鼻腔深部难治性鼻出血临床分析  

Clinical analyses of patients with intractable epistaxis originated from deep-seated nasal cavity

作　　者：许彤[1] 李娜[1] 姜彦[1] 于海玲[1] 于龙刚[1] 姜叶 

机构地区：[1]青岛大学医学院附属医院耳鼻咽喉头颈外科,266003

出　　处：《中华耳鼻咽喉头颈外科杂志》2015年第7期556-559,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的 探讨鼻腔深部难治性鼻出血的临床特点、治疗方法及疗效.方法 回顾性分析青岛大学医学院附属医院耳鼻咽喉头颈外科2008年6月至2014年6月因鼻腔深部难治性鼻出血入院治疗的195例患者的临床资料,分析常见危险因素、出血部位、治疗方法及疗效等.以SPSS 17.0软件进行统计分析.结果 195例患者中男性162例,女性33例;年龄15 ～ 88岁,平均（52±16）岁;单侧出血187例（95.9％）,双侧出血8例（4.1％）.合并高血压病或入院测得血压高于正常值者126例（64.6％）.经镇静、降压及支持疗法治愈8例.余187例均在全身麻醉下行内镜下鼻腔探查止血术,其中一次探查止血治愈184例（98.4％）,二次探查止血治愈3例（1.6％）;未明确出血点予鼻腔填塞止血13例,有明确出血点并行电凝止血174例;单一出血部位127例,2处及以上出血部位47例,共记录出血部位222处.常见出血部位依次为：下鼻道后部74处（33.3％）,嗅裂区中隔面59处（26.6％）,中鼻甲根部31处（14.0％）.高血压、糖尿病是危险因素（OR值分别为3.411、7.142,P值均＜ 0.05）结论 入院治疗的鼻腔深部难治性鼻出血患者男性多于女性,单侧鼻出血多于双侧;高血压病为常见合并症;鼻内镜下鼻腔探查电凝止血术是行之有效的治疗方法.Objective To investigate the clinical features and management of intractable deep-seated epistaxis.Methods Clinical data were analyzed retrospectively in 195 patients with intractable deep-seated epistaxis treated in Affiliated Hospital of Qingdao College between June 2008 and June 2014.The analyses included common risk factors,bleeding sites,treatments and therapeutic effects.SPSS 17.0 software was used to analyze the data.Results There were 162 males and 33 females,aged from 15 to 88 years old （mean 52 16 years）.One hundred and eighty-seven cases （95.9%） were unilateral and 8 cases （4.1%） were bilateral.One hundred and twenty-six eases （64.6%） had the history of hypertension or blood pressure higher than normal on admission.Eight patients were cured by nasal packing and appropriate drugs,and 187 patients were treated by endoscopy and electrocoagulation.The numbers of treatment needed to stop bleeding were 1 time in 184 cases（98.4%）,2 times in 3 cases（1.6%）.Thirteen cases did not have certain bleeding point,while the other 174 had certain one or more bleeding sites.The rewarded bleeding sites were 222,which were found in the following different sites：posterior inferior nasal meatus （33.3%,74/222）,olfactory cleft of nasal septum （26.6%,59/222）,the root of the middle turbinate （14.0%,31/222）,and so on.Hypertension and diabetes were risk factors（OR value was 3.411,7.142,both P 〈 0.05）.Conclusions Intractable deep-seated epistaxis are mainly found in males and are almost unilatera1.Hypertension and diabetes are the common risk factor.The most effective and safe treatment for intractable deep-seated epistaxis is electrocoagulation under nasal endoscopy.

关 键 词：鼻出血 内窥镜检查 电凝术 治疗结果 

分 类 号：R765.23[医药卫生—耳鼻咽喉科]