内镜评估出血点联合电凝止血在鼻出血中的应用

Endoscopic Evaluation Bleeding Sites and combined with Electrocoagulation in the Treatment of Epistaxis

目的:明确鼻出血部位对诊断和治疗鼻出血至关重要。本研究的目的是评估系统的鼻内镜检查确定每个出血部位的分布联合电凝止血在急诊严重鼻出血诊疗中的应用价值。方法:收集2019年12月至2020年12月我院162例行全身麻醉下鼻内镜探查并双极电凝止血的严重自发性鼻出血患者的临床资料。对患者鼻出血的侧别,具体出血部位,止血成功率,手术前后疼痛VAS评分,住院时间、手术医生职称资料等进行分析。结果:158例患者成功寻找到出血点并成功电凝止血,4例患者术中未发现出血点行内镜下局部微填塞治愈。148例(91.4%)为动脉瘤样出血。最常见为下鼻道后穹隆部(72.2%),其次是中鼻甲嗅裂区(13.5%)、鼻腔顶(6.2%)、中鼻道(2.5%)、上鼻道(1.9%),鼻中隔鼻腔前中段(1.2%)。不能明确出血部位(2.5%)。手术前鼻腔填塞疼痛评分(4.94±0.24)与术后1天疼痛评分(0.96±0.65)比较(P<0.05)差异有统计学意义。初级医师和中级医师在发现出血部位上无明显统计学差异(P>0.89)。结论:系统有序的鼻内镜评估能有效明确97.5%患者的鼻出血部位。内镜下双极电凝止血是有效控制严重鼻腔出血的方法。本组患者主要为鼻腔后段出血,以下鼻道后穹隆部最常见。

Objective:To evaluate the value of systematic nasal endoscopy combined with electrocoagulation in the diagnosis and treatment of severe epistaxis in the emergency department and to ascertain the distribution of bleeding sites in severe epistaxis. Methods:Retrospectively analyze data of 162 patients with severe spontaneous epistaxis who underwent nasal endoscopy under general anesthesia and bipolar electrocoagulation hemostasis in our hospital from December2019 to December 2020. Results:A total of 158 patients were found the bleeding sites and hemostasis,while 4 patients were treated with endoscopic local micro-packing after no bleeding points were found intraoperatively. 148 cases(91.4%)were like aneurysmal hemorrhage. The most common bleeding area was the posterior vault of the inferior meatus(72.2%),followed by the olfactory sulcus,(13.6%),the top of the nasal cavity(6.2%),the middle nasal canal(2.5%),the superior nasal canal(1.9%),and the anterior middle nasal septum(1.2%). Unable to identify the site of bleeding(2.5%). There was statistically significant difference between the pain score before surgery(4.94 ±0.24)and one day after surgery(0.96±0.65)(T=73.1,P=0.03)There was no statistically significant difference in founding the site of bleeding between primary and intermediate physicians(P>0.05). Conclusion:Systematic endoscopic assessment can effectively identifiy the bleeding sites in 97.5% epistaxis patients. Endoscopic bipolar electrocoagulation can effectively control severe epistaxis. The posterior vault of the inferior nasal canal was the most common bleeding site.