鼻内镜治疗难治性鼻出血121例疗效分析

Electric coagulation hemostasis under nasal endoscopy for 121 cases of intractable nosebleed

目的分析难治性鼻出血的鼻内镜治疗效果,并与传统的填塞止血方法进行比较。方法回顾分析2011年1月至2012年12月接受治疗的鼻出血患者的临床资料。比较鼻内镜下止血组与鼻腔内填塞止血组患者的治疗效果、疼痛程度、术后并发症、再出血(治疗后至随访2个月结束)、出血量(治疗开始至随访2个月结束)、术后鼻腔恢复通气时间、鼻黏膜恢复时间等。结果鼻内镜组治愈率高于鼻腔内填塞组,差异有统计学意义(97.2%,69/71 vs 84.0%,42/50;P=0.009 5);术后2个月内鼻内镜组再出血率低于鼻腔内填塞组,差异有统计学意义(5.6%,4/71 vs 46.0%,23/50;P<0.001);治疗中及治疗后鼻内镜组疼痛评分平均值均低于鼻腔内填塞组,差异均有统计学意义(3.08±0.72 vs 4.72±0.49;P<0.001;2.59±0.48 vs 4.21±0.58;P<0.001);鼻内镜组患者术后并发症发生率低于鼻腔内填塞组,差异有统计学意义(21.1%,15/71 vs 42.0%,21/50;P=0.013 4);鼻内镜组总出血量低于鼻腔内填塞组,差异有统计学意义[(35.75±9.83)mL vs(64.89±14.32)mL,P<0.001];鼻内镜组术后恢复通气时间短于鼻腔内填塞组,差异有统计学意义[(3.34±0.87)d vs(7.14±2.31)d,P<0.001];鼻内镜组患者术后鼻黏膜恢复时间早于鼻腔内填塞组,差异有统计学意义[(5.68±3.21)d vs(9.31±3.76)d;P<0.001)。结论鼻内镜下电凝止血术疗效可靠,并发症少,术后恢复较快,可作为难治性鼻出血的首选治疗方法。

Objective To study the clinical effect of electric coagulation hemostasis under nasal endoscopy for treatment of intractable nosebleed. Methods Clinical data of intractable nosebleed patients received treatment at our hospital from 2011 to 2012 were retrospectively analyzed. Patients were divided into two groups. Group A received nasal endo- scopic treatment and group B received packing hemostasis treatment. Cure rate, complications, pain scale, recovery and rehaemorrhagia rate were compared between the two groups. Results Group A had a higher cure rate than group B （ 97.2%, 69/71 vs 84.0%, 42/50 ; P = 0.009 5 ）. The pain scales were lower in group A both peri-treatment and post- treatment than in group B （3.08 ± 0.72 vs 4.72± 0.49 ; P 〈 0. 001 ; 2.59 ± 0.48 vs 4.21 ± 0.58 ; P 〈 0. 001 ）. The group A patients had a sooner recovery than group B patients （ P 〈 0.001 ）. Group A patients had a lower rehaemorrha- gia rate than group B patients（5.6%, 4/71 vs 46.0%, 23/50; P 〈 0. 001 ）. Conclusion Electric coagulation hemo- stasis under nasal endoscopy is a safe and effective treatment for intractable nosebleed.