Vaiman Michael, Segal Samuel, Eviatar Efraim
Department of Otolaryngology, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
Rhinology. 2002 Jun;40(2):88-91.
Our study was made to prove the second-generation surgical fibrin sealant Quixil to be an effective substitute for nasal packing, chemical coagulation and cautery in management of patients with epistaxis. Our series includes 204 patients with anterior epistaxis (186), and with posterior epistaxis (18) as results of trauma, clotting disorders, chronic and/or atrophic rhinitis and upper respiratory infections, and hypertension. Patients were randomly divided into four groups: with fibrin glue (67) (Quixil), with electric cautery (61), with silver nitrate coagulation (60), and with foam nasal packing (16). For the fibrin glue group, hemostasis was achieved by spraying with 0.3 ml Quixil fibrin glue to each bleeding nostril. The results were excellent in all of the 62 (92.5%) patients of the fibrin glue group with complete and immediate hemostasis. We found good healing of bleeding sites, no swelling and secondary bleeding, no inflammation, no plaque or crists. Three months monitoring of atrophic changes of the nasal mucosa proved absence of atrophy of the nasal mucosa. In this group, the bleeding time averaged 2 min 30 sec since the moment of admittance. In the groups where cautery, coagulation, or nasal packing was used, we found local swelling, pain, and slow healing of the bleeding site with accidental atrophy of the nasal mucosa. The rates of these side effects were significantly higher in comparison with the fibrin glue group. The bleeding time was also longer. We found that the fibrin glue is more effective hemostatic in comparison with foam nasal packing, cautery and coagulation, and provides no complications usual for these types of treatment of epistaxis.
我们开展这项研究是为了证明第二代外科手术用纤维蛋白密封剂Quixil可有效替代鼻腔填塞、化学凝血和烧灼术，用于鼻出血患者的治疗。我们的研究系列包括204例鼻出血患者，其中186例为鼻前部出血，18例为鼻后部出血，病因包括创伤、凝血障碍、慢性和/或萎缩性鼻炎、上呼吸道感染以及高血压。患者被随机分为四组：使用纤维蛋白胶组（67例）（Quixil）、电烧灼组（61例）、硝酸银凝血组（60例）和泡沫鼻腔填塞组（16例）。对于纤维蛋白胶组，通过向每个出血鼻孔喷洒0.3 ml Quixil纤维蛋白胶来实现止血。纤维蛋白胶组的62例（92.5%）患者均实现了完全且即刻止血，效果极佳。我们发现出血部位愈合良好，无肿胀和继发性出血，无炎症，无斑块或结痂。对鼻黏膜萎缩变化进行的三个月监测证明鼻黏膜无萎缩。在该组中，自入院时刻起平均出血时间为2分30秒。在使用烧灼术、凝血或鼻腔填塞的组中，我们发现局部肿胀、疼痛，出血部位愈合缓慢，且鼻黏膜意外萎缩。与纤维蛋白胶组相比，这些副作用的发生率显著更高。出血时间也更长。我们发现，与泡沫鼻腔填塞、烧灼术和凝血相比，纤维蛋白胶止血效果更佳，且不会引发鼻出血这类治疗通常会出现的并发症。
