腭大孔注射利多卡因肾上腺素混合液对鼻内镜术野出血的影响

Effect of Pterygopalatine Fosse Injection on Surgical Field Bleeding in Sinus Endoscopic Surgery

目的探讨腭大孔注射利多卡因肾上腺素混合液对鼻内镜术野出血的影响。方法选择2011年1～7月符合海口标准的Ⅰ、Ⅱ、Ⅲ型鼻窦炎手术患者各30例,以一侧为实验组腭大孔注射利多卡因肾上腺素混合液20 ml,对侧为对照组,采用Bezoart术野出血分级法观察术野出血情况。结果 90例180侧术野出血5级有2例(3侧),皆为Ⅲ型患者,其中对照组1例(2侧)、实验组1例(1侧),此2例因出血终止手术,进一步治疗鼻腔病变后二次手术;余88例手术均一次完成。Ⅰ、Ⅱ、Ⅲ型患者实验组术野出血分级显著优于对照组(Z=-2.244,P=0.025;Z=-2.354,P=0.019;Z=-2.002,P=0.045)。结论腭大孔注射利多卡因肾上腺素混合液能有效改善鼻内镜手术术野出血情况,提高鼻内镜手术的术野清晰度。

Objective To explore the efficacy of pterygopalatine fosse injection with lidocaine and adrenalin in surgical field bleeding control in sinus endoscopic surgery. Methods From January to July 2011,90 patients with nasosinusitis were enrolled into this study（types Ⅰ,Ⅱ,and Ⅲ based on the Haikou Criteria,30 in each type）.Infection of pterygopalatine fosse with lidocaine and adrenalin（20 ml） was performed on the 90 patients at one side and the other side was set as a control group.The surgical field bleeding grading（Bezoart） was then observed. Results In the 90 patients（180 sides）,grade 5 hemorrhage was observed in 2 cases（3 sides）,both of them were type III（one of them was from the control group（2 sides）,and the other was from the experiment group（1 side）.The surgery was terminated because of the hemorrhage,and the patients received a second surgery after further treatment on their lesions.The operation was completed in the other 88 cases.In types I,II,and III,the grade of surgical field bleeding in the experimental group were all significantly higher than that in the control group（Z=-2.244,P=0.025;Z=-2.354,P=0.019;Z=-2.002,P=0.045）. Conclusion Pterygopalatine fosse injection with lidocaine and adrenalin ameliorated surgical field bleeding during sinus endoscopic surgery.