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。     

自制药物纱条在鼻腔填塞应用中的疗效分析

目的探讨自制药物纱条与凡士林纱条行鼻腔填塞后的疗效差异。方法对采用自制药物纱条与凡士林纱条行鼻腔填塞的136例患者的临床资料进行分析，对两组患者填塞后疼痛反应程度、填塞材料抽除难易度、纱条拔出后出血情况进行比较。结果两组患者填塞后6，12，24h进行疼痛测评并比较，其中填塞后12h比较P〈0．01，填塞后6、24h比较P〈0．05；两组患者填塞后反应程度、填塞材料抽除难易度、抽出后出血情况比较，P均〈0．05，差异均有统计学意义。结论自制的药物纱条填塞鼻腔具有压迫止血和药物止血的双重作用，鼻黏膜反应轻，出血少，可减少感染的机率，减轻患者头痛等不良反应。     

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。     

三种鼻腔填塞材料在鼻内镜手术中的疗效比较

目的：探讨三种鼻腔填塞材料在鼻内镜手术中的应用效果。方法：2004年1月至8月为慢性鼻窦炎、鼻息肉75例行内窥镜鼻窦手术，男49例,女26例,平均42 岁。Ⅱ型2期36例,Ⅱ 型3期21例,Ⅲ型18例。局部或全身麻醉下行Messerklinger鼻窦内窥镜手术,术后随机予以凡士林油纱条、Merocel高分子止血棉、瑞纳凝胶快速止血材料中的一种填塞鼻腔,每组25例，48～72?h后取出填塞物，观察患者鼻痛、头痛的程度及取出填塞物后的渗血情况，判断疗效。结果：凡士林油纱条组80％的患者出现鼻痛、头痛等症状，64％的患者抽出鼻腔填塞物后有渗血；瑞纳凝胶快速止血材料组60％的患者出现鼻痛、头痛等症状，12％的患者抽出鼻腔填塞物后有渗血；Merocel高分子止血棉组44％的患者出现鼻痛、头痛等症状，24％的患者抽出鼻腔填塞物后有渗血；三组比较差异有统计学意义(P＜0.05)。结论：三种鼻腔填塞材料中凡士林油纱条疗效可靠，价格低廉，但痛苦明显；Merocel 高分子止血棉、瑞纳凝胶快速止血材料止血效果好，痛苦小，但价格略昂贵，临床应用中可视情况而定。     

碱性成纤维细胞生长因子止血绫浸片与膨胀海绵联用治疗血液病鼻出血

目的：观察重组牛碱性成纤维细胞生长因子（rb-bFGF）止血绫浸片与膨胀海绵联合在治疗血液病鼻出血的应用效果。方法：前瞻性研究选取2009-01-2011-02期间血液病鼻出血患者96例,随机分为两组：治疗组50例,对照组46例,均经鼻内镜检查明确出血部位。治疗组应用rb-bFGF止血绫浸片联合膨胀海绵行前鼻孔填塞止血治疗,对照组应用凡士林纱进行鼻腔填塞。每例患者均对填塞后鼻腔疼痛评分和止血效果进行分析比较。结果：治疗组与对照组比较,止血效果差异无统计学意义,但填塞后再出血率、填塞不同时间鼻腔疼痛程度,治疗组明显低于对照组,差异有统计学意义（P〈0.05）。结论：rb-bFGF吸收性止血绫浸片联合膨胀海绵止血效果确切、创伤小、拔出填塞时鼻腔再出血发生率低且鼻腔填塞痛苦少,适合血液病鼻出血的局部填塞治疗。     

上颌窦根治术后应用水囊压迫止血疗效观察

临床上对上颌窦根治术后常规采用凡士林纱条填塞压迫止血。1993年至今，我们采用水囊压迫法对上颌窦根治术后进行压迫止血，并与凡士林纱条填塞止血进行疗效比较，现将临床结果报道如下。一、临床资料将行上颌窦根治术77例随机分为两组。凡士林纱条填塞止血组：41例，男24例，女17例；年龄17～52岁。水囊压迫止血组：36例，男20例，女16例；年龄18～52岁。二、治疗方法（一）凡士林纱条填塞止血组；术后采用凡士林纱条填塞方法压迫止血，24～48小时取出纱条。常规应用抗生素预防感染。（二）水囊压迫止血组；将消毒的单囊上颌窦水囊从鼻腔开…     

慢性鼻窦炎鼻内镜术后无鼻腔填塞的临床分析

目的探讨在局麻下鼻内镜术后有与无填塞的优缺点。方法106例I、Ⅱ型慢性鼻窦炎患者行鼻内镜术后,A组（电凝止血组）52例和B组（肾上腺素棉片止血组）54例未行鼻腔填塞,对照组46例行凡士林纱条填塞。结果不填塞组104例术后无严重出血,B组2例渗血较多,需要补充填塞,与对照组术后渗血量比较差异无统计学意义;术后渗血时间A组（210．12±12．45）min,B组（298．23±30．34）min,对照组（366．22±40．12）min,各组比较差异均有统计学意义（P〈0．05）;术后疼痛评分A组（1．81±0．39）min,B组（1．85±0．52）min,两组比较差异无统计学意义（P〉0．05）,对照组（3．76±0．41）min,与A、B两组比较差异有统计学意义。结论局麻下对I、Ⅱ型慢性鼻窦炎行鼻内镜手术后应用电凝和肾上腺素棉片止血,可以减少鼻腔填塞造成的术后不适。     

角型钛夹组合在下鼻甲部分切除免填塞中的应用研究

目的：观察自制的角型钛夹组合用于下鼻甲部分切除免填塞的效果。方法：选择符合下鼻甲部分切除适应证的152例患者为研究对象,其中92例为实验组,以2~4个角型钛夹首尾相接闭合鼻甲创面,中鼻道以上有手术创面者,仅作中鼻道以上微填塞,裸露呼吸区,保持通气,1~3d后取出角型钛夹;60例为对照组,术后用凡士林油纱条或Merocel止血海绵填塞鼻腔止血。观察术后1~3d的鼻通气情况、出血量、口干、耐受、头痛鼻痛、睡眠和换药次数共7项指标。结果：实验组在术后除出血量与对照组比较差异无统计学意义外,其余各项指标优于对照组（均P〈0.05）。结论：角型钛夹组合应用于下鼻甲部分切除免填塞中,患者获得较好的舒适度,避免了抽取填塞物的痛苦,提高了患者围手术期的生活质量。     

内镜鼻窦手术后Rhino凝胶填塞效果的观察

目的 前瞻性比较新型鼻腔填塞材料Rhino凝胶与传统填塞物用于内镜鼻窦手术后填塞的效果.方法 对双侧病变基本对称,手术范围基本相同的24例慢性鼻窦炎患者行内镜鼻窦手术,术后右侧鼻腔以Rhino凝胶填塞(观察组),左侧鼻腔以藻酸钙+油纱条填塞(对照组).术后1日抽取对照侧填充物,观察侧凝胶保留至术后1周第1次内镜复查时清理,鼻腔冲洗、鼻喷糖皮质激素等其他局部处理双侧鼻腔相同.采用视觉模拟量表(visual analog scale,VAS)记录两侧鼻腔术后当天(填塞期)、术后第1天(抽取左侧填充物时)、术后第2天(抽取左侧填充物后)患者鼻痛、鼻堵程度,分泌物、渗血、流泪量,以及术后内镜复查术腔恢复情况(干痂、分泌物、反应膜、黏膜水肿、囊泡、窦口阻塞),并对两组上述11项观察项目评分和上皮化时间进行比较.结果 苏醒时因血压过高,凝胶侧鼻腔出血改用纱条填塞1例;外地患者失访2例.余21例完成2～20个月的随访.术后当天、术后第1天鼻痛,术后当天流泪评分,Rhino组<对照组(Z值分别为-3.575、-3.546、-2.736,P值均<0.05);术后第1天渗血评分,Rhino组<对照组(Z=-3.075,P<0.05);术后1周术腔干痂评分,Rhino组<对照组(Z=-2.103,P<0.05);其余各项评分差异无统计学意义;凝胶侧术腔平均上皮化时间为(10.7±2.6)周,对照侧为(10.6±2.9)周,两组差异无统计学意义(t=-0.146,P=0.886).结论 Rhino凝胶可减轻患者鼻腔填塞期的不适,并可避免专门撤除填充物造成的痛苦和出血,较传统方法有明显的优越性.在促进术腔恢复方面与传统方式相当.     

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。     

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.     

塞纳斯凝胶在鼻息肉伴睡眠呼吸障碍成年患者鼻内镜术中的应用

目的 为选择更适合鼻内镜术临床应用的填塞材料,总结归纳塞纳斯凝胶在慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)引起的睡眠呼吸障碍(SDB)患者行鼻内镜术中的应用情况,探讨SDB患者与非SDB患者应用塞纳斯凝胶后其舒适度的差异。 方法 双侧CRSwNP成人患者216例施行鼻内镜手术,其中伴SDB 156例,不伴SDB 60例。分为4个组,其中A组为不伴SDB患者术中填塞塞纳斯凝胶60例、B组为伴SDB患者术中填塞塞纳斯凝胶组56例, C组为伴SDB患者术中填塞纳吸棉组47例, D组为伴SDB患者术中填塞医用膨胀海绵组53例。采用视觉模拟评分法(VAS)对其鼻腔反应进行比较。 结果 A组和B组比较,塞纳斯凝胶在头痛、鼻痛及术后出血三方面差异有统计学意义(P<0.05),SDB患者在这三方面更不耐受。B组与C组比较,在头痛、鼻痛、鼻塞感、流泪四方面差异有统计学意义(P<0.05),塞纳斯凝胶优于纳吸棉。B组与D组比较,在头痛、鼻痛、鼻塞感、流泪、吞咽障碍、术后出血6个方面差异均有统计学意义(P<0.05),但临床意义不同,在术后出血方面塞纳斯凝胶组的效果虽差于医用膨胀海绵组,但仍可接受,其余方面塞纳斯凝胶明显优于膨胀海绵。 结论 塞纳斯凝胶是更适合于临床应用的填塞材料,能为患者带来更高的术后舒适度。另外SDB能加重患者头痛、鼻痛和术后出血症状,可能与长期缺氧致炎症反应较重有关。     

鼻内镜术后两种鼻腔填塞物的疗效对比

目的 比较鼻内镜术后数字纱布和藻酸钙鼻腔填塞的疗效。方法 将60例慢性鼻窦炎/鼻息肉患者随机分组,鼻内镜术后分别行数字纱布或藻酸钙填塞,并行鼻内镜手术前后自查量表调查。该自查量表包括术前鼻腔通气评分,手术当天及术后第1天(拔除填塞物当天)鼻腔通气评分、鼻腔胀痛评分、头痛评分、牙齿酸痛评分、鼻腔出血停止时间、出血量情况及发热情况等。通过该量表的调查,分析比较数字纱布和藻酸钙的疗效。结果 两组患者术前鼻腔通气评分差异无统计学意义。两组患者手术当天鼻腔通气评分有统计学差异,而鼻腔胀痛评分、头痛评分、牙齿酸痛评分、鼻腔出血停止时间均差异无统计学意义;两组患者鼻腔出血均为阴性、无发热。两组患者术后第1天鼻腔通气评分、鼻腔胀痛评分、头痛评分、牙齿酸痛评分、鼻腔出血停止时间均差异无统计学意义,两组患者鼻腔出血均为阴性、无发热。结论 数字纱布作为一种新型的鼻腔填塞物用于慢性鼻窦炎/鼻息肉患者鼻内镜术后,相比藻酸钙而言,具有鼻腔通气佳等优点,值得在临床推广使用。     

Nasal septum suture combined with inferior turbinate coblation after septoplasty: Does it improve quality of life and reduce complications?

ObjectiveNasal packing is routinely applied after septoplasty. Patients, however, report feeling very uncomfortable while the packing is in place. The aim of this study was to compare the effects of nasal septum suture combined with inferior turbinate coblation to the effects of nasal packing after septoplasty.MethodsIn this study, 135 patients undergoing septoplasty were divided into 3 groups: group 1 patients had microdebrider with packing, group 2 received coblation with packing and group 3 had coblation with suture. Early postoperative quality of life and complications were compared between the 3 groups.ResultsThe patients in group 1 experienced the most postoperative nasal pain, headache, dysphagia, sleep disturbance and bleeding on the night of surgery; while the patients in group 3 experienced the fewest symptoms. No difference in epiphora was observed between the 3 groups. More pain and bleeding were experienced when comparing the pack removal (Group 1 and 2) with the clearance of the nasal cavity (Group 3). We noted one case of postoperative bleeding in group 1, one septal hematoma in group 1 and a second septal hematoma in group 2. No such postoperative complications were found in group 3.ConclusionNasal septum suture combined with inferior turbinate coblation was not only associated with less pain, increased patient satisfaction and an improved quality of life; but also reduced postoperative complications. Our results confirm that it is a more comfortable, reliable alternative to the more common nasal packing.     

改良鼻中隔缝合联合等离子下鼻甲消融在鼻中隔偏曲矫正术中的选择性应用

目的 鼻中隔偏曲矫正术后使用改良鼻中隔缝合技术,等离子消融下鼻甲,术后不填塞鼻腔,比较其与传统方法的疗效.方法 80例行鼻中隔偏曲矫正术患者分为填塞组和缝合组,行鼻中隔矫正术后,填塞组吸切钻切削下鼻甲后行鼻腔填塞,缝合组行改良鼻中隔缝合、等离子消融下鼻甲,无填塞.比较两组患者术后症状、体征评分.结果 填塞组在手术后鼻部...     

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.     

藻酸钙在鼻中隔手术中的应用

目的 观察藻酸钙与凡士林纱条在鼻中隔手术中应用的效果.方法 60例鼻中隔偏曲在本科接受手术治疗的成年患者,随机分组,实验组和对照组各30例.两组患者接受相同的手术治疗(鼻中隔黏膜下切除术)及常规处理.实验组采用藻酸钙(Sorbalgon)、凡士林纱条鼻腔填塞;对照组采用常规的凡士林纱条填塞.结果 实验组患者鼻腔填塞后自觉不适反应轻;鼻腔尤其鼻中隔黏膜损伤反应较对照组轻,创面渗出少,鼻中隔黏膜修复优于对照组.结论 藻酸钙具有良好的保护创面作用,有利于鼻腔黏膜的早期愈合.     

A randomized trial of Rapid Rhino Riemann and Telfa nasal packs following endoscopic sinus surgery

Objectives: To compare Telfa with the Rapid Rhino Riemann nasal pack for use following endoscopic sinus surgery. Design: Prospective, randomized, double‐blind, paired trial. Setting: Tertiary otolaryngology hospital. Participants: Forty‐five adult patients undergoing bilateral endoscopic sinus surgery for either chronic rhinosinusitis or nasal polyps. Main outcome measures: A visual analogue scale was used to assess discomfort caused by the presence of the packs in the nose and by their removal. The amount of bleeding was noted with the packs in place and following their removal. Crusting and adhesions were assessed 2 and 6 weeks following surgery. Results: Both packs performed well giving good haemostasis and causing little bleeding on removal. Both packs caused only mild discomfort while in the nose. On the visual analogue scale of 0–10 cm the mean visual analogue score for Rapid Rhino Riemann pack was 1.7 and for Telfa 2.0 (P = 0.371). The Rapid Rhino Riemann pack caused significantly less pain on removal compared with the Telfa pack with a mean visual analogue score of 2.0 in comparison with 3.7 for Telfa (P = 0.001). There were less adhesions with the Rapid Rhino Riemann than Telfa pack but this was not statistically significant (P = 0.102). Conclusions: Both Telfa and Rapid Rhino Riemann packs can be recommended as packs that control postoperative haemorrhage, do not cause bleeding on removal and cause little discomfort while in the nose. The Rapid Rhino Riemann pack has the advantage of causing significantly less pain on removal.     

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。