鼻内镜下可吸收材料微填塞与电凝止血治疗老年动脉性鼻出血的效果比较

目的 探讨鼻内镜下可吸收材料微填塞填压出血点治疗老年动脉性鼻出血可行性、有效性及预后,并与传统电凝止血治疗法进行比较。方法 将2018年1月至2021年11月在阜阳市肿瘤医院就诊行手术治疗的96例老年动脉性鼻出血患者纳入研究,按照随机数字表法分成观察组(48例)与对照组(48例);2组均采用局部麻醉手术,其中观察组患者在鼻内镜下定位出血点后行可吸收生物胶喷洒出血点、可吸收止血纱布填压;对照组采用电凝止血,并用明胶海绵保护创面;治疗后随访3个月,对比2组患者的治愈率、术中疼痛程度、术后粘连、术后鼻腔干燥或麻木不适例数、术后黏膜恢复速度。结果 2组患者治疗后,观察组的治愈率低于对照组,但观察组患者术中疼痛感、术后鼻腔干燥或麻木不适例数、术后粘连例数均低于对照组,且复查见观察组黏膜恢复速度更快,差异均有统计学意义(P<0.05)。结论 对于老年动脉性鼻出血的治疗,鼻内镜下可吸收材料微填塞出血点和电凝止血均可以作为治疗手段,可吸收材料微填塞对鼻腔黏膜损伤更少,但治愈率有待提高。     

综合护理干预对鼻内镜术后双侧鼻腔填塞患者疼痛及满意度的影响

目的:探讨综合护理干预对鼻内镜术后双侧鼻腔填塞患者术后疼痛及满意度的影响。方法:将128例鼻内镜术后双侧鼻腔填塞患者随机分为观察组和对照组各64例,对照组给予常规护理措施,观察组实施综合护理干预,比较两组患者术后疼痛程度和患者满意度。结果:观察组患者轻度疼痛例数明显多于对照组,中重度疼痛例数明显少于对照组(P0.05);观察组患者满意度明显高于对照组(P0.05)。结论:综合护理干预在鼻内镜术后双侧鼻腔填塞患者中应用效果显著,值得临床推广应用。     

鼻内镜下电凝治疗鼻出血的效果分析

目的探讨鼻内镜下电凝治疗鼻出血的临床疗效。方法随机抽取2015年2月~2017年2月本院收治的鼻出血患者,共48例。按照随机数字表法,将48例患者分为观察组与对照组。对照组实施鼻腔填塞,观察组则采用鼻内镜下电凝治疗。治疗后随访3个月,对比两组治疗效果及安全性。结果观察组、对照组总有效率分别为95.83%(23/24)、66.67%(16/24),有统计学意义(P0.05);观察组鼻腔通气功能恢复时间短于对照组,鼻腔黏膜恢复时间短于对照组,疼痛评分低于对照组,有统计学意义(P0.05);治疗后随访3个月,观察组所有患者均未出现同一部位再出血现象,对照组6例再出血,发生率为25.00%(6/24),有统计学意义(P0.05)。结论鼻出血采用鼻内镜下查找出血点联合电凝治疗的效果更为理想,且安全可靠,值得进行深入研究和推广。     

氧氟沙星眼膏在慢性鼻窦炎内镜手术后的应用

[目的]探讨氧氟沙星眼膏在功能性鼻内镜鼻窦手术后的应用效果。[方法]将208例慢性鼻窦炎患者随机分为对照组和观察组，观察组病人用氧氟沙星眼膏滴鼻治疗，对照组病人用复方薄荷油滴鼻治疗。并比较两组患者术后鼻腔黏膜的恢复和鼻腔粘连发生情况。[结果]观察组患者术后鼻腔黏膜的恢复时间缩短，鼻腔粘连发生率明显降低。[结论]氧氟沙星眼膏可使鼻黏膜恢复时间缩短，鼻腔粘连的发生率明显降低。     

鼻内镜下鼻腔深部出血填塞物的选择及疗效观察

目的观察鼻内镜下鼻腔深部出血填塞物的选择及其止血效果。方法46例非外伤性鼻腔深部出血患者经鼻内镜明确出血部位后,随机分为A,B组各23例,分别应用明胶海绵＋膨胀止血材料、明胶海绵＋凡士林沙条填塞止血,比较2组填塞期间及抽取沙条时患者舒适程度、控制鼻出血有效性和抽取填塞物的难易程度。结果A组填塞期间及抽取填塞物时患者不适感较B组轻,2组控制鼻出血的有效性均为100％。结论鼻内镜检查可明确鼻腔深部出血;应用明胶海绵＋膨胀止血材料填塞患者不适感较轻,可作为鼻腔深部出血的常规填塞材料。     

鼻内镜下二氧化碳激光和Nd:YAG激光治疗鼻出血的比较研究

目的分析鼻内镜下二氧化碳(CO2)激光和Nd:YAG激光治疗鼻出血的临床疗效差异。方法选择在该院接受治疗的鼻出血患者作为研究对象,随机分为接受Nd:YAG激光治疗的观察组及接受二氧化碳(CO2)激光治疗的对照组,比较两组患者的手术相关指标、预后及生活质量评分等差异。结果观察组患者接治疗后的术中出血量、止血时间及手术时间均明显少于对照组患者(P0.05)。观察组患者接受治疗后的术后首次出血时间短于对照组,术后3个月内鼻出血次数以及主观嗅觉减弱例数均明显少于对照组患者(P0.05)。观察组患者接受治疗后的躯体功能、心理功能、社会功能及物质生活状态等生活质量评分均显著高于对照组患者(P0.05)。结论鼻内镜下Nd:YAG激光治疗鼻出血可以显著减少术中出血量、缩短手术时间,且减少术后复发及对嗅觉的影响,提升患者生活质量。     

内镜评估出血点联合电凝止血在鼻出血中的应用

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。     

耳鼻喉科门诊鼻内镜下查找出血点加电凝治疗鼻出血的疗效研究

目的研究耳鼻喉科门诊鼻内镜下查找出血点加电凝治疗鼻出血的疗效及优点。方法选取我院耳鼻喉科门诊2014年1月~2016年1月收治的85例鼻出血患者。随机分为鼻内镜+电凝组42例和填塞组43例。填塞组采取鼻腔填塞的方法进行治疗;鼻内镜+电凝组采取鼻内镜下查找出血点加电凝治疗。就两组患者治疗后平均疼痛评分、鼻腔总出血量、鼻腔黏膜恢复时间、鼻腔通气恢复时间和鼻出血治疗效果、治疗并发症发生率、治疗后疼痛程度进行比较。结果鼻内镜+电凝组鼻出血治疗效果明显高于填塞组(P0.05)。鼻内镜+电凝组治疗并发症发生率明显低于填塞组(P0.05)。鼻内镜+电凝组患者疼痛评分、鼻腔总出血量、鼻腔黏膜恢复时间、鼻腔通气恢复时间均少于填塞组(P0.05)。鼻内镜+电凝组治疗后疼痛程度明显比填塞组轻(P0.05)。结论耳鼻喉科门诊鼻内镜下查找出血点加电凝治疗鼻出血的疗效确切,可有效止血,减少出血量,还可有效缓解患者疼痛感,减少鼻腔粘连、鼻中隔穿孔等并发症的发生,促进鼻腔通气的恢复,加速鼻腔黏膜愈合,对患者预后有益,值得推广。     

鼻内镜鼻窦术后鼻腔填塞与不填塞临床观察比较报告

目的:探索鼻内镜下鼻窦鼻腔手术后鼻腔不填塞的可行性.方法:将临床诊断为慢性鼻炎-鼻窦炎、鼻窦疾病的患者随机分为两组:实验组70例,鼻内窥镜下鼻窦鼻腔手术后鼻腔不予填塞;对照组30例,在行鼻内窥镜下鼻窦开放等手术后给予皮康霜纱条填塞进行对照.结果:实验组70例中仅有1例发生术后出血,发生率为1.45%,对照组30例中在术后抽取纱条时发生鼻出血2例,发生率为6.6%,两组比较实验组出血并不高于对照组.术后患者主观感觉两组有显著性差异,实验组感觉良好者明显优于对照组,术后生命体征变化两组比较有显著性差异,实验组明显小于对照组,术后鼻腔近期的变化有明显差异,但较远期鼻腔鼻窦变化无显著性差异.结论:鼻内窥镜下鼻腔-鼻窦手术后鼻腔不填塞发生鼻出血的机率较小,不填塞可使患者获得较为轻松而舒适的术后状态和感觉,避免术后抽取纱条的痛苦或抽取纱条时发生再次出血的可能,使患者生命体征更加平稳且变化小,缩短了住院时间,因此鼻内镜下鼻窦鼻腔手术后鼻腔不填塞是可行的.     

鼻内镜下低温等离子治疗顽固性 鼻出血患者的临床观察

目的 观察鼻内镜下使用等离子治疗顽固性鼻出血的临床疗效。方法 随机选取该院行鼻腔填塞后仍顽固性鼻出血患者86例,均进行鼻内镜下等离子疗法进行手术治疗,对患者治疗效果及术后恢复情况等临床资料进行回顾性分析。结果 鼻内镜下等离子疗法可准确判定出血位置并进行止血,止血效果明显。其中78例（90.70%）患者经1次等离子止血后出血停止,4例（4.65%）患者经2次等离子止血后出血停止,2例（2.33%）患者经4次等离子止血后出血停止,出血部位不明确的2例（2.33%）患者经凡士林纱条袋状填塞后未再出血。 结论 使用鼻内镜下低温等离子治疗顽固性鼻出血患者疗效显著,术后并发症少,恢复快。     

Intraoperative gastrointestinal endoscopy in the management of occult gastrointestinal bleeding.

Intraoperative gastrointestinal endoscopy has become an increasingly valuable diagnostic and therapeutic adjunct in the management of a variety of complicated problems in surgical patients. At the Medical College of Georgia, intraoperative gastrointestinal endoscopic technics have been successfully used to locate the site and cause of occult gastrointestinal bleeding; to diagnose, biopsy, and, when appropriate, resect lesions during operations conducted for other pathologic processes; to gain endoscopic access for resection of lesions otherwise inaccessible (endoscopically) by virtue of intestinal distortion caused by adhesions; to guide the operating surgeon to an area of resectable disease through dense adhesions secondary to multiple previous laparotomies; and to enhance diagnosis at laparotomy. The value of intraoperative gastrointestinal endoscopy in lesions resulting in occult gastrointestinal hemorrhage and the value of combined radiographic and intraoperative endoscopic technics in diagnosing and managing occult GI bleeding are discussed.     

耳内镜下经鼓室口行咽鼓管球囊扩张治疗伴有慢性化脓性中耳炎的延迟开放型咽鼓管功能障碍的临床研究

目的 对伴有慢性化脓性中耳炎的延迟开放型咽鼓管功能障碍（ETD）患者,在实施中耳乳突手术的基础上联合行耳内镜下咽鼓管鼓室口球囊扩张术,以探讨耳内镜下治疗的有效性。方法 选取2016年2月-2021年2月来该院就诊的伴有慢性化脓性中耳炎的延迟开放型ETD患者50例,按随机分配原则分为观察组和对照组,各25例。观察组采用中耳乳突手术联合耳内镜下咽鼓管鼓室口球囊扩张术,对照组采用中耳乳突手术联合鼻内镜下咽鼓管咽口球囊扩张术。比较两组患者术前及术后1年咽鼓管功能障碍评分（ETDQ-7）及术后复发率。结果 两组患者组内术前与术后1年ETDQ-7评分比较,差异有统计学意义（P <0.05）。观察组术后乳突腔引流通畅,未出现脓性渗出液。观察组术后1年复发率明显低于对照组,两组患者比较,差异有统计学意义（P <0.05）。结论 对伴有慢性化脓性中耳炎的延迟开放型ETD患者,在实施中耳乳突手术的基础上,行耳内镜下咽鼓管鼓室口球囊扩张术,较行鼻内镜下咽鼓管咽口球囊扩张术更加安全,且术后复发率低,效果更好。故在可能的情况下,对伴有慢性化脓性中耳炎的延迟开放型ETD患者行中耳乳突手术联合耳内镜下咽...     

隐蔽性鼻出血常见出血部位及鼻内镜治疗策略

目的研究隐蔽性鼻出血常见出血部位以及鼻内镜下治疗策略。方法回顾性分析2012年1月—2012年12月我院门诊就诊的329例隐蔽性鼻出血的出血部位及鼻内镜下治疗方法。结果在门诊行鼻内镜检查发现明确出血点298例,经治疗后成功止血,出血部位主要位于嗅裂区、下鼻道后穹窿部及中鼻道。16例存在严重鼻中隔偏曲,1例鼻息肉,内镜均不能探及中、下鼻道或嗅裂区,入院行手术治疗后止血。14例未找到明确出血部位,于可疑出血部位填塞膨胀海绵,门诊留观未再次出血。所有患者随访1个月均无再次出血。结论隐蔽性鼻出血绝大多数可在鼻内镜下探查到明确出血点,鼻内镜下烧灼止血或常见出血部位局限性填塞有效且安全。     

鼻内镜下切除扁桃体及腺样体的临床探索

目的 比较鼻内镜下低温等离子切除扁桃体及腺样体与鼻内镜下扁桃体电切术和腺样体吸切术的临床疗效.方法 选取该院因扁桃体及腺样体肥大需要手术的患儿80例.其中,实验组(n=40)为鼻内镜下低温等离子切除扁桃体及腺样体,对照组(n=40)为鼻内镜下电切扁桃体与腺样体吸切,比较两组患儿术中和术后相关指标的差异.结果 实验组手术...     

Use of Hemostatic Nasal Plugs in Emergency Medical Services in the Netherlands: A Prospective Study of 33 Cases

Background: Epistaxis is a common medical emergency with possible life-threatening complications. In the prehospital setting, epistaxis can be treated with nasal tampons. HemCon® Nasal Plug is a nasal tampon impregnated with oxidized cellulose, which has hemostatic properties. Objective: The objective of this study was to determine the effectiveness and usability of HemCon Nasal Plugs in the treatment of severe epistaxis in the prehospital setting. Methods: From June 2012 to December 2014, all ambulances of two emergency medical services in the Netherlands were equipped with HemCon Nasal Plugs. The plug was used according to protocol; if conventional treatment failed to control severe epistaxis or if conventional treatment was unlikely to achieve hemostasis. The ambulance personnel filled in an evaluation form after each use. Results: A total of 33 patients were treated with HemCon Nasal Plugs. Twenty-four patients were taking anticoagulants or suffered from a clotting disorder. The cause of epistaxis was idiopathic in the majority of the patients. Inserting HemCon Nasal Plugs resulted in cessation of epistaxis in 25/33 patients and resulted in reduction of epistaxis in 4/33 patients. HemCon Nasal Plugs failed to control epistaxis in 4/33 patients, possible due to an unreachable site of bleeding. Conclusion: This study demonstrated that HemCon Nasal Plug is an effective adjunct in the prehospital treatment of severe and uncontrolled epistaxis.     

鼻内镜下低温等离子射频消融与传统方式切除鼻前庭囊肿的临床疗效观察

目的比较鼻内镜下低温等离子与传统方式(经齿龈沟径路)行鼻前庭囊肿切除的临床疗效观察分析。方法选取青海大学附属医院耳鼻咽喉科2010年1月-2016年1月经手术治疗的鼻前庭囊肿患者68例,并将其按照随机分组的方式分为对照组和实验组,其中对照组34例,实验组34例。对照组患者采取传统方式(经齿龈沟径路)行囊肿切除,实验组采取鼻内镜下低温等离子方式行囊肿切除。比较两组患者手术时间、术中出血情况、术后疼痛情况、术后伤口愈合时间及手术并发症等。结果实验组手术时间、术中出血量、术后疼痛及伤口愈合时间均优于对照组(P0.05),手术并发症发生率明显低于对照组(P0.05)。结论鼻内镜下低温等离子术治疗鼻前庭囊肿具有痛苦少、创伤小、疗效好和并发症少等优点,值得临床应用及推广。     

难治性鼻出血的临床特征及鼻内镜下微创治疗措施分析

目的：探讨难治性鼻出血的临床特征及鼻内镜下微创治疗的临床疗效。方法回顾性分析我院自2010年12月至2012年12月收治的100例难治性鼻出血患者的临床资料,根据患者的年龄将其分为两组,年龄＜40岁的患者作为对照组,年龄≥40岁的患者作为观察组,调查患者发病年龄、发病季节、伴随疾病、出血部位等临床特征,分析引起患者鼻出血的原因。对所有鼻出血患者均进行鼻内镜下微创治疗。结果鼻出血的发病率随年龄的增加而增长,以40～59岁的发病率最高,之后发病明显有所降低;患者季节发病特征明显,每年10月到次年3月的发病人数最多,为高发期;合并一种或多种全身性疾病的比例较高,鼻出血部位以鼻中隔较多见。两组患者出血原因中高血压所占比例最高,其次为鼻中隔偏曲为主,组间比较差异不具有统计学意义。鼻内镜下微创治疗后治愈率较高,1次治愈为94.0%,2次治愈为6.0%,且术后3个月无复发、无并发症发生。结论高血压是导致难治性鼻出血最常见的原因,发病年龄、季节、合并伴随疾病等均是引起难治性鼻出血的相关危险因素。鼻内镜下微创治疗不仅能迅速找出出血点,且止血效果好,值得在临床上广泛推广。     

Comparative Effectiveness of Topically Administered Tranexamic Acid Versus Topical Oxymetazoline Spray for Achieving Hemostasis in Epistaxis

BackgroundThe use of tranexamic acid (TXA) has recently gained popularity as a treatment modality for epistaxis in the emergency department. Previous studies have compared topical TXA to nasal packing. However, topical TXA has not yet been compared with topical oxymetazoline in the treatment of epistaxis.ObjectivesThis study compares the efficacy of the intravenous formulation of TXA applied topically vs. the vasoconstrictor oxymetazoline applied topically in achieving hemostasis in patients presenting to the emergency department with anterior epistaxis.MethodsIn this prospective study, patients presenting to the emergency department with the chief complaint of epistaxis, and meeting inclusion criteria, were allocated into 2 treatment groups; topical oxymetazoline vs. topical application of the intravenous preparation of TXA. Patients were assessed for time to hemostasis in the emergency department as well as the occurrence of rebleeding within the next 48 h after discharge.ResultsHemostasis was achieved in 14 (78%) of the 18 patients in the TXA group compared with 7 (35%) of the 20 patients in the oxymetazoline group. While there were occurrences of rebleeding in the emergency department before discharge and at 48 h in both groups, 11 patients in the TXA group had no recurrence of bleeding compared with 5 in the oxymetazoline group.ConclusionThis study demonstrated that the topical application of the intravenous preparation of TXA is more effective than topical oxymetazoline for achievement of hemostasis in anterior epistaxis. This has clinical significance toward preventing an avoidable need for escalation of treatment that could include applying nasal packing or cautery as well as preventing avoidable return emergency department visits. These outcomes would increase cost, potentially increase patient discomfort, and prolong emergency department throughput time.     

鼻内镜下单极电刀切除儿童扁桃体的临床观察

目的通过鼻内镜下单极高频电刀切除儿童扁桃体,观察术中、术后相关指标,评价手术疗效,并与传统扁桃体剥离术相比较。方法选择4~9岁儿童40例,严格根据扁桃体切除手术指征,完善相关必要术前检查,排除手术禁忌证,鼻内镜下单极高频电刀切除扁桃体手术,观察手术中出血量、手术持续时间、术后疼痛、术后伪膜生长情况和术后出血情况,传统扁桃体剥离手术方式选择40例患儿。结果通过鼻内镜手术组患者手术时间、术中出血量均明显低于传统扁桃体剥离组(P0.05),鼻内镜组术后无出血,传统扁桃体剥离组1例迟发性出血,术后疼痛持续时间、术后疼痛程度和白色伪膜脱落时间两组之间比较差异无统计学意义(P0.05)。结论鼻内镜下进行单极高频电刀切除儿童扁桃体过程中出血少,手术操作时间短,手术视野清楚,周围组织损伤小,伤口恢复快,能有效减少患儿痛苦,值得临床应用。     

Risk Factors for Recurrent Spontaneous Epistaxis

ObjectiveTo identify risk factors associated with spontaneous recurrent epistaxis.Patients and MethodsThis was a retrospective cohort study assessing patients in the Marshfield Clinic system diagnosed as having epistaxis between January 1, 1991, and January 1, 2011. There were 461 cases with at least 2 episodes of spontaneous epistaxis within 3 years and 912 controls with only 1 episode in the same time frame. More than 50 potential risk factors were investigated, including demographic features, substance use, nasal anatomical abnormalities, nasal infectious and inflammatory processes, medical comorbidities, medications, and laboratory values. A Cox proportional hazards regression modeling approach was used to calculate hazard ratios of epistaxis recurrence.ResultsTraditional risk factors for epistaxis, including nasal perforation, nasal septum deviation, rhinitis, sinusitis, and upper respiratory tract infection, did not increase the risk of recurrence. Significant risk factors for recurrent epistaxis included congestive heart failure, diabetes mellitus, hypertension, and a history of anemia. Warfarin use increased the risk of recurrence, independent of international normalized ratio. Aspirin and clopidogrel were not found to increase the risk of recurrence. Few major adverse cardiovascular events were observed within 30 days of the first epistaxis event.ConclusionCongestive heart failure is an underappreciated risk factor for recurrent epistaxis. Hypertension and diabetes mellitus may induce atherosclerotic changes in the nasal vessels, making them friable and more at risk for bleeding. Patients with recurrent epistaxis may also be more susceptible to developing anemia. Physicians should promote antiplatelet and antithrombotic medication adherence despite an increased propensity for recurrent epistaxis to prevent major adverse cardiovascular events.