鼻内镜双极电凝止血联合微填塞对难治性鼻出血患者应激反应的影响

Effect of Bipolar Electrocoagulation Hemostasis Combined with Microtamponade on the Stress Response of Patients with Intractable Epistaxis

目的探讨鼻内镜双极电凝止血联合微填塞对难治性鼻出血患者应激反应的影响。方法回顾性收集天津市宝坻区人民医院2018年2月—2019年10月接诊的50例难治性鼻出血患者临床资料,根据术式的不同分为对照组(25例)和试验组(25例)。对照组行传统局部填塞治疗,试验组行鼻内镜双极电凝止血联合微填塞治疗。对比两组手术疗效、应激反应[皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)]、再出血率及术后并发症发生率。结果试验组手术疗效优于对照组,差异有统计学意义(P<0.05);试验组应激反应指标(Cor、NE、E)水平高于术前,低于对照组,差异有统计学意义(P<0.05);试验组再出血率、术后并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论应用鼻内镜双极电凝止血联合微填塞治疗难治性鼻出血可获得满意的治疗效果,可减轻机体应激反应,降低再出血率及术后并发症发生率,值得临床推广。

Objective To investigate the effect of bipolar electrocoagulation and micro packing on the stress response of patients with intractable epistaxis.Methods The clinical data of 50 patients with intractable epistaxis who received treatment in the hospital from February,2018 to October,2019 were collected retrospectively,and divided into control group(25 cases)and experimental group(25 cases)according to the different operation methods.The control group was treated with traditional local packing,and the experimental group was treated with endoscopic bipolar coagulation and micro packing.The operative effect,stress response(cortisol,epinephrine,NE),rebleeding rate and postoperative complications were compared between the two groups.Results The operative effect of the experimental group was better than that of the control group,and the difference was statistically significant(P<0.05).The level of stress response indexes(Cor,NE,E)in the experimental group was higher than that before operation,lower than that in the control group,and the difference was statistically significant(P<0.05).The rates of rebleeding and postoperative complications in the experimental group were lower than those in the control group,and the difference was statistically significant(P<0.05).Conclusion The treatment of intractable epistaxis with bipolar electrocoagulation and micro packing under nasal endoscope can achieve satisfactory therapeutic effect,reduce the stress response of the body,reduce the rate of rebleeding and postoperative complications,which is worthy of clinical promotion.