难治性鼻出血15例临床分析

目的：探讨难治性鼻出血的临床出血特点及治疗方法。方法：回顾性地分析了2000至2008年我科收治的鼻出血病例中住院时间在8～20 d,鼻出血次数多达6次以上15例临床病例资料,其中男性10例,女性5例（1例系孕妇,妊娠达5月）,男女比例2∶1,其中右侧鼻腔出血5例,左侧出血4例,双侧出血6例,最大年龄64岁,最小年龄17岁,出血次数4～10次,平均7次,鼻内镜下止血次数为2～5次,平均3次,全麻5例,局麻10例,双极电凝止血5例,电凝后行金霉素眼膏2.5 g/支＋皮康霜10 g/支混合侵纱条填塞鼻腔5例,明胶海绵＋金霉素眼膏2.5 g/支＋皮康霜10 g/支混合侵纱条前鼻腔填塞6例,金霉素眼膏2.5 g/支＋皮康霜10 g/支纱条前鼻腔填塞＋鼻后孔填塞4例,双鼻腔出血处止血纱布碎片贴盖1例,行颈外动脉结扎术5例（右侧3例,左侧2例）,住院时间为8～20 d,平均住院12 d,其中输血5人,小量多次输血次数为2～3次,平均2次,输血量为300～900 mL,平均400 mL。结果：15例患者中有明确病因3例,无明确病因12例,全部病例经全身和局部等多种方法综合治疗全部治愈,治愈率100%。结论：难治性鼻出血是一种严重危害人体健康的急症,临床特点：（1）难以明确病因,出血频繁、反复无常,出血范围广泛,无明确的固定出血部位。（2）出血时间长、出血频率高,出血量大,止血次数多,止血方法繁多,止血效果差。（3）住院时间长,医疗费用高,患者痛苦大、紧张焦虑、情绪不稳定。

Clinical Study of 15 Cases with Intractable Epistaxis

Objective： To analyze the clinic characteristics and treatment of intractable epistaxis.Methods： The clinical data of 16 patients with epistaxis,bleeding more than 6 times were retrospectively analyzed when they were in hospital for 8-20 days,13 days on average.In the 15 cases,ration of male to female is 2∶1,in which 5 patients＇ right noses bled,4 patients＇ left noses bled and 6 patients＇ both noses bled.The eldest one was 64 while the youngest 17.Bleeding frequency was from 4 to 10,7 on average,stopping bleeding under endoscopic sinus 2-5 times,3 times on average,5 patients under general anesthesia while 10 under local anesthesia.Five patients stopped bleeding with bipolar electric coagulation and another 5 through stuffing the nasal cavity by the mixture of chlortetracycin hydrochloride eye ointment,skinheal cream and gauze,6 stopped bleeding through stuffing the front nasal cavity by the mixture of gelatine sponge,chlortetracycin hydrochloride eye ointment,skinheal cream and gauze and 4 by using the mixture of hlortetracycin hydrochloride eye ointment,skinheal cream and gauze to stuff the front nasal cavity and nostrils,another 1 to stop bleeding by fragment of hemostatic gauze.Moreover,5 patients ligatured carotid artery（3 in the right,2 in the left）.During the hospital days,5 patients transfused blood 2-3 times on average with small amount and high frequency,300-900 mL in total,400 mL on average.Results： As for the cause of illnesses,3 was clear and 12 was unclear.All patients have been cured by means of general and local treatment.Conclusion： Intractable epistaxis is an acute disease which is very harmful to health,the clinic characteristics of which are as follows： First,the causes of epistaxis are unclear and with the characteristics of high frequency,inconsistency,wide range and unfixed positions.Second,the time and amount of epistaxis is long and large and with frequent stypsis of numerous means and low therapeutic efficacy.Third,patients will be in hospital for a long time and will pay high medical fees.The great pains caused by epistaxis always make them anxious and emotional.