Endoscopically Guided Chitosan Nasal Packing for Intractable Epistaxis
Endoscopically Guided Chitosan Nasal Packing for Intractable Epistaxis
复制标题
内镜引导下壳聚糖鼻填塞治疗顽固性鼻出血
DOI：
10.2500/ajra.2011.25.3539
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发表时间：
2011
影响因子：
2.6
通讯作者：
Mohannad Alqudah
中科院分区：
文献类型：
--
作者：
Alan H. Shikani;K. Chahine;Mohannad Alqudah
背景本研究的目的是评估内镜引导下壳聚糖填塞控制顽固性鼻出血的有效性和安全性。进行了前瞻性病例系列研究。方法 这是一项于 2009 年 1 月至 2009 年 11 月在三级鼻科专科培训医院进行的前瞻性临床研究。研究人群包括使用 10 厘米 Pope PVA Merocel 或 Rapid-Rhino 进行传统前后鼻填塞均无效的顽固性鼻出血患者。使用鼻内窥镜识别出血部位，并使用包裹着聚乙烯醇缩醛鼻海绵的 ChitoFlex 壳聚糖敷料制成的包进行控制。结果 意向治疗人群包括 20 名严重鼻出血受试者（8 名男性和 12 名女性），尽管采用传统的前后鼻填塞术，但仍继续出血。平均年龄为 67 岁（±19 岁）。十六名受试者服用抗血小板剂和/或抗凝剂。 11 名受试者 (55%) 出现前鼻出血，7 名受试者 (35%) 出现后鼻出血。壳聚糖鼻腔填塞在门诊进行，19/20 的受试者（95%）获得了有效且立即的止血效果。一名受试者在第一次包装尝试后出现持续出血，并在 30 分钟内成功重新包装。 19 名受试者完全停止出血的时间为 3.6 ± 2.2 分钟； 48 小时后将包袋取出，没有任何再出血或任何严重副作用的证据。结论 内镜引导下壳聚糖填塞治疗顽固性鼻出血是一种安全、有效、耐受性良好的门诊治疗方法。
Background The purpose of this study was to evaluate the effectiveness and safety of endoscopically guided chitosan packing in controlling intractable epistaxis. A prospective case series was performed. Methods This is a prospective clinical study conducted in a tertiary rhinology fellowship training hospital between January 2009 and November 2009. The study population consisted of patients with intractable epistaxis that failed to respond to traditional anterior–posterior nasal packing using either a 10-cm Pope PVA Merocel or a Rapid-Rhino. The bleeding site was identified using a nasal endoscope and controlled using a pack made of a ChitoFlex chitosan dressing wrapped around a polyvinyl acetal nasal sponge. Results The intent-to-treat population consisted of 20 severe epistaxis subjects (8 men and 12 women) who continued to bleed despite traditional anterior–posterior nasal packing. The mean age was 67 years (±19 years). Sixteen subjects were on antiplatelets and/or anticoagulants. Eleven subjects (55%) presented with anterior epistaxis, and 7 subjects (35%) presented with posterior epistaxis. Chitosan nasal packing was performed on an outpatient basis and resulted in effective and immediate hemostasis in 19/20 subjects (95%). One subject had persistent bleeding after the first packing attempt and was successfully repacked within 30 minutes. Time to complete cessation of bleeding was 3.6 ± 2.2 minutes in the 19 subjects; the pack was removed after 48 hours, without any evidence of rebleeding or any serious side effects. Conclusion Endoscopically guided chitosan packing is a safe, effective, and well-tolerated outpatient treatment for the management of intractable epistaxis.