老年严重鼻出血的解剖定位及分级治疗策略  

Anatomic localization and classified treatment on serious epistaxis in aged patients

作　　者：叶伟雄 陈勇挺[2] 彭华[2] 徐夏[2] 邓文婷[2] 

机构地区：[1]中国南方航空公司航空卫生中心,广东广州510000 [2]广州军区广州总医院耳鼻咽喉科,广东广州510010

出　　处：《局解手术学杂志》2015年第5期490-494,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：广东省自然科学基金(S2013040014929)

摘　　要：目的探讨老年严重鼻出血解剖定位、疾病特点及治疗策略。方法对134例严重的老年鼻出血患者进行鼻内镜下分区探查,定位出血点,采用分级治疗的方法止血。结果出血部位在鼻腔前上区2例（1.49%）、前下区44例（32.84%）、后上区18例（13.43%）、后下区22例（16.42%）、鼻咽部3例（2.24%）,出血部位不明的45例（33.58%）。全部患者一次住院均完全治愈,最终治疗方式采用药物保守治疗及局部微创烧灼或电凝止血（Ⅰ~Ⅲ级）46例（34.33%）,应用前鼻孔填塞（Ⅳ级）88例（65.67%）,后鼻孔填塞（Ⅴ级）9例（6.72%）,血管栓塞（Ⅵ级）1例（0.75%）。前部、后部以及出血部位不明的患者在采用初次止血方式即获成功82例（61.19%）,采用升级治疗获得成功52例（38.81%）。不同区域出血采取的止血方式以及是否有升级治疗均存在显著性差异（止血方式：χ2=16.35,P=0.00;升级治疗：χ2=16.35,P=0.00）。结论对于老年人难治性鼻出血,鼻内镜下分区定位,分级治疗可快速定位出血部位,止血效果好,创伤小,并可减少患者痛苦及降低治疗费用。Objective To explore the common bleeding location,disease features,and the management strategies of intractable aged epistaxis. Methods 134 serious epistaxis patients were examined step by step according to nasal anatomic structure and treated by a stepwise way under endoscopy. Results The bleeding location of the intractable aged epistaxis were found as follows： 2 cases（ 1. 49%） in anterosuperior area,44 cases（ 32. 84 %） in anteroinferior area,18 cases（ 13. 43%） in posterosuperior area,22 cases（ 16. 42%） in posteroinferior area,3 cases（ 2. 24%） in nasopharynx,and the bleeding site of the other 45 cases（ 33. 58%） were not found. All the patients were healed. The final treatment way were： 46 cases（ 34. 33%） with pharmacotherapy or cauterization（ grade Ⅰ ~ Ⅲ）,88 cases（ 65. 67%）with anterior nasal packing（ grade Ⅳ）,9 cases（ 6. 72%） with posterior packing（ grade Ⅴ）,1 case（ 0. 75%） with selective angiographic embolization（ grade Ⅵ）. There were 82 cases（ 61. 19%） succeed with the initial hemostasis methods while 52 cases（ 38. 81%） succeed with the upgrade therapy. Both hemostasis methods and upgrade therapy had statistical significance in different nasal position groups（ hemostasis methods： χ2= 16. 35,P = 0. 00; upgrade therapy： χ2= 16. 35,P = 0. 00）. Conclusion Compartmental examination and classified treatment steps by using endoscope may locate and stop nose bleeding promptly while decrease patients＇ pain and medical cost.

关 键 词：鼻出血 老年人 解剖 分级治疗 

分 类 号：R765.23[医药卫生—耳鼻咽喉科]