Using a swimmer's nose clip in the treatment of epistaxis in the A&E department

A swimmer's nose clip is a very useful adjunct when treating patients with spontaneous, anterior epistaxis. This clip is extremely efficient at providing constant, localised pressure over the bleeding vessel, in Little's area, and alleviates the need to pinch the nose. This allows for haemostasis to occur. This should alleviate the need for nasal packs and thus for admission into hospital. Any medical practitioner treating epistaxis patients can apply it.     

A pilot study of the holmium YAG laser in nasal turbinate and tonsil surgery

A pilot study of the holmium YAG laser (a solid-state pulsed laser, wavelength 2.1 mum) was performed for tonsillectomy and nasal turbinate surgery. In the nose, intraoperative bleeding was negligible, facilitating an excellent view of the operative field and avoiding the need for postoperative nasal packs. There was no occurrence either of primary or secondary hemorrhage. Some intranasal crusts separated with no difficulty between 3 and 6 weeks. There was no significant delayed tissue destruction. Tonsillectomy was almost bloodless. There was some minor difficulty in mobilizing the upper tonsillar pole. Postoperative pain was no worse than routine tonsillectomy pain and may have been less than would be expected. The tonsil beds healed within two weeks. The comparable roles of the CO 2, the neodymium YAG, and the KTP/532 laser for nasal and oropharyngeal surgery are discussed. These preliminary results suggest a potential role for the holmium YAG laser in nasal turbinate and tonsillar surgery and the need for further evaluation.     

鼻腔大出血治疗问题回顾性分析（附5例报告）

目的：探讨鼻腔大出血的治疗方法及效果。方法：从鼻腔大出血病因、诊断、治疗等方面探讨以提高诊断及处理水平。结果：治疗5例,成功4例,死亡1例。结论：鼻出血病因复杂,出血部位不一,临床在明确病因和部位的基础上,可根据患者的不同情况选择不同的治疗方法。     

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。     

Management of epistaxis

Family physicians frequently encounter patients with epistaxis (nasal bleeding). In rare cases, this condition may lead to massive bleeding and even death. Although epistaxis can have an anterior or posterior source, it most often originates in the anterior nasal cavity. A directed history and physical examination generally determine the cause of the bleeding. Both local and systemic processes can play a role in epistaxis. Nasal bleeding usually responds to first-aid measures such as compression. When epistaxis does not respond to simple measures, the source of the bleeding should be located and treated appropriately. Treatments to be considered include topical vasoconstriction, chemical cautery, electrocautery, nasal packing (nasal tampon or gauze impregnated with petroleum jelly), posterior gauze packing, use of a balloon system (including a modified Foley catheter), and arterial ligation or embolization. Topical or systemic antibiotics should be used in selected patients. Hospital admission should be considered for patients with significant comorbid conditions or complications of blood loss. Referral to an otolaryngologist is appropriate when bleeding is refractory, complications are present, or specialized treatment (balloon placement, arterial ligation, angiographic arterial embolization) is required.     

负压装置在定位隐匿性鼻出血部位中的临床应用

目的 探讨负压装置定位隐匿性鼻出血部位的临床应用价值及安全性。方法 收集2018年8月-2021年7月该科收治的隐匿性鼻出血患者318例作为观察组,2015年8月-2018年7月该科收治的隐匿性鼻出血患者264例作为对照组。观察组嘱患者屏气后,应用负压吸引装置诱发鼻出血,然后应用鼻内镜检查定位出血部位。对照组行常规鼻内镜检查。两组患者的鼻腔出血部位均用可吸引电极电凝止血。回顾性分析两组患者鼻出血部位检出率、手术时间、住院时间、鼻出血复发例数、术中疼痛、术后鼻腔局部粘连例数和术后分泌性中耳炎患病例数。结果 观察组较对照组鼻出血检出率更高,手术时间和住院时间明显缩短,复发例数减少,术中疼痛明显减轻,术后鼻腔粘连例数减少,差异均有统计学意义（P <0.05）。且观察组未见非出血部位黏膜异常损伤,术后随访未出现分泌性中耳炎。结论 应用负压装置定位隐匿性出血部位治疗鼻出血安全有效,值得临床推广。     

Is nasal packing really required after septoplasty?

Objective: Septoplasty is one of the most common operations performed by otorhinolaryngologists. Nasal packing is not an innocuous procedure. The most common problem encountered by the patients after septoplasty is the pain and discomfort during removal of the nasal packs. The objective of this study was to evaluate the results of septoplasty without postoperative nasal packing. Methods: Septoplasty was performed by standard technique. No nasal packing was used in these cases. Results: Seventy‐eight patients were included in the study. The majority of the patients (64.1%; 50/78) on a morning list were operated. Sixty‐two patients were discharged home the same day, the remaining others were discharged the next day. Our postoperative haemorrhage rate was 7.7% (6/78) and only 3.8% (3/78) patients required nasal packing. Majority (84.6%) of the patients were satisfied with the operation at the postoperative follow up 3 months later. Conclusions: Septoplasty can be safely performed without postoperative nasal packing. Only 3.8% patients required nasal packing in this study.     

鼻内镜下鼻止血术后再出血的鼻内镜处理

目的：探讨鼻内镜下鼻止血术后再次出血的鼻内镜下处理技巧及疗效。 方法：回顾性分析2014年1月至2021年1月符合入选标准的我科住院行鼻内镜鼻止血术后再出血患者的临床资料，随访3个月，分析患者出血高危因素，观察再次鼻内镜下鼻止血效果，总结技术要点。 结果：共入选53例鼻内镜下鼻止血术后再出血患者，年龄31~79岁，平均58.6岁；女性10例（18.87%），男性43例（81.13%）。再出血发生于首次鼻内镜下止血后0.5 h~23 d；其中出血发生于24 h 内25例（47.18%），24~72 h12例（22.64%），72 h~7 d 8例（15.09%），7~30 d 8例（15.09%）。所有患者均再次接受经鼻内镜下鼻止血术，术后即刻止血成功率100%，术后随访3个月2例发生间断少量出血，对症治疗后出血停止，其余患者未再有活动性出血。 结论：鼻内镜下鼻止血术后再出血采用鼻内镜再次处理有效。     

藻酸钙敷料用于鼻内填塞的效果观察

[目的 ]选择有效的鼻腔填塞止血材料。 [方法 ]将病人随机分为两组 ,分别采用藻酸钙敷料和凡士林纱条鼻腔填塞 ,比较引起鼻胀痛、止血效果及填塞后鼻腔反应情况。 [结果 ]应用藻酸钙敷料止血效果好 ,头痛及鼻腔疼痛较轻 ,抽除填塞物时鼻腔很少出血 ,术后鼻黏膜反应好。 [结论 ]藻酸钙敷料的作用明显优于凡士林纱条 ,有利于鼻内镜术后病人的恢复     

重度鼻中隔偏曲并发鼻出血行鼻中隔矫正术治疗临床分析

鼻中隔偏曲是鼻出血的主要原因之一,对于此类鼻出血以前认为应先进行填塞或其它物理方法烧灼止血后,待鼻黏膜完全愈合后再行二期鼻中隔手术。但对于重度鼻中隔偏曲导致的鼻出血患者,因鼻腔过于狭窄而无法进行准确堵塞及其它物理方法止血,反而因反复堵塞造成鼻腔黏膜损伤、感染,     

鼻腔隐蔽部位鼻出血的治疗

目的:探讨鼻腔后部隐蔽部位鼻出血的有效治疗方法。方法:对112例鼻腔后部肉眼无法观察的鼻出血电凝止血。结果:112例全部治愈。结论:鼻内窥镜下电凝止血是鼻腔隐蔽部位出血的有效止血方法。     

106例鼻出血前后鼻孔填塞的护理

目的探讨106例前后鼻孔填塞进行止血的护理措施.方法106例鼻出血都行前后鼻孔填塞,填塞天数为5d～14d,平均天数为9.5d.结果通过积极治疗原发病和有效的护理措施,止血效果满意.结论针对前后鼻孔填塞的特点,进行积极有效的护理,对终止鼻出血,减少并发症和预防再出血,促进鼻出血的康复过程有重要的临床意义.     

鼻内镜下鼻腔结构性处理在鼻出血治疗中的意义

目的探讨伴鼻腔结构异常的鼻出血患者,治疗中处理结构异常的必要性。方法在鼻内镜下对35例伴有鼻腔结构异常的鼻出血患者,分别采取鼻中隔矫正术、下鼻甲部分切除术、中鼻甲塑形术和鼻腔粘连分离术,暴露出血点后采用射频治疗或压迫填塞。结果术后随访3个月以上,治愈率94.3%,无并发症发生。结论对鼻腔结构明显异常患者,作结构性处理,尽量恢复鼻腔结构的生理状态,不仅是止血的需要,而且对改善鼻腔通气、预防鼻腔粘连有帮助。     

鼻内镜术后患者应用纳吸棉填塞鼻腔的效果

目的探讨鼻内镜术后患者应用纳吸棉填塞鼻腔的效果。方法将162例手术患者按患者意愿分为试验组和对照组,试验组术后以纳吸棉填塞鼻腔,对照组术后以凡士林纱条填塞鼻腔,观察两组患者术后鼻部胀痛、鼻腔出血量、睡眠时间、饮食状况、住院天数情况的差异。结果试验组患者术后疼痛、出血、睡眠及食欲情况均显著好于对照组(均P<0.05)。结论鼻内镜术后应用纳吸棉填塞鼻腔治疗能更有效地缓解患者术后疼痛、减少出血,延长睡眠时间和促进患者食欲,减少了患者术后的痛苦,值得临床推广。     

鼻内镜术后术腔填塞物应用体会

目的选择有效的鼻腔填塞止血材料。方法比较200例鼻内镜手术应用碘仿纱条和S-100吸收性止血绫填塞止血及填塞后鼻腔反应情况。结果应用S-100吸收性止血绫止血效果好,头疼及鼻腔疼痛较轻,术后鼻腔反应轻。结论S-100吸收性止血绫是一种良好的鼻腔鼻窦手术后填塞材料。     

经鼻内镜下行改良三腔二囊管合并硬化剂治疗食道静脉曲张破裂出血的临床疗效（附14例临床分析）

目的：观察经鼻内镜检查引导下通过改良三腔二囊管加沙氏导丝引导支撑,结合内镜下硬化剂治疗肝硬化食管静脉曲张破裂出血的疗效。方法：14例肝硬化食道静脉曲张破裂出血患者经过经鼻内镜检查后通过改良的三腔二囊管加沙氏导丝支撑下,结合内镜下硬化剂治疗食管静脉曲张破裂出血,观察止血效果以及并发症。结果：14例患者均1次止血成功,1例患者治疗后8 h再次出血,行急诊TIPSS手术治疗。主要反应为胸骨后疼痛,持续时间为2-7 d,对症处理后消失,3、6个月后再次复查食道胃底曲张静脉明显改善,3例10 d左右行内镜下再次硬化治疗（因第1次硬化剂量少或治疗不完全）。结论：经鼻内镜检查行改良三腔二囊管加沙氏导丝引导支撑下,结合内镜下硬化剂治疗肝硬化食管静脉曲张破裂出血是一种有效的治疗方法。     

鼻内镜下高频电凝止血治疗鼻出血36例临床疗效观察

目的:观察鼻内镜下高频电凝止血治疗鼻出血的临床近期疗效。方法:对我院2004年1月~2005年12月36例鼻出血患者鼻内镜下高频电凝止血。结果:36例鼻出血患者经过鼻内镜下高频电凝止血治愈率达97·2%。结论:鼻内镜下高频电凝止血效果良好,值得常规使用。     

凶险型前置胎盘合并切口植入18例临床分析

【目的】探讨产科凶险型前置胎盘合并切口植入的止血技术及子宫切除时机与指征。【方法】回顾性分析2007年7月至2011年7月本院产科收治的凶险性前置胎盘并切口部位植入直径5cm范围以上18例患者的临床资料。【结果】18例病例中7例行子宫切除,11例采用产科改良B-Lynch缝合＋宫腔填塞止血成功保留子宫。【结论】凶险型前置胎盘并切口部位植入直径5cm范围以上者手术止血多需要结合多种方法;改良B-Lynch缝合＋官腔填塞能成功用于其术中的止血;适时手术切除子宫可降低并发症的发生。     

Sorbalgon藻酸钙敷料在鼻内镜术后的应用

目的 :选择鼻内镜术后良好的鼻腔填塞材料。方法 :比较鼻内镜术后应用Sorbalgon藻酸钙敷料和凡士林纱条填塞鼻腔的止血效果及填塞后鼻腔局部反应情况。结果 :应用Sorbalgon藻酸钙敷料在鼻内镜术后填塞鼻腔的止血效果好 ;鼻腔疼痛及头痛程度轻 (P <0 0 1) ;抽取填塞物时鼻出血少 (P <0 0 1) ;术后鼻腔黏膜水肿反应轻 (P <0 0 5 )。结论 :Sorbalgon藻酸钙敷料是一种良好的鼻内镜术后鼻腔填塞止血材料     

Nasolaryngoscopy for family physicians

Nasolaryngoscopy is easy to learn and safe and convenient to perform. It is readily accepted by patients and is a rich source of clinical information. The flexible nasolaryngoscope allows the physician to directly observe the anatomy of the nasal passages, pharynx and larynx. The procedure is helpful for identifying the etiology of chronic nasal complaints and hoarseness. Other possible indications for nasolaryngoscopy include suspected nasal foreign body, recurrent nasal or pharyngeal bleeding, and epiglottitis. With the use of this instrument, treatment of otolaryngologic conditions may be more specific, thereby reducing unnecessary referral or delay in treatment.