鼻腔深部出血不同治疗方式的对比观察

目的 探讨更为完善的鼻腔深部出血的首选治疗方式。方法 A组：首选前鼻孔填塞，其次是后鼻孔填塞和相关动脉结扎术。B组：首选前鼻孔填塞，部分行后鼻孔填塞，其次行鼻内镜检查及明胶海绵微型填塞。C组：首选鼻内镜检查及明胶海绵微型填塞。结果 A组(52例)：前鼻孔填塞2～5次；无效后30例行后鼻孔填塞1～3次；仍出血者行动脉结扎术18例。治愈45例，转院7例，痊愈率86．5％(45／52)；输血者17例，平均住院14．4d，均未见确切出血点。B组(58例)：均前鼻孔填塞1～3次，9例1次后鼻孔填塞后行鼻内镜检查；明确出血点55例，明胶海绵填塞治愈：首次37例，二次18例；自愈3例，痊愈率100％(58／58)，输血者5例，平均住院10．7d。C组(67例)镜下明确出血点63例，明胶海绵填塞治愈：首次58例，二次5例；自愈4例，痊愈率：100％(67／67)。无输血者，平均住院5．7d。结论 鼻内镜下明胶海绵微型填塞，应该逐步成为鼻腔深部出血的首选治疗方式，而且尤其适用于鼻腔狭窄、隐蔽部位出血状态。

A Contrast between Different Therapies for Deep Epistaxis

Objective To search for a more efficient primary therapy for deep epistaxis. Methods Group A: To make anterior nares packing the first choice, followed by posterior nares packing. When neither therapy works out, a related artery ligation operation is needed. Group B: To make anterior nares packing the first choice, followed by posterior nares packing in some cases. If it does not work out, nasal endoscopy checkup is carried out. When hemorrhage points occur, glutin sponge mini packing is conducted. Group C: To make nasal endoscopy the first choice. When hemorrhage points occur, glutin sponge mini packing is carried out. Results Group A: There are altogether 52 cases of deep epistaxis, 17 of which receive blood transfusion. The patients stay in hospital for 14.4 days on average, none of whom have obvious hemorrhage points. 52 have anterior nares packing treatment from twice to five times respectively, i.e., an average level of 3.4 times, with 22 cured. 30 receive posterior nares packing treatment from once to three times, i.e., an average level of 1.6 times, with 9 cured. And 18 have yet another related artery ligation operation, with 14 cured. With 7 left uncured, the recovery rate is 86.54% (45/52). Group B: There are altogether 58 cases of deep epistaxis staying in hospital for 10.7 days on average, 5 of which receive blood transfusion. 58 have anterior nares packing treatment from once to three times respectively, i.e., an average level of 1.8 times, 9 of whom also receive posterior nares packing. Nasal endoscopy checkup is carried out to search for hemorrhage points, with 20 cured the first time and 35 cured the second time. Glutin sponge mini packing is conducted, with 37 cured the first time and 18 cured the second time. With 3 more self-cured, the recovery rate is 100% (58/58). Group C: There are altogether 67 cases of deep epistaxis staying in hospital for 5.7 days on average, none of which receive blood transfusion. Nasal endoscopy checkup is carried out to search for hemorrhage points, with 53 cured the first time and 10 cured the second time. With 4 more self-cured, the recovery rate is 100% (67/67). Conclusion Nasal endoscopy checkup and glutin sponge mini packing are recommended for the primary therapies for deep epistaxis, especially when it comes to the strait and concealed parts of nasal cavity or in the state of hemorrhage.