鼻内镜手术出血相关因素分析  

Influence factors of bleeding during sinus endoscopic surgery

作　　者：张建[1] 刘雅洁 张钦鑫 王欢欢 史雅文[1] 殷敏[1] ZHANG Jian;LIU Yajie;ZHANG Qinxin;WANG Huanhuan;SHI Yawen;YIN Min(Department of Otorhinolaryngology,the First Affiliated Hospital,Nanjing Medical University,Jiangsu,210029,China)

机构地区：[1]南京医科大学第一附属医院耳鼻咽喉科,南京210029

出　　处：《中国中西医结合耳鼻咽喉科杂志》2020年第6期427-431,共5页Chinese Journal of Otorhinolaryngology in Integrative Medicine

摘　　要：目的探讨影响鼻内镜手术术中出血量的因素。方法选择2019年9月~2020年1月在江苏省人民医院耳鼻咽喉头颈外科需要行鼻内镜手术共48例,术后根据术中出血量的多少分为两组:出血量>150ml组(A组),A组为出血量多组;出血量≤150ml组(B组),B组为出血量少组。对影响术中出血量原因进行单因素和多因素分析,包括性别、年龄、疾病种类、变态反应的状态、术前鼻内镜及CT总评分、术者因素、手术时长、术前和术中收缩压(SBP)、舒张压(DBP)、术前术后1天凝血功能包括凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、术前、术后1天外周血嗜酸性粒细胞计数。结果影响出血的因素主要在于以下几个因素,包括术前术中血压、变态反应状态及病变范围。结论鼻内镜术中出血量与术前血压、术中血压、变态反应评分、术前嗜酸性粒细胞、手术时长、手术量评分、术前鼻内镜评分、术前CT评分有关,是影响鼻内镜手术出血量的重要因素。Objective To investigate the causes of intraoperative blood loss in endoscopic sinus surgery.Methods From September 2019 to January 2020,48 patients in Department of Otorhinolaryngology Head and neck surgery of Jiangsu Provincial People’s hospital were selected and divided into two groups according to the amount of intraoperative blood loss:group A with bleeding volume>150 ml(group A),group A with more bleeding volume,group B with less bleeding volume.Univariate and multivariate analysis was performed on the causes of intraoperative blood loss,including gender,age,disease type,preoperative allergic reaction,preoperative nasal endoscopy and CT total score,operator factors,operation duration,preoperative and intraoperative systolic blood pressure(SBP),diastolic blood pressure(DBP),coagulation function including prothrombin time(PT),activated partial prothrombin time(APTT)Thrombin time(TT),fibrinogen(FIB),peripheral blood eosinophil count before and 1 day after operation.Results The main factors affecting bleeding are the following factors,including preoperative and intraoperative blood pressure,allergic state and lesion range.Conclusion Intraoperative blood loss and preoperative blood pressure,intraoperative blood pressure,allergy score,preoperative eosinophils,operation duration,surgical volume score,preoperative endoscopic score and preoperative CT score are important factors affecting the amount of bleeding in endoscopic sinus surgery.

关 键 词：鼻内镜 术中出血量 出血因素 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]