Bachelet J T, Bourlet J, Gleizal A
Service de chirurgie maxillo-faciale, université Claude-Bernard Lyon-1, groupement hospitalier Nord, CHU de Lyon, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France.
Rev Stomatol Chir Maxillofac Chir Orale. 2013 Nov;114(5):310-4. doi: 10.1016/j.revsto.2013.07.015. Epub 2013 Sep 9.
The management of traumatic epistaxis is an important issue for maxillofacial trauma patients, because of their frequency and severity. We assessed a single use sterile hemostatic gel matrix (surgiflo© [SF], Floseal © [FS]) available for this indication.
Ten patients were managed between 2008 and 2012 by the same surgeon. The following data was documented for each patient: gender, age, mechanism of trauma or type of surgery, characteristics of epistaxis, the various hemostatic techniques used before using SF, and its effectiveness. The primary endpoint was SF effectiveness compared with usual techniques. The secondary endpoint was the evaluation of patient comfort compared to other hemostatic methods, using a visual analogue scale (VAS).
In nine out of ten cases, epistaxis was controlled after endonasal instillation of SF after failure of wicking, or double balloon catheter in first line treatment, or use of SF directly as first line treatment. The mean post procedure VAS was: 7/10 for wicking (eight patients), 9.3/10 for the double balloon catheter (three patients), 3.2/10 for SF (ten patients).
Our study highlights the effectiveness of hemostatic gel matrix in the management of post-traumatic epistaxis compared to usual methods. It also pointed out better patient comfort. A prospective comparative study on a larger cohort of patient would support the legitimacy of SF as first-line treatment for severe posttraumatic epistaxis.
由于创伤性鼻出血的发生频率和严重程度，其管理对于颌面创伤患者而言是一个重要问题。我们评估了一种可用于该适应症的一次性使用无菌止血凝胶基质（surgiflo© [SF]，Floseal © [FS]）。
2008年至2012年间，同一位外科医生对10例患者进行了治疗。记录了每位患者的以下数据：性别、年龄、创伤机制或手术类型、鼻出血的特征、在使用SF之前使用的各种止血技术及其有效性。主要终点是将SF的有效性与常规技术进行比较。次要终点是使用视觉模拟量表（VAS）评估与其他止血方法相比患者的舒适度。
在10例病例中的9例中，在一线治疗中采用棉条引流、双气囊导管失败后，或直接将SF作为一线治疗，经鼻内滴注SF后鼻出血得到控制。术后VAS的平均值为：棉条引流为7/10（8例患者），双气囊导管为9.3/10（3例患者），SF为3.2/10（10例患者）。
我们的研究强调了与常规方法相比，止血凝胶基质在创伤后鼻出血管理中的有效性。它还指出患者舒适度更高。对更大患者队列进行的前瞻性比较研究将支持SF作为严重创伤后鼻出血一线治疗方法的合理性。
