内镜下经蝶垂体瘤术后鼻腔出血的现状及危险因素分析  

Analysis the status and risk factors of nasal bleeding after endoscopic transsphenoidal resection in patients with pituitary adenomas

作　　者：王莺 王巍 张玉坤 Wang Ying;Wang Wei;Zhang Yukun(Department of Neurosurgery,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Emergency Room,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院神经外科,杭州310009 [2]浙江大学医学院附属第二医院急诊抢救室,杭州310009

出　　处：《中国实用护理杂志》2022年第26期2056-2061,共6页Chinese Journal of Practical Nursing

基　　金：浙江省医药卫生科技计划面上项目(2021KY175)。

摘　　要：目的了解内镜下经蝶垂体瘤术后鼻腔出血的现状,并探讨其危险因素。方法采用便利抽样法,回顾性分析浙江大学医学院附属第二医院神经外科在2019年6月至2021年6月行内镜下经蝶垂体瘤切除术的413例患者病历资料,以内镜下经蝶垂体瘤术后鼻腔出血现状调查表和危险因素调查表对患者进行调查,对调查结果进行单因素分析和Logistic回归分析。结果内镜下经蝶垂体瘤术后出现鼻腔出血的患者有38例,发生率为9.2%。在出血患者中,25例占65.8%的患者鼻腔出血存在诱因,主要是打喷嚏和咳嗽(11例)和便秘(9例),出血季节主要是冬季(13例)和秋季(14例),术后鼻出血发生的平均时间为术后(13.13±7.78)d;单因素分析结果显示:高血脂、吸烟史、抗凝药史、便秘、术中蝶腭动脉损伤、手术入路方式(单、双鼻孔)、手术持续时间、鼻腔冲洗、红细胞、血小板有统计学意义(P<0.05);Logistic回归分析显示:抗凝药史、便秘、术中蝶腭动脉损伤、鼻腔冲洗、血小板是内镜下经蝶垂体瘤术后鼻腔出血的影响因素(P<0.05)。结论内镜下经蝶垂体瘤术后鼻腔出血发生率高,存在明显的季节和压力等诱因,医护人员应重点做好术前和术中评估,对于术前有抗凝药物史、便秘、血小板低以及术中可能存在蝶鄂动脉损伤及其分支损伤的患者,应在做好常规预防措施的基础上重点做好鼻腔冲洗等保护措施,避免诱发鼻腔出血的因素,以降低术后鼻腔出血的风险。Objective To understand the status of nasal bleeding after endoscopic transsphenoidal resection in patients with pituitary adenomas and to explore its risk factors.Methods By using the convenience sample way,a total of 413 patients in pituitary adenomas who were admitted to the endoscopic transsphenoidal resection from the Second Affiliated Hospital of Zhejiang University School of Medicine were selected as study objects from June,2018 to December,2019.The status questionnaire and factors questionnaire of nasal bleeding after endoscopic transsphenoidal resection in patients with pituitary adenomas was used to measure the status and factors of nasal bleeding.The risk factors were analyzed by single factor analysis andlogistic regression analysis.Results There were 38 patients with nasal bleeding after endoscopic transsphenoidal resection in patients with pituitary adenomas,with a incidence rate of 9.2%.Among them,25 patients(65.8%)had precipitating factors of nasal bleeding,mainly sneezing and coughing(11 cases)and constipation(9 cases),and the bleeding season were mainly winter(13 cases)and autumn(14 cases),the average time of postoperative nasal bleeding occurred on the 13th day.The single factor analysis indicated that nasal bleeding related to hyperlipidemia,smoking,anticoagulants,constipation,intraoperative sphenoid artery injury,surgical approach(single and double nostrils),duration of surgery,nasal irrigation,red blood cells,platelets(P<0.05).The Logistic regression analysis showed that anticoagulants,constipation,intraoperative sphenoid artery injury,nasal irrigation,platelets related to nasal bleeding(P<0.05).Conclusion The incidence of nasal bleeding after endoscopic transsphenoidal resection in patients with pituitary adenomas high,and have obvious triggers.The medical staff should focus on preoperative and intraoperative assessment,for the patients had anticoagulant history,constipation,low platelet and possible sphenoid artery and branch injury,should wary the nasal bleeding,nasal irrigation should us

关 键 词：危险因素 护理 经蝶垂体瘤切除术 鼻腔出血 

分 类 号：R473.73[医药卫生—护理学]