von Schoenberg M, Robinson P, Ryan R
Ferens Institute, Middlesex Hospital, London.
J Laryngol Otol. 1993 Oct;107(10):902-5.
Ninety-five patients undergoing routine nasal surgery were enrolled into a randomized, prospective trial to investigate the efficacy and morbidity of nasal packing. The patients were randomized to receive a bismuth iodoform paraffin paste (BIPP) pack, a Telfa pack or no pack. Patients for septal surgery were randomized between the BIPP and Telfa groups only. They were independently randomized to receive or not receive, a silastic nasal splint for the first post-operative week. Post-operative pain levels were analysed using a visual analogue scale. Mean pain scores were increased 50 per cent by the use of nasal packs and pack removal, particularly BIPP which, was a most painful event (p < 0.001). Reactionary haemorrhage occurred in only two patients (2.1 per cent), both of whom had packs in situ. Vestibulitis was unique to the patients with a silastic splint, who were packed with BIPP, occurring in 21 per cent of them. Similarly septal perforation was unique to this group. There was no significant difference in the incidence of adhesions between the groups which received packs and those who did not. Routine nasal packing, especially with BIPP, would seen difficult to justify in view of the increased pain levels and increased complications which occur without any demonstrable benefit in the majority of patients. Therefore packing should be reserved for cases where there is concern about persistent haemorrhage. In these cases Telfa would be preferable to BIPP.
95例行常规鼻腔手术的患者被纳入一项随机前瞻性试验，以研究鼻腔填塞的疗效和并发症。患者被随机分为接受铋碘仿石蜡糊剂（BIPP）填塞、特氟纶填塞或不填塞。仅行鼻中隔手术的患者在BIPP组和特氟纶组之间随机分组。他们被独立随机分为在术后第一周接受或不接受硅胶鼻夹板。使用视觉模拟量表分析术后疼痛程度。使用鼻腔填塞物和取出填塞物会使平均疼痛评分增加50%，尤其是BIPP，这是最痛苦的事件（p<0.001）。仅2例患者（2.1%）发生继发性出血，这2例患者均有填塞物在位。前庭炎仅发生在使用硅胶夹板且用BIPP填塞的患者中，发生率为21%。同样，鼻中隔穿孔也仅发生在该组。接受填塞的组与未接受填塞的组之间粘连发生率无显著差异。鉴于疼痛程度增加和并发症增多，而大多数患者又无明显益处，常规鼻腔填塞，尤其是使用BIPP填塞，似乎难以成立。因此，填塞应仅用于担心持续出血的病例。在这些情况下，特氟纶比BIPP更可取。
