顽固性鼻出血的临床分析

A Clinical Analysis of Intractable Epistaxis

目的探讨顽固性鼻出血的出血部位、治疗方法和防治策略。方法对68例经规范的鼻腔填塞未能控制的鼻出血患者出血部位与季节、年龄、性别、伴随疾病及疗效进行回顾性分析。结果出血部位依次为:鼻中隔中后部、下鼻道顶部、嗅裂、中鼻道后上部及部位不明者。出血部位与季节、年龄、性别、伴随疾病有关。68例中,除2例电凝失败而行血管造影颌内动脉栓塞外,其余66例均采用电凝吸引器止血。全部病例1次治愈61例,2次治愈4例,3次治愈1例,随访1～3个月无复发。结论鼻内镜技术结合电凝吸引器及中、下鼻甲骨折移位,对探讨顽固性鼻出血具有重要意义。一旦出血发生,治疗重点应放在首次治疗上,多种形式的综合治疗也是其必要手段。

Objective To explore the nasal bleeding points,the management and the prevention strategy of intractable epistaxis.Methods The bleeding points and its correlation with the onset season,age,sex,associated disease and the effects were analyzed retrospectively in 68 patients,in whom the bleeding points were not controlled with standard nasal packing.Results The bleeding points were found in the following different sites： postmesian wall of nasal septums,superior wall of inferior nasal meatus,olfactory cleft,posterosuperior wall of middle nasal meatus and uncertain.The result showed that the bleeding points had correlation with the onset season,age,sex and the associated disease.Epistaxis was well controlled by electrocoagulation aspirator in 66 cases,transcatheter maxillary artery embolization in 2 cases.Among the 68 cases,the numbers of treatment needed to stop bleeding were 61 cases after 1 time of treatment,4 cases after 2 times and 1 cases after 3 times.There were no complications during a followed-up for 1-3 months after management.Conclusion It was important to explore and treat intractable epistaxis that endoscopy combined with electrocoagulation aspirator and displacement of the middle and inferior turbinate.Once epistaxis occurred,the importance of the first treatment for the haemostasis should be emphasized.For the uncontrollable epistaxis,multiple interventions were necessary.