262例鼻出血患者鼻内镜下电凝止血治疗的回顾分析

袁薇 叶菁 罗五根 江红群 罗庆

[摘要] 目的 回顧分析鼻出血的常见出血部位、相关风险因素及鼻内镜下电凝止血的治疗优点。 方法 统计2011年1月～2019年7月南昌大学第一附属医院耳鼻喉头颈外科行鼻内镜下电凝止血治疗的262例鼻出血病例，分析出血部位、相关风险因素及住院期间复发情况。 结果 262例患者中有232例可以找到出血部位，30例未找到明确出血点。其中鼻中隔前下共92例，鼻中隔中后部共52例，嗅裂区共39例，中鼻甲共13例，中鼻道共13例，下鼻甲共18例，下鼻道共10例。男202例，女60例。伴随高血压病63例，伴糖尿病10例，伴恶性肿瘤病史的患者6例，伴心脏疾病6例，同时患有其他疾病的患者11例。所有病例中仅有2例术后3 d内出现再次出血情况，余术后3 d在院期间均无再次出血。 结论 鼻中隔前下区为鼻出血最易出血部位，男性或40～60岁人群为易出血人群，高血压或为鼻出血相关危险因素，鼻内镜技术使止血更准确有效。

[关键词] 鼻出血;出血部位;相关风险;鼻内镜

[中图分类号] R765.2          [文献标识码] B          [文章编号] 1673-9701（2020）16-0076-04

Retrospective analysis of 262 patients with epistaxis treated by electrocoagulation under nasal endoscopy

YUAN Wei   YE Jing   LUO Wugen   JIANG Hongqun   LUO Qing

Department of Otorhinolaryngology Head and Neck Surgery， the First Affiliated Hospital of Nanchang University， Nanchang   330000， China

[Abstract] Objective To retrospectively analyze common bleeding sites， related risk factors and the advantages of electrocoagulation hemostasis under nasal endoscopy. Methods 262 cases of epistaxis who underwent endoscopic electrocoagulation hemostasis treatment in the Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Nanchang University from January 2011 to July 2019 were selected. The location of bleeding， related risk factors and recurrence during hospitalization were analyzed. Results Among the 262 patients， 232 cases could find the bleeding site， and 30 cases had no clear bleeding point. There were 92 cases of anterior and lower nasal septum， 52 cases of posterior nasal septum， 39 cases of olfactory region， 13 cases of middle turbinate， 13 cases of middle nasal tract， 18 cases of lower turbinate， and 10 cases of lower nasal tract. There were 202 males and 60 females. There were 63 patients with hypertension， 10 patients with diabetes， 6 patients with a history of malignant tumors， 6 patients with heart disease， and 11 patients with other diseases. Only 2 cases of all cases had rebleeding within 3 days after surgery， and the remaining had no rebleeding within 3 days after surgery. Conclusion The anterior and lower nasal septum is the most prone to hemorrhage. Men or people aged 40 to 60 years are prone to bleeding. Hypertension may be the risk factors for epistaxis. Nasal endoscopy technology makes hemostasis more accurate and effective.

[Key words] Epistaxis; Bleeding sites; Related risks; Nasal endoscopy

鼻出血为耳鼻喉头颈外科的常见症状，且多为急症。国外有文献报道，大约7%～14%的成年人会在一生中的某个时候经历鼻出血[1]。鼻腔血供丰富，作为临床医师，掌握临床鼻出血的常见部位，了解相关风险因素，对于鼻出血的治疗十分重要。传统的治疗方法包括鼻孔填塞法、烧灼法及动脉结扎法等[2]，而鼻内镜下电凝止血的治疗方式，可以让术者在清晰直观的条件下，更加准确快速的止血，减少患者的痛苦。……