鼻内镜治疗难治性鼻出血的疗效分析

Electric coagulation hemostasis under nasal endoscope for treatment of intractable epistaxis

目的分析鼻内镜治疗难治性鼻出血的疗效,与传统的填塞止血方法比较。方法回顾性分析2013年1月-2014年12月接受治疗的鼻出血患者79例的临床资料。比较鼻内镜止血组(61例)与鼻腔填塞止血组(18例)的治疗效果、疼痛程度、再出血(治疗后至随访4周结束)、出血量(治疗开始至随访4周结束)、术后鼻腔恢复通气时间等。结果鼻内镜组患者治愈率为91.8%,高于鼻腔填塞组(72.2%)。术后4周内鼻内镜组患者再出血率为6.5%,低于鼻腔填塞组38.9%。治疗中鼻内镜组患者疼痛评分平均值为(3.11±2.72),与鼻腔填塞组(3.74±1.49)比较,差异无统计学意义(P>0.05),治疗后疼痛评分平均值(1.59±0.48)低于鼻腔填塞组(3.43±1.37)。鼻内镜组总出血量(31.05±12.83)m L低于鼻腔内填塞组(51.09±18.32)m L。鼻内镜组术后主观鼻腔恢复通气时间(3.1±1.8)d短于鼻腔填塞组(6.4±1.8)d。以上各项指标两组比较,除治疗中患者疼痛评分平均值外,其他指标差异均有有统计学意义(P<0.01)。结论鼻内镜下电凝止血术操作出血点位置准确,疗效可靠,出血量少,疼痛较轻,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 endoscope for treatment of intractable epistaxis and compared with traditional packing hemostasis method. Methods Clinical data of intractable epistaxis patients received treatment at our hospital from Jun 2013 to Dec 2014 were retrospectively analyzed. Patients were divided into two groups. Group A （ total 61 patients） received nasal endoscope treatment;Group B （ total 18 patients） received packing hemostasis treatment. Cure rate, pain scale, nosal ventilation function of recovery and rehaemorrhagia rate were compared between the two groups. Results Group A had a higher cure rate than Group B, and the difference was statistically significant （91.8% vs 72.2%, P〈0.01）;The pain scales were lower in Group A in post？treatment time than Group B, and the difference was statistically significant （1.59±0.48 vs 3.43±1.37,P〈0.01）, while this difference was not statistically significant in treatment time （3.11±2.72 vs 3.74±1.49, P〉0.05）;The amount of bleeding was lower in Group A than in Group B, and the difference was statistically significant（31.05±12.83 vs 51.09± 18.32, P〈0.01）; Group A had a lower rehaemorrhagia rate than Group B, and the difference was statistically significant （6.5% vs 38.9%, P〈0.01）;The Group A had a sooner ventilation function of recovery than Group B, and the difference was statistically signifi？cant （3.1±1.8 vs 6.5±1.8, P〈0.01）. Conclusion Electric coagulation hemostasis under nasal endoscope is a safe and effective treat？ment for intractable nosebleed.