Altaf Jawairia, Ashfaq Ahmed Hasan, Riaz Nida, Arshad Muhammad, Ayub Nayyer, Rehman Abdur, Maqbool Shahzaib
Department of ENT and Head and Neck Surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan.
HBS Medical and Dental College, Islamabad, Pakistan.
Eur Arch Otorhinolaryngol. 2025 Jan;282(1):235-240. doi: 10.1007/s00405-024-09005-0. Epub 2024 Oct 1.
Control of bleeding is very important during endoscopic sinus surgery. Saline heated up to 50 °C causes dilatation of vessels and edema without nasal mucosa necrosis. It also promotes the clotting cascade so helps in having a bloodless procedure.
This randomized controlled trial was conducted on 60 patients divided into two groups (30 each). Group A was the interventional group in which patients were irrigated with saline of 50 °C during surgery. Group B was the control group where room-temperature saline was used. The operative field was assessed using the Boezaart score, duration of surgery, and bleeding in ml.
The Boezaart score in group A came out to be 2.23 ± 0.72 whereas it was 3.43 ± 0.72 in group B. Most of the patients who were in the interventional group had their surgery completed within 60 min with comparatively less bleeding (mean bleeding = 221.83 ml). Patients of the control group had increased duration of surgery mostly and bleeding (mean = 265.67 ml). Our study showed a strong correlation amongst the Boezaart score, duration of surgery, and bleeding in ml with a p value of < 0.001 where all three variables significantly improved in the interventional group due to a good operative field provided by warm saline heated up to 50 °C.
Normal saline heated up to 50 °C is a cost-effective way to achieve a bloodless operative field during endoscopic sinus surgery. Reduced bleeding also decreases the duration of surgery.
在内镜鼻窦手术中控制出血非常重要。加热至50°C的生理盐水会导致血管扩张和水肿，而不会引起鼻黏膜坏死。它还能促进凝血级联反应，因此有助于实现无血手术。
本随机对照试验对60例患者进行，分为两组（每组30例）。A组为干预组，手术期间用50°C的生理盐水冲洗患者。B组为对照组，使用室温生理盐水。使用博扎尔特评分、手术时间和出血量（毫升）来评估手术视野。
A组的博扎尔特评分为2.23±0.72，而B组为3.43±0.72。干预组的大多数患者在60分钟内完成手术，出血相对较少（平均出血量=221.83毫升）。对照组患者的手术时间大多延长，出血量增加（平均=265.67毫升）。我们的研究表明，博扎尔特评分、手术时间和出血量（毫升）之间存在很强的相关性，p值<0.001，由于加热至50°C的温生理盐水提供了良好的手术视野，干预组的所有三个变量均有显著改善。
加热至50°C的生理盐水是在内镜鼻窦手术中实现无血手术视野的一种经济有效的方法。减少出血也会缩短手术时间。
