摘要
目的:鼻内窥镜手术后填塞止血材料的选择是鼻内镜外科技术中的重要组成部分。分析几种填塞止血材料的生物学特性及作用的局限性,并与传统的凡士林纱条相比较。方法:应用计算机检索中国期刊全文数据库1999-01/2007-06有关止血材料的理化性能、止血性能及其在鼻内镜手术中应用的相关研究文章,检索词"凡士林纱条,高膨胀止血棉,无痛止血海绵,藻酸钙敷料,明胶海绵,生物相容性,鼻内窥镜"。纳入标准:①凡士林纱条、Merocel高膨胀止血棉、Ivalon无痛止血海绵、Sorbalgon藻酸钙敷料及明胶海绵的在鼻内镜手术后的应用的原著类文章。②不同类型止血材料的性能、生物相容性、安全性评价的研究文章。排除重复研究。符合纳入标准的文献30篇。结果:①Merocel高膨胀止血棉与Ivalon无痛止血海绵均为高分子合成的高膨胀止血材料,质地柔韧,有高度亲水性,吸收液体后迅速膨胀压迫出血区,可塑性强,并且可以作为药物载体,减轻炎症反应。填塞后黏膜损伤、炎症反应等全身反应情况较凡士林纱条轻,其不足之处在于产生的压力强度有限,较剧烈的出血得不到有效控制。②Sorbalgon藻酸钙敷料由柔软的海藻与酸钙纤维制成,有良好的生物相容性、顺应性和很强的亲水性,当其与血液和伤口分泌物中的钠盐接触时,即转化为一种凝胶状物质,起到较好的止血作用。填塞后的疼痛、头痛及鼻腔黏膜水肿反应优于凡士林纱条。由于藻酸钙敷料过于柔软,遇水后液化迅速,缺乏韧性和弹性,因此压迫力度不够。③明胶海绵组织相容性好,对人体无明显毒副作用,无抗原性,不会产生过敏反应,但存在压力不够的缺陷。与凡士林纱条一起使用,可以克服单纯胶原蛋白海绵填塞压力不足的缺点,避免了凡士林纱条与创面的直接接触,减少填塞后出血。结论:不同填塞止血材料各有所长,也各有其局限性,可根据患者的具体情况,结合不同止血材料的生物学特性,选择不同材料实行混合填塞和重点填塞。
AIM： Packing hemostatic material after endoscopic sinus surgery is very important in the surgery. This study investigated the biological characters and limitations of several packing hemostatic materials, and compared them with traditional vaseline gauze. METHODS： A computer-based online search of CNKI database was undertaken to identify articles about the physicochemical and hemostatic properties and the application of hemostatic material in endoscopic sinus surgery dated from January 1999 to June 2007 with the keywords of ＂vaseline gauze, highly expansive sponge, painless hemostatic sponge, calcium alginate dressing, gelatin sponge, biocompatibility, nasal endoscope＂ in Chinese. All （1）original articles about the application of vaseline gauze, Merocel highly expansive sponge, Ivalon painless hemostatic sponge, Sorbalgon calcium alginate dressing, and gelatin sponge in endoscopic sinus surgery and （2） articles about the property, biocompatibility, and safety of various hemostatic materials were selected. Repetitive studies were excluded. Thirty articles were in accordance with the inclusive criteria. RESULTS： （1）As polymer highly expansive hemostatic materials, Merocel highly expansive sponge and Ivalon painless hemostatic sponge have soft texture, high hydrophilicity, which make them compress the hemorrhage region after absorbing liquid, and strong plasticity. They can serve as drug carrier to lessen inflammatory reaction. Moreover, the general reactions such as mucosal injury and inflammatory reaction after packing are lighter than vaseline gauze. However, their pressure intensity cannot effectively control massive hemorrhage. （2）Sorbalgon calcium alginate dressing is composed of soft algae and calcium fiber. It has good biocompatibility, compliance, and strong hydrophUicity. The gelatinous substance forms when the dressing is in contact with blood and wound secretion, and presents hemostatic effect. The pain, headache, nasal mucosal edema and other symptoms caused by packing are superior to vaseline gauze. However, because the dressing is too soft and lacking of plasticity, the pressure intensity is weak. （3）With good histocompatibility, gelatin sponge does not have obvious toxic effect, adverse effects, or antigenicity, but the pressure intensity is weak. The pressure is increased when the sponge is used with vaseline gauze. Moreover, this method avoids the direct touch of vaseline gauze with wound, and reduce hemorrhage after packing. CONCLUSION： Because different hemostatic materials have their advantages and limitations, it is better to select the material according to the condition of patients and the biological characters of materials.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第48期9801-9804,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
