动脉性鼻出血的不同方法治疗及疗效探讨

目的：探讨门诊及急诊工作中动脉性鼻出血的不同治疗方法及特点。方法：鼻内窥镜下以传统的前鼻孔填塞法及电热烧灼法、微波凝固法治疗动脉性鼻出血。结果：共治疗鼻腔浅部动脉出血患者693例，其中前鼻孔填塞法治疗230例，抽纱条时停止出血患者193例（83．9％），两周以内原部位又出血者35例（18．1％）；电热烧灼法治疗328例患者，包括65例呈持续性血管搏动性出血，均治疗成功；微波烧灼法治疗135例，在出血点暂时闭合时施行手术成功者95例（70．4％），40例患者在活动性出血状态下以微波烧灼术治疗失败，改用电热烧灼法治疗后获成功。电热灼法和微波法治疗后2周以内，鼻出血患者原部位均无再次出血。结论：（1）传统前鼻孔填塞法为治疗动脉性鼻出血的一种有效方法，适宜于不易暴露的嗅裂区出血点治疗，但此法治疗时间长，患者痛苦较大，填塞术后再次出血的机会较多。（2）微波烧灼法对于活动性动脉出血点很难奏效，这与微波不能有效凝结快速流动血液有关。（3）电热灼法对静止性动脉出血点或活动性动脉出血点均能有效治疗，为最迅速和可靠的止血方法之一。

Discussion on Treating Arterial Epistaxis

Objective:To probe different methods in treating arterial epistaxis.Methods:Using electro-cauterization,microwave-cauterization and traditional anterior nose packing in treating serious superficial arterial epistaxis under endoscopy.Results:693 cases of serious arterial epistaxis were treated,among them 230 patients were treated with anterior nose packing,after withdrawing the gauze,193 cases(83.9%)stop bleeding immediately.35 cases(18.1%)rebleed in the original site.328 cases were treated with electro-cauterization,which showed successful in all patients including 65 cases manifested as persistent arterial pulsating bleeding.Using microwave-cauterization method in treating nose bleeding patients for 135 cases,when the bleeding spots temporarily stopped,then performed operation which won success in 95 cases(70.4%),the other 40 failed patients under active bleeding status changed to electro-cauterization,all won successful results.There were no recurrent bleeding within 2 weeks.Conclusion:(1)Traditional anterior nasal packing can also be provided as one of the simple and effective methods,especially for the bleeding point in the olfactory fissura,the time for the treatment is longer,the suffering is more serious,while after packing,the opportunity of recurrent bleeding is more than using other methods.(2)Microwave-cauterization is seldom effective in treating active arterial bleeding,which is due to that microwave can't coagulate the rapid flowing blood effectively.(3)electro-cauterization could be performed on calming down as well as active arterial bleeding spot effectively,which is one of the most rapid and reliable haemostatic measures.