创伤性颅底骨折致口鼻大出血的血管内治疗

目的 探讨颅底骨折致口鼻大出血的救治策略.方法 回顾分析14例严重颅底骨折伴口鼻大出血患者,入院即行气管切开或气管插管,保证呼吸道通畅,抗休克同时送入介入室行颈动脉造影,找到出血血管,然后通过介入栓塞手段行血管内栓塞止血.结果 全组14例患者口鼻腔出血经栓塞后均及时成功止血,未出现栓塞后并发症.恢复良好10例,重残3例,死亡1例.重残及死亡均与脑外伤有关.结论 保持呼吸道通畅、维持有效血压后紧急行血管内介入栓塞止血能有效提高颅底骨折致口鼻大出血休克的抢救成功率,特别为合并脑创伤患者的成功抢救提供了保证.

Endovascular treatment of nose and mouth bleeding caused by traumatic skull base fractures

Objective To explore the treatment strategy for mouth and nose bleeding caused by skull base fractures. Methods A retrospective analysis was done on 14 patients with severe skull base fracture combined with nose and mouth bleeding admitted to hospital. Tracheotomy or tracheal intubation was performed to ensure airway patency. When anti-shock was performed, the patients were sent for carotid artery angiography to identify the blood vessel. Then, hemostasis was done by means of direct intravascular interventional embolization. Results Timely and successful hemostasis was achieved in all 14 patients after embolization, with no complications occurred. Of all patients, there were 10 patients with good recovery, three with disability and one death. Severe disability and death were related to brain injury. Conclusions After maintenance of airway patency and effective blood pressure, emergency endovascular embolization can effectively improve the rate of successful treatment of nose and mouth bleeding caused by traumatic skull base fractures, especially for patients combined with traumatic brain injury.