摘要：
[目的]比较慢性鼻-鼻窦炎(CRS)患者行功能性鼻内镜术后三种材料填充的止痛及止血效果.[方法]选择本院2013年7月至2015年12月收治的93例CRS患者作为研究对象,按随机数字表分为A组、B组与C组,各31例.三组患者均行功能性鼻内镜手术,A组术后应用凡士林纱条填充止血,B组应用AVF膨胀止血海绵止血,C组应用自制辅舒良胶原蛋白海绵止血.比较三组术后4h、12 h、24 h、48 h的疼痛视觉模拟评分(VAS)、术后出血率、黏膜上皮化进程及不良反应发生率.[结果]三组中术后4h、12 h、48 h的疼痛VAS评分均为C组最低,显著低于B组与A组对应时刻的疼痛VAS评分(均P＜0.05),同时B组也高于A组(P＜0.05);A、B、C三组的术后出血率分别为71.0％、64.5％、54.8％,两两比较均无统计学意义(P＞0.05);三组术后3个月及6个月的术腔黏膜上皮化率均为C组最高,高于A组及B组(均P ＜0.05),A、B两组间的差异则无统计学意义(P＞0.05);三组均未见填充相关性不良反应.[结论]CRS功能性鼻内镜术后应用凡士林纱条、膨胀止血海绵与自制辅舒良胶原蛋白海绵进行填充止血的止血效果接近,但自制辅舒良胶原蛋白海绵的止痛效果更佳,且利于术腔黏膜上皮化,临床应用价值更大.%[Objective]To compare acesodyne and hemostatic effects of three filling materials after function endoscopic sinus surgery in patients with chronic rhinosinusitis (CRS).[Methods] A total of 93 patients with chronic rhinosinusitis treated in our hospital from July 2013 to December 2015 were selected as the research objects.They were divided by random number table into group A,B and C (with 31 cases in each group).Function endoscopic sinus surgery was performed in all patients,vaseline gauze was used as filling materials to stop bleeding after the operation in group A,AVF expansion hemostatic sponges were used in group B,and self-made flixonase collagen sponges were used in group C.Pain VAS score,postoperative bleeding rate,epithelial process and adverse reaction rate at postoperative 4h,12h,24h,48h in the three groups were compared.[Results] Group C was the lower than both groups A and B in VAS pain scores at postoperative 4h,12h,48h among the three groups,and the differences were statistically significant (P ＜0.05).The scores of groups A,B and C were (5.4±0.7)score,(4.7±0.5)score,(3.3±0.4)score respectively.The score in group B was high-er than group A (P ＜0.05).Postoperative bleeding rates of group A,B and C were 71.0％,64.5％,54.8％ respectively;there were no significant differences (P ＞0.05).Among the three groups,group C was the highest in mucous epithelization of operative cavity rate 3 months and 6 months after the operation;they were 71.0％,96.8％ respectively,which were higher than group A and B (all P ＜0.05),while there was no significant difference in group A and B (P ＞ 0.05).No filling related adverse reactions occurred in the three groups.[Conclusion] Hemostatic effect of vaseline gauze,AVF expansion hemostatic sponges and self-made flixonase collagen sponges to stop bleeding after chronic rhinosinusitis function endoscopic sinus surgery is similar,but the acesodyne effect of self-made flixonase collagen sponges is the most desirable.It is conducive to mucous epithelization of operative cavityand has the greatest clinical application value.
