Application effect of modified nasal cavity tamping system in elderly patients after nasal endoscopic surgery
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摘要:目的 观察改良鼻腔填塞系统在老年患者(≥60岁)功能性鼻内镜术(FESS)术后鼻腔填塞的应用效果。方法 选取行FESS治疗的72例老年患者为研究对象，根据不同鼻腔填塞情况分为研究组(使用改良鼻腔填塞系统)38例和对照组(使用膨胀海绵)34例。比较2组术前1 h与术后6 h血压和心率，记录2组术后6 h收缩压、血氧饱和度(SpO2)、心率、视觉模拟评分法(VAS)评分、鼻腔出血情况。比较抽取填塞物时2组疼痛程度、出血情况、术后1个月和3个月鼻腔Lund-Kennedy评分。结果 研究组术后6 h收缩压、心率与术前比较，差异无统计学意义(P > 0.05); 对照组收缩压及心率均高于术前，差异有统计学意义(P < 0.05)。研究组术后6 h收缩压、心率低于对照组, SpO2高于对照组，差异有统计学意义(P < 0.05)。研究组术后6 h轻中度鼻腔胀痛不适患者占比高于对照组，重度鼻腔胀痛不适患者占比低于对照组，抽取鼻腔填塞物时轻度和重度疼痛患者占比高于对照组，中度疼痛患者占比低于对照组，差异有统计学意义(P < 0.05); 术后6 h, 2组鼻腔出血侧严重程度比较，差异无统计学意义(P>0.05); 研究组抽取填塞物时中重度出血侧占比低于对照组，差异有统计学意义(P < 0.05)。结论 改良鼻腔填塞系统用于老年人鼻内镜术后填塞可改善术后疼痛、鼻塞情况，显著降低因术后疼痛不适诱发心脑血管疾病的风险。
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关键词:
- 改良鼻腔填塞系统 /
- 老年人 /
- 功能性鼻内镜手术 /
- Lund-Kennedy评分
Abstract:Objective To observe the application effect of modified nasal cavity tamping system in elderly patients (≥60 years old) after functional endoscopic sinus surgery (FESS).Methods A total of 72 patients treated with FESS were selected as study subjects. According to different tamping of nasal obstruction, they were divided into study group (modified nasal obstruction system, 38 cases) and control group (expanded sponge, 34 cases). Systolic pressure and heart rates were compared 1 h before surgery and 6 h after surgery in the two groups. Systolic pressure, blood oxygen saturation (SpO2), heart rate, Visual Analog Scale (VAS) score and nasal blood loss conditions were recorded 6 h after surgery in the two groups. Pain degree, blood loss, and Lund-Kennedy scores were compared between the two groups at 1 month and 3 months postoperatively.Results At 6 hours after operation, the systolic pressure and heart rate in the study group showed no significant differences when compared with those before operation (P>0.05), while the systolic pressure and heart rate in the control group were significantly higher than before operation (P < 0.05). The systolic pressure and heart rate in the study group were lower and SpO2 was higher than those in the control group (P < 0.05). The proportions of patients with mild and moderate nasal distending pain and discomfort sensation 6 h after surgeryin the study group were higher than those in the control group, the proportions of patients with severe nasal distending pain and discomfort were lower than that in the control group (P < 0.05). The proportions of patients with mild and severe nasal pain were higher in the study group than those in the control group, and the proportions of patients with moderate pain were lower than those in the control group (P < 0.05). At 6 h after operation, there was no significant difference in the severity of the bleeding sides of the nasal cavity between the two groups (P>0.05). The proportions of moderate and severe bleeding sides in the study group were lower than those in the control group (P < 0.05).Conclusion The modified nasal filling system used for postoperative nasal endoscopic filling in the elderly can improve postoperative pain and nasal congestion, and significantly reduce the risk of occurrence of cardiovascular and cerebrovascular diseases caused by postoperative pain and discomfort. -
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表 1 2组收缩压、SpO2、心率水平比较(x±s)
组别 n 心率/(次/min) 收缩压/mmHg SpO2 < 95%频次/次 术前1 h 术后6 h 术前1 h 术后6 h 术后6 h 研究组 38 88.02±4.53 87.71±5.35# 127.33±6.60 126.46±5.77# 1.46±0.53# 对照组 34 88.06±4.64 97.46±6.08* 127.37±6.39 137.91±7.02* 1.80±0.57 SpO2: 血氧饱和度。与术前1 h比较, *P < 0.05; 与对照组比较, #P < 0.05。 
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表 2 2组术后疼痛、出血情况比较[n(%)]
指标 研究组(n=38) 对照组(n=34) 术后6 h鼻腔胀痛不适情况 轻度 23(60.52)* 20(58.82) 中度 11(28.95)* 4(11.76) 重度 4(10.53)* 20(58.82) 抽取填塞物时疼痛程度 轻度 20(52.63)* 11(32.35) 中度 13(34.21)* 19(55.88) 重度 5(13.16)* 4(11.77) 术后6 h鼻腔出血侧 轻度 44(77.19) 45(78.94) 中度 12(21.05) 11(19.30) 重度 1(1.76) 1(1.76) 抽取鼻腔填塞物时出血侧 轻度 53(89.83)* 43(72.88) 中度 6(10.17)* 13(22.03) 重度 0* 3(5.09) 与对照组比较, *P < 0.05。
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表 3 2组鼻黏膜水肿程度评分比较(x±s)
分 组别 侧数 术后1个月 术后3个月 研究组 70 7.72±2.66 5.32±3.02 对照组 64 7.87±2.33 5.51±2.97
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