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[功能性内镜鼻窦手术中可溶解鼻窦敷料的比较]

[Comparison of dissolvable sinus dressings in functional endoscopic sinus surgery].

作者信息

Szczygielski Kornel, Rapiejko Piotr, Wojdas Andrzej, Jadczak Marcin, Jurkiewicz Dariusz

机构信息

Klinika Otolaryngologii Wojskowego Instytutu Medycznego.

出版信息

Otolaryngol Pol. 2007;61(5):852-6. doi: 10.1016/S0030-6657(07)70541-3.

Abstract

OBJECTIVES

Nasal packing is commonly practiced in postoperative care after nose and sinus surgery, not only for haemostasis but also as internal stabilisation and synechia formation control. The aim of our study was to compare the pain level, adhessions and haemostatic properties of Stammberger sinus dressing (SSD) with Dissolvable Sinu-Knit (DSK) and routine nasal packing in latex gloves finger (RNP) after FESS in adult patients.

METHODS

45 patients with bilateral chronic rhinosinusitis (CRS) (totally 90 sides) were recruited into our trial. All patients underwent bilateral FESS without septoplasty. Following completion of surgery, every single nasal cavity side was packed with one of the studied dressing chosen randomly. In 41 sides nasal cavities were packed with Stammberger Sinus Dressing (SSD) in 26 sides packed with Dissolvable Sinu-Knit and 23 sides were filled with routine nasal packing in latex gloves finger (RNP). Haemostatic effect was assessed during the recovery period, pain level was recorded by the patients on a visual analogue scale 24 hours after surgery. Tendency to postoperative middle meatal synechia formations was assessed during control visits in the 1, 2, 4 and 8 week postoperatively.

RESULTS

Three (7.3%) of sides packed with SSD and four (15.3%) packed with DSK had primary postoperative bleeding that required additional packing. Finally 3D patients were packed with RNP. In patients packed with RNP bleeding didn't appear. Mean pain level for SSD was 0.85 (range from 0 to 3) and for DSK 2.1 (range 0 to 5) whereas for RNP was 5.6 (range from 2 to 9). Five (13.1%) of thirty-eight sides with SSD and five (22.7%) of twenty-two sides with DSK had synechia in middle meatus whereas eight (26.6%) of total thirty sides packed with RNP had synechia at any one of the control visits.

CONCLUSION

We found that Rapid Rhino Stammberger Sinus Dressing and Dissolvable Sinu-Knit are associated with very low local pain level and with a good effect in postoperative bleeding and synechia formation control.

摘要

目的

鼻腔填塞常用于鼻及鼻窦手术后的护理,不仅用于止血,还可作为内部稳定措施及控制粘连形成。本研究的目的是比较成年患者功能性内镜鼻窦手术(FESS)后,施坦伯格鼻窦敷料(SSD)、可溶解鼻窦编织物(DSK)和乳胶手套手指常规鼻腔填塞(RNP)的疼痛程度、粘连情况及止血性能。

方法

45例双侧慢性鼻-鼻窦炎(CRS)患者(共90侧鼻腔)纳入我们的试验。所有患者均接受双侧FESS,未行鼻中隔成形术。手术完成后,每侧鼻腔随机选择一种研究敷料进行填塞。41侧鼻腔用施坦伯格鼻窦敷料(SSD)填塞,26侧用可溶解鼻窦编织物填塞,23侧用乳胶手套手指常规鼻腔填塞(RNP)。在恢复期间评估止血效果,患者在术后24小时用视觉模拟量表记录疼痛程度。在术后1、2、4和8周的复查中评估术后中鼻道粘连形成的倾向。

结果

用SSD填塞的侧别中有3侧(7.3%)、用DSK填塞的侧别中有4侧(15.3%)术后发生原发性出血,需要额外填塞。最后有3例患者用RNP填塞。用RNP填塞的患者未出现出血。SSD组的平均疼痛程度为0.85(范围0至3),DSK组为2.1(范围0至5),而RNP组为5.6(范围2至9)。使用SSD的38侧中有5侧(13.1%)、使用DSK的22侧中有5侧(22.7%)中鼻道出现粘连,而使用RNP填塞的30侧中共有8侧(26.6%)在任何一次复查时出现粘连。

结论

我们发现,快速犀牛施坦伯格鼻窦敷料和可溶解鼻窦编织物与极低的局部疼痛程度相关,并且在控制术后出血和粘连形成方面效果良好。

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