经腭大孔翼腭窝肾上腺素盐水注射在慢性鼻-鼻窦炎内镜手术中的应用研究  

Research ofpterygopalatine fossa infiltration with adrenalinethrough the greater palatine foramen in endoscopic surgery for chronic sinusitis

作　　者：魏欣[1] 粘家斌[1] 郑静[1] WEI Xin;NIAN Jiabin;ZHENG Jing(Department of Otolaryngology Head and Neck Surgery,Hainan General Hospital,Haikou,Hainan,570311,China)

机构地区：[1]海南省人民医院耳鼻咽喉头颈外科

出　　处：《中国耳鼻咽喉头颈外科》2019年第12期652-654,共3页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：国家自然科学基金地区科学基金项目(81760186、81760187);海南省重点研发计划项目(ZDYF2017115);海南省自然科学基金项目(818MS8130)

摘　　要：目的了解经腭大孔翼腭窝肾上腺素盐水注射是否可以减少慢性鼻窦炎内镜手术中的出血,探讨可能起效的注射浓度及剂量。方法选择需进行全组鼻窦开放的慢性鼻-鼻窦炎伴鼻息肉患者20例,均经腭大孔翼腭窝肾上腺素盐水单侧注射,同一患者未注射侧作为对照组。20例患者随机分成3组,A组5例注射浓度为1∶100 000的肾上腺素盐水1 ml;B组5例注射浓度为1∶50 000的肾上腺素盐水3 ml;C组10例注射浓度为1∶33 000的肾上腺素盐水3 ml。在注射针头2.5 cm处80°弯折,经腭大孔刺入针头直至弯折处,回抽无血后注射。注射肾上腺素盐水和鼻内镜手术分别由两名医师完成,每5分钟由手术医师进行术野出血评分一次,每侧评分取平均值进行统计学分析比较。结果所有患者均顺利完成经腭大孔翼腭窝肾上腺素盐水注射,无张口受限、翼腭窝出血、眼球运动障碍、视力下降等并发症。A、B、C三组注射侧与非注射侧术中出血评分比较无统计学差别,A组注射侧术中出血平均评分(3.36±0.22)高于非注射侧评分(3.27±0.23,P=0.63),B组注射侧术中出血平均评分(2.8±0.21)低于非注射侧评分(2.98±0.28),但不超过10%(P=0.296),C组中注射侧术中出血平均评分(2.57±0.09)低于非注射侧评分(2.87±0.1)且超过10%(P=0.056)。结论经腭大孔翼腭窝肾上腺素盐水注射可能减少鼻内镜术中出血。OBJECTIVE To investigate whether pterygopalatine fossa infiltration with adrenaline through the greater palatine foramen can reduce bleeding during endoscopic surgery for chronic sinusitis,and to explore the effective dose and concentration of injection.METHODSTwenty patients of chronic rhinosinusitis with nasal polyps who underwent FESS were injected with adrenaline saline through the pterygopalatine fossa of the palatal foramen in one side and the same patient’s non-injection side served as the control group.Twenty patients were randomly divided into 3 groups.Five patients in group A were injected 1ml saline with 1:100 000 adrenaline;five patients in group B were injected 3 ml saline with 1:50 000 adrenaline;and ten patients in group C were injected 3 ml saline with 1:33 000 adrenaline.The needle was bent at 2.5 cm with 80 degree and inserted into the greater palatine canal until the bend,and adrenaline salinewas infiltrated into the pterygopalatine fossa after aspiration.Pterygopalatine fossa infiltration and endoscopic surgery were performed by two surgeons respectively.The surgeon was asked to grade about bleeding every 5 min,and the average value of each side was taken for statistical analysis.RESULTS All patients successfully completed the pterygopalatine fossa infiltration through the greater palatine foramen,without any complications such as mouth opening restriction,pterygopalatine fossa hemorrhage,eye movement disorder,visual impairment.There was no significant difference in intraoperative hemorrhage score between injection side and non-injection side in group A,B and C.The average score of intraoperative hemorrhage in group A was(3.36±0.22),which was higher than(3.27±0.23),that was in non-injection side(P=0.63).The average score of intraoperative hemorrhage in group B was 2.8±0.21,lower than that in the non-injection side,which was(2.98±0.28) but not more than 10% of non-injection side(P=0.296).In group C,the average score of intraoperative hemorrhage in injection side was(2.57±0.09),lower than

关 键 词：翼腭窝 内窥镜检查 肾上腺素 腭大孔 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]