难治性鼻出血患者出血部位各年龄段间的差异与特点

目的　探讨难治性鼻出血位点与年龄相关的分布特点及规律。方法　回顾性分析住院治疗的149例难治性鼻出血患者的临床资料，按年龄分为青年组（≤39岁）、中年组（40～59岁）、老年组（≥60岁），分析其出血部位的特点及规律。结果　149例患者中，男性110例，女性39例；年龄 18～87岁，平均（53±14）岁；青年组36例，中年组52例，老年组61例。149例患者均行鼻内镜下鼻腔探查止血术。其中明确出血部位后行电凝止血或微填塞145例，并记录出血部位；未明确出血部位患者4例。三组患者最常见出血部位依次为：青年组：下鼻道穹窿22例（61%），中鼻甲后段13例（36.1%），嗅裂区中隔面1例（2.7%）；中年组：下鼻道穹窿23例（44.2%），中鼻甲后段10例（19.2%），嗅裂区中隔面17例（32.7%）；老年组：嗅裂区中隔面37例（60.6%），中鼻甲后段15例（24.6%），下鼻道穹窿7例（11.5%）。结论  难治性鼻出血患者中，青、中年患者出血部位以蝶腭动脉分支出血居多；老年患者出血部位以筛前动脉、筛后动脉分支出血居多。随年龄增长蝶腭动脉分支出血比例减少，筛前动脉、筛后动脉分支出血机会增加。

Age-related clinical characteristics and differences of refractory nasal bleeding site

OBJECTIVE To investigate the distribution and regularities of intractable nasal bleeding site in different aged patients.METHODS The clinical data of 149 patients with intractable epistaxis were reviewed respectively.RESULTS Of the 149 patients, 110 cases were male and 39 cases were female with a age ranged from 18 to 87 years. They were divided into young group (39y or less), middle age group(40~59 y) and elderly group(60y or older), and there were 36, 52 and 61 cases in each group respectively. Hemostasis was performed with local anesthesia or general anesthesia under nasal endoscope. There were 145 cases with definite bleeding site, and electrocautery or micropacking was used for stop the bleeding. There were 4 cases without definite bleeding site. The bleeding site was on the posterior fornix of inferior meatus in 22 cases(61%), posterosuperior of middle nasal meatus in 13 cases(36.1%) and olfactory cleft of nasal septum in one case(2.7%) in young group; The bleeding site was on the posterior fornix of inferior meatus in 23 cases(44.2%), posterosuperior of middle nasal meatus in 10 cases(19.2%) and olfactory cleft of nasal septum in 17 cases(32.7%) in the middle age group; In the elderly group, the bleeding site was on the olfactory cleft of nasal septum in 37 cases(60.6%), posterosuperior of middle nasal meatus in 15 cases(24.6%) and posterior fornix of inferior meatus in 7 cases(11.5%).CONCLUSION In patients with refractory nasal bleeding, the majority responsible vessel was sphenopalatine artery or its branches in young and middle-aged patient and branches of anterior/posterior ethmoidal artery in elderly patients. Along with the increase of age, the sphenopalatine artery branch bleeding decreased, but the branches of anterior/posterior ethmoidal artery bleeding increased.