纱条,应用于功能性内窥镜鼻窦外科手术（FESS）后鼻腔填塞,并与凡士林纱条对照,以相同方式填塞鼻腔,留置3d后取出。从手术后疼痛、出血、取出时出血以及手术后异味等方面对比两种材料的效果。〖HTW〗结果〓〖HTK〗凡士林纱条组手术后疼痛、出血、取出时出血和异味的出现率分别是25.74%,30.69%,42.57%,40.59%,中药油纱组分别是17.65%,16.47%,12.94%,16.47%。〖HTW〗结论〓〖HTK〗中药油纱是一种具有良好的止血止痛效果、感觉舒适、可以留置时间较长而且又十分经济的鼻腔填塞新材料。     

Double-blind randomised controlled trial comparing Merocel with Rapid Rhino nasal packs after routine nasal surgery

INTRODUCTION: Nasal packing after routine nasal surgery is commonly practiced in the UK. The most popular pack appears to be Merocel, however this can be associated with significant pain on its removal. AIM: To test the efficacy of a relatively new nasal pack--the Rapid Rhino Goodman pack--introduced to our department, which claims to reduce pain and bleeding after nasal surgery. METHODS: Fourteen patients undergoing routine nasal surgery were recruited into a randomised controlled trial. One nasal cavity was packed with a Merocel pack and the other with a Rapid Rhino Goodman pack. Patients were asked to record pain levels on each side using a visual analogue scale. RESULTS: We found no difference between packs whilst in-situ, with all patients recording low to moderate pain scores. There were significantly higher pain levels associated with Merocel pack removal than with Rapid Rhino pack removal (average pain scores 5.64 vs 1.64, p < 0.001) and less bleeding overall. CONCLUSIONS: Rapid Rhino (Goodman pack) is associated with significantly less pain on removal than Merocel pack, causes less bleeding and is not more painful whilst in-situ. We therefore recommend its use in routine nasal surgery.