| BackgroundFunctional nasal endoscopic surgery(FESS)for the 1990 s the rise of a technology,the traditional radical surgery is a according to the extent of the lesion,on the basis of clear lesions,as much as possible,keep the nose,sinuses and normal mucosa structure,good ventilation and drainage,promote the morphology and physiological function of nasal sinus mucosa recovery,more and more widely used in clinical,functional nasal bleeding during nasal endoscopic surgery is the most common problems.Clinically often face serious hemorrhage surgical profile often shows the whole or partial surgical wound blood extravasation,like sweating,can not find a definite haemorrhage,Except to consider systemic factors caused by the reasons and with the increase of blood capillary permeability of the local abundant capillaries and have obvious relations,in correcting the whole body blood coagulation dysfunction and,on the basis of blood pressure,an electrocautery unit,such as still cannot achieve hemostasis,use of topical hemostatic agent can achieve an immediate effect.Except to consider systemic factors caused by the reasons and with the increase of blood capillary permeability of the local abundant capillaries and have obvious relations,in correcting the whole body blood coagulation dysfunction and,on the basis of blood pressure,an electrocautery unit,such as still cannot achieve hemostasis,use of topical hemostatic agent can achieve an immediate effect.Hydrochloric acid cerlords thiazole moiety is an effective local nasal vasoconstrictor,direct effects on the nasal mucosa of alpha adrenergic receptors,especially 2 receptor alpha,make the small blood vessels constrict produces vasoconstriction,reducing blood flow and nasal congestion,nasal cavity and a vasoconstrictor quickly,small side effects,long duration,side effects and little effect after or without dilate blood vessels and has as over-the-counter drugs are widely used in clinical,abroad to replace ephedrine,many clinical and experimental study confirmed that it has a good therapeutic effect.Objective1 Hydrochloric acid cerlords thiazole moiety in functional hemostatic effect of nasal endoscopic surgery were observed;2 Hydrochloric acid cerlords thiazole moiety in functional nasal endoscopic surgery in drug safety,the effect of vasoconstriction,drug effect time for related research;MethodsExperiment part: select 30 SD health rabbit,male and femaleunlimited,1.3 4 kg weight were randomly divided into 3 groups,adopt the maxillary sinus is not completely blocked + sinus cavity lien batt improved modeling method,establishing the model of chronic sinusitis biological,After 10 days or so,ethology score: pus stuff,symptoms such as sneezing,conjunctival edema,congestion,nasal mucosal resection on the subjects for,three groups of rats were injected with 0.05% hydrochloric acid arcelor azole Lin,0.05 ‰ and adrenaline saline.Intraoperative blood loss using attractor collection,less blood loss and blood retention aspirator pipe secondary factors,add 100 ml saline absorption,the bleeding by collecting liquid total income minus 100 ml,compared by the method of container(unit: ml).Cannot use the attractor's collection of blood,wipe with a sterile dressing vampire dressing minus the hemostatic before the original weight,the weight of the contrast with weighing method(unit: g),postoperative nasal cavity filling,postoperative blood loss padded out by 24 h after nasal dressing weight minus to use before dressing(unit: g),the weight of the nasal mucosa and skin at the junction of the rear 0.3--0.5 cm,obtain the nasal mucosa specimens made nasal mucosal vascular tissue section observation on each vasoconstriction.Clinical part: choose from 2016,200 cases of outpatient and hospitalization 40 patients with nasal endoscopy ? type in patients with stage 3 chronic sinusitis surgery in hospital,as the subjects.Any age 18-45 years of age,gender,patients with nasal surgery for the first time,all exclusion criteria: coronary heart disease,high blood pressure,atrioventricular block and diabetes.Patients with nasal endoscope inspection group: the same,on the left side of the nasal cavity by the los thiazole moiety nasal spray nasal contraction cotton piece,and on the right of the nasal adrenaline nasal contraction processing cotton piece,every time 3 min.Are completed by the same physician and the same nasal endoscopy,VAS evaluation standard: 0 to 10,0: painless;The following three points: a mild pain,patients can endure;4 a six points: patients pain and affect morpheus,tolerable;A 10 points,7 patients have gradually intense pain,pain.Compared two groups of nasal mucosa contraction in patients with bilateral nasal comfort.Inpatient treatment: random grouping method of 40 patients ? type iii is divided into two groups,patients with chronic sinusitis surgery in hospital on all of the patients after into the operating room,regular monitoring ecg,noninvasive blood pressure,etc.,in the two groups respectively to 0.05% arcelor thiazole moiety cotton piece and 0.05 ‰ adrenaline cotton piece for nasal mucosal surface shrinkage,observation group nasal contraction,with nasal endoscopic screenshots,intraoperative respectively record the los thiazole moiety and adrenaline group before medication,medication after 5 min,15 min,30 min,blood pressure,heart rate changes,at the same time observation of the maxillary sinus after fully open,put 0.05% los thiazole moiety cotton piece and a 0.05 ‰ adrenaline cotton piece to observe the hemostatic effect,and with nasal endoscopic screenshots,records in the two groups respectively within 6 h after surgery the bleeding time and the cavity secondary tamping cases,observation group hemostatic effect,duration,and safety.Results1.Three groups of rabbit in functional nasal endoscopic surgery,applying the los thiazole moiety group A and group B adrenaline and normal saline group C,the intraoperative blood loss,intraoperative blood dressing and postoperative blood loss,there was no significant difference compared with group B,group A group A and group B and group C intraoperative blood loss,intraoperative blood dressing and significant differences in postoperative blood loss compared,statistically significant,P < 0.05)in functional nasal endoscopic surgery in hydrochloric acid thiazole moiety of hemostatic effect and the adrenaline the hemostatic effect of P > 0.05,no significant difference,than the blank control group.2.Outpatient nasal endoscopic examination,the same patients,"the left nasal cavity with 0.05% of los thiazole moiety cotton piece of nasal mucosa contraction,on the right side of the nasal cavity to 0.05 ‰ adrenaline cotton piece of nasal mucosa contraction,both to cotton piece of moist but not drop out of the solution for the degree of mild extrusion,pain VAS score,P < 0.05,cerlords thiazole moiety comfort is better than that of epinephrine group.3.Functional nasal endoscopic surgery,the maxillary sinus with 0.05% respectively the los thiazole moiety cotton(group A)and 0.05 ‰ adrenaline cotton piece(group B)contraction bleeding,observation of nasal endoscopic screenshot shows: there was no evident difference degree of two groups of nasal mucosa contraction,intraoperative can keep good operation field.4.In the two groups after 5 min,15 min,30 min,blood pressure,heart rate changes the comparison results,two groups are different degrees of elevated blood pressure,heart rate,the average blood pressure rise adrenaline group were not more than 35 MMHG,heart rate,the average heart rate rise is not more than 25 times/min,cerlords thiazole moiety group average blood pressure also have varying degrees of rise,but has not been in more than 20 MMHG,heart rate has not been the average rise more than 15 times/min.Two groups of blood pressure,heart rate comparison before medication(P > 0.05,two group in blood pressure,heart rate changes after medication is P < 0.05,this research that intraoperative cerlords thiazole moiety security than the adrenaline group.5.Intraoperative observation,cerlords thiazole moiety group no 1 case in nasal mucosal hyperemia,swelling,reflective adrenaline group has 3 cases appeared in 1.5-2.0 h after drug nasal mucosal hyperemia,swelling,reflective,need to secondary nasal contraction before surgery,P < 0.05,with statistical significance.6.Cerlords thiazole moiety and adrenaline group within 6 h after cavity bleeding time,for the first time to the secondary tamping cases,two groups of no 1 cases with secondary nasal cavity filling,P > 0.05,no statistical significance.Conclusions1.In functional nasal endoscopic surgery in hydrochloric acid thiazole moiety of hemostatic effect,and the hemostatic effect of adrenaline.2.In nasal endoscopy with the los thiazole moiety cotton piece surface anesthesia treatment than 0.05 ‰ adrenaline cotton piece surface anesthesia processing comfort level is higher,and drug safety.3.In functional nasal endoscopic surgery using the los thiazole moiety cotton piece of nasal contraction processing relative to 0.05 per thousand adrenaline nasal contraction processing cotton piece;Quick time,lasting time,avascular bounce,etc.4.All cases,regardless of the application of nasal endoscopy or applied to functional nasal endoscopic surgery,hydrochloric acid and thiazole moiety hemostatic effect fast,long duration and drug safety is higher,is worth popularizing practice. |
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