慢性鼻-鼻窦炎术后三种不同填塞方法对患者不适感的影响  

The uncomfortable influence of three nasal packing on postoperative patients of chronic rhinosinusitis

作　　者：丁锋[1] 王然然 刘艳[1] 李波蓬 蔡洁[1] 杨莎莎[1] 刘雪萍 DING Feng;WANG Ranran;LIU Yan;LI Bopeng;CAI Jie;YANG Shasha;LIU Xueping(Department of Otolaryngology,Hankou Hospital of Wuhan,Wuhan,430012,China)

机构地区：[1]武汉市汉口医院耳鼻咽喉科,430012 [2]武汉市红十字会医院

出　　处：《中国中西医结合耳鼻咽喉科杂志》2018年第5期354-358,369,共6页Chinese Journal of Otorhinolaryngology in Integrative Medicine

摘　　要：目的探讨在慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)术后分别用凡士林纱条、膨胀海绵、Sorbalgon藻酸钙敷料进行鼻腔和术腔填塞对患者不适感的影响。方法 126例患者随机分为A、B、C三组,A组42例术腔和鼻腔均用凡士林纱条填塞;B组42例术腔用藻酸钙敷料填塞,鼻腔用膨胀海绵填塞;C组42例术腔和鼻腔均用藻酸钙敷料填塞。采用视觉模拟量表(visual analogue scale,VAS)分别对三组患者术后第1天和第2天的鼻塞、鼻部疼痛、头痛、睡眠影响及抽取填塞物时疼痛感进行评分,记录患者使用双氯灭痛栓(50mg/粒/次)和艾司唑仑片(2mg/次)的次数、72h内出血量、咽后壁异物感发生数。结果术术后第1天和第2天,三组患者的鼻塞、鼻痛、头痛、睡眠影响的评分中,C组均低于A、B组,差异均有统计学意义(均P<0.05)。C组患者使用双氯灭痛栓和艾司唑仑的数量均低于A、B组,差异均有统计学意义(P<0.05),A组和B组差异无统计学意义(P>0.05)。三组患者术后出血量分别为(12.64±5.27)ml、(12.07±4.94)ml、(10.19±6.28)ml,差异无统计学意义(P>0.05)。术后患者出现咽后壁异物感的数量分别是A组17例、B组0例、C组11例,B组的发生率明显低于A、C组,差异均有统计学意义(P<0.05),A组与C组差异无统计学意义(P>0.05)。三组患者术后抽取鼻腔填塞物时疼痛感VAS评分,C组明显低于A、B组,A组低于B组,差异均有统计学意义(P<0.05)。结论 CRS术后鼻腔和术腔填塞藻酸钙敷料可有效止血,术后所致的疼痛、鼻塞、睡眠障碍等不适感评分均优于凡士林纱条和膨胀海绵,术后可减少止痛药物和镇静药物的使用,可有效改善术后患者的舒适度,提高患者术后的生活质量。Objective To compare the uncomfortable influence of nasal packing with vaseline gauze, expansive sponge and Sorbalgon strips on the postoperative patients of chronic rhinosinusitis （CRS）. Methods Total of 126 patients being randomly divided in 3 groups, who were investigated on their postoperative comfort, namely, A group （42 patients, the operation cavity and nasal cavity were filled with vaseline gauze）, B group（42 patients, the operation cavity was filled with Sorbalgon strips and nasal cavity was filled with expansive sponge） and C group （42 patients, the operation cavity and nasal cavity were filled with Sorbalgon strips）. A visual analogue scale（VAS） was used to score three groups of patients with nasal obstruction, rhinodynia, headache, sleeping and pain of extracting packing material during the first and second days after operation. Recording the numbers of diclofenac suppository （50mg/granule/times） and estazolam （2mg/times） used by patients, the amount of nasal bleeding in 72 hours, and the number of foreign body sensation occurred in the posterior pharyngeal wall. Results The scores of nasal obstruction, rhinodynia, headache and sleeping in group C were significantly lower than those in group A and group B （P〈0.05）. The numbers of diclofenac？suppository and estazolam in group C were significantly lower than those in group A and group B （P〈0.05）, but there was no statistically significant difference between group A and group B （P〉0.05）. The postoperative hemorrhage in three groups were （12.64±5.27） ml, （12.07±4.94） ml, and （ 10.19±6.28） ml, respectively, the differences were not significantly significant （P〉0.05）. The number of patients with postoperative posterior pharyngeal peculiar sense were 17 cases, 0 case, and 11 cases, respectively, and the incidence of group B was significantly lower than group A and group C （P〈0.05）, but group A and group C had no significantly difference （P〉0.05）. The pain VAS scores of group C w

关 键 词：鼻窦炎 鼻腔填塞 藻酸钙敷料 凡士林纱条 膨胀海绵 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]