Objective To investigate the importance of out-of-hospital care after endoscopic surgery in patients with chronic rhinosinusitis, sinusitis and nasal polyps. Methods: To retrospectively summarize and analyze the effect of out-of-hospital care on the postoperative mucosal regression of 150 patients with chronic rhinosinusitis and nasal polyps after endoscopic surgery in our department from July 2004 to July 2006, and to further understand the important role of formal out-of-hospital care in improving the efficacy of surgery and reducing the recurrence rate after surgery. The results showed that 150 patients with chronic sinusitis and nasal polyps of all types had good surgical results after regular postoperative care. Conclusion For patients with chronic sinusitis and nasal polyps, surgery is only the first step of treatment, and postoperative out-of-hospital care in-hospital care is equally important . Yu Guojang, Department of Otolaryngology, Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University
Chronic sinusitis and nasal polyps are common diseases in otolaryngology, mostly caused by nasal diseases (such as deviated septum, nasal polyps, etc.) and excessive tiredness and cold. Nasal endoscopic sinus surgery is less traumatic and less painful, and has become the preferred segment for the surgical treatment of chronic rhinitis a sinusitis. It not only ensures the thoroughness of lesion removal, but also preserves the function of the nasal cavity and sinuses and reduces the local reaction after surgery. However, relying solely on surgery without paying attention to postoperative care does not lead to satisfactory long-term results. Most patients have little knowledge of postoperative care and are not able to provide standardized out-of-hospital care after discharge, which leads to postoperative cavity adhesions and even recurrence. In this paper, a retrospective study was conducted to summarize the out-of-hospital care of 150 cases of chronic sinusitis and nasal polyps after endoscopic surgery in our department from July 2004 to July 2006 and the effect on the regression of postoperative cavity mucosa, which is reported as follows.
1 Clinical data 1.1 General data 150 patients with chronic sinusitis and nasal polyps were collected from July 2004 to July 2006 in our department, including 92 males and 58 females; the youngest was 14 years old, the oldest was 70 years old, and the average was 45.7 years old. There were 12 cases of type I stage 1, 17 cases of type I stage 2, 29 cases of type I stage 3, 47 cases of type II stage 1, 32 cases of type II stage 2, 10 cases of type II stage 3, and 3 cases of type III, all of whom underwent CT scan before surgery.
1.2 Surgical method The Stryker nasal endoscope and imaging system from the United States were used. 143 cases were treated with local anesthesia and 7 cases with general anesthesia. According to the range indicated by the coronal/horizontal CT of the sinuses, the operation was guided by the Messerkings technique. Postoperatively, the nasal cavity was filled with iodine spun gauze. 2 Results ( Table 1 )
Table 1: Results of 150 patients with chronic sinusitis and nasal polyps
3 Nursing measures 3.1 Pre-operative nursing patiently and meticulously communicate with patients according to their specific conditions, explain disease related knowledge to patients in detail; assist patients to conduct several pre-operative examinations, quit smoking and alcohol, and ensure sufficient sleep.
3.2 Postoperative care (1) In-hospital care: postoperative semi-recumbent position, close observation of nasal bleeding, rinse the nasal cavity with saline 500ml plus gentamicin 80,000U from the next day 24 to 48 h after extraction of nasal gauze, once a day for about a week; (2) Out-of-hospital care: first of all, postoperative psychological guidance should be given to patients of different ages and cultural levels, explaining the advanced and scientific nature of surgery. (2) out-of-hospital care: first of all, post-operative psychological guidance should be provided to patients of different ages and cultural levels, explaining the advanced and scientific nature of the surgery, which is different from traditional surgery, eliminating patients’ nervousness and fear after discharge and enhancing their confidence in the efficacy of surgery. After nasal endoscopy, most patients are discharged from the hospital in a week or so. After the nasal gauze is withdrawn, the nasal mucosa is swollen, and coupled with the inflammatory stimulation of surgical trauma, there will be increased nasal obstruction, headache, dizziness, nasal frontal distension, wound pain and dry mouth, etc. We should explain to them in detail that these discomforts will gradually lighten, and take the initiative to give them psychological comfort. After the operation, many patients will breathe through the mouth because of nasal obstruction, so they need a good environment. Therefore, after discharge from the hospital, we should avoid strong light stimulation, keep quiet, temperature 18-20 degrees, humidity 70-80, close the door and windows when going to sleep, and avoid upper sensation. The nasal endoscopic surgery is only the first step in the treatment plan, and the epithelial regeneration starts slowly after the surgery. Epithelial regeneration is a longer process, and if the postoperative care is not proper, the lesion may regenerate and appear as vesicles, granules, polyps, connective tissue regeneration, etc., leading to incomplete epithelialization or adhesions, and even complete obstruction of the sinus opening and operative cavity. Postoperative cavity epithelialization takes an average of 10-14 weeks or even longer, and the patient’s hospitalization time is about one week, so in-hospital care alone is far from enough, and strengthening out-of-hospital care is especially important for patients with type II stage 2 or above and type III. After discharge from the hospital, the nasal cavity can be flushed with 500~1000 ml of mineral water once a day for 1~3 months. This can be supplemented with intranasal topical glucocorticoids. Studies have shown that long-term inflammatory stimulation of the nasal cavity and sinuses leads to significant capillary hyperplasia in the bone and mucous membrane, leukocyte infiltration in the inflammatory tissue, and increased release of inflammatory transmitters and cytokines, and glucocorticoids can block the occurrence of inflammation in the nasal cavity and sinuses by multiple routes. Therefore, co-corticosteroids can be given as morning nasal spray for 2 to 3 months after surgery, once a day. If the secretion is still a lot after discharge, self-treatment with appropriate antibiotics can be given until the symptoms are relieved. The diet should be advocated high protein, low fat, light diet, keep the bowels unobstructed, do not cough, blow the nose, rub the nose, spray, etc.; do not do strenuous exercise for 1 month to avoid inducing postoperative bleeding. During the dry season or when working in dust and other harmful gas environment, wear a mask to isolate pollution and keep the nasal cavity moist.
The treatment of chronic sinusitis and nasal polyps consists of a complete and comprehensive treatment process. Relying on nasal endoscopic surgery and postoperative in-hospital care alone without focusing on postoperative out-of-hospital care does not lead to satisfactory long-term outcomes. Postoperative out-of-hospital care plays a crucial role in reducing mucosal edema, timely removal of abnormal secretions, and reduction of secretion retention. Postoperative care is as important as surgery, and surgery is only half of the treatment, while most patients know little about postoperative out-of-hospital care, so postoperative follow-up and care has become a complex and long-term task for our medical workers. In this paper, through the study of 150 patients with chronic sinusitis and nasal polyps after nasal endoscopic surgery, we believe that surgery is only the first step of treatment for patients with chronic sinusitis and nasal polyps, and postoperative out-of-hospital care is as important as in-hospital care. It plays a very important role in reducing the recurrence rate of disease after surgery and improving the efficacy of surgery.