202例住院鼻出血患者的治疗.DOCVIP

临床医学论文-202例住院鼻出血患者的治疗 【关键词】? 鼻腔填塞术 　　摘???? 要：目的：探讨住院鼻出血病人快捷有效的治疗方法。方法：对近五年来我科住院治疗的鼻出血病人202例进行回顾性总结。结果：2例鼻咽癌放疗后复发病人大出血死亡，3例白血病病人转科治疗，余均治愈出院。方法有：单纯油纱前鼻孔填塞、前―后鼻孔填塞，部分患者选择时机行鼻内窥镜下微波热凝止血术。结论：传统的鼻腔填塞仍是住院鼻出血病人必不可少的治疗方法，选择适当的填塞材料能减少病人的痛苦，提高止血效果。在适当的时机下行鼻内窥镜下微波热凝止血术是行之有效的方法，寻找出血点及把握止血时机至关重要。 　　关键词：???? 鼻出血；???? 鼻腔填塞术；???? 鼻内窥镜；???? 微波热凝术 　　The Therapy of 202 Inpatients with Nosebleed 　　　Abstract： Objective: To explore fast and effective therapeutic method of inpatients with nosebleed. Method: 202 patients with nosebleed hospitalized in recently 5 years were performed with retrospective sum-up. Result: 2 cases with nasopharyngeal carcinoma were recurrent and dead because of massive hemorraihage after radiotherapy, 3 cases with leukaemia were transferred and treated, the rest were cured and leave hospital. Methods were as follows: simple oil gauze was packed in anterior and anterior=posterior naris, partial suffers chosen opportunity and were performed microwave thermocoagulation hemostasis with rhinoscope. Conclusion: Traditional nasal packing was still absolutely necessarily therapeutic method, proper packing materials chosen could reduce pain of suffers, to elevate hemostatic result. To perform microwave thermocoagulation hemostasis in proper opportunity was effective method, to find bleeding spot and grasp hemostatic opportunity were very important. 　　Key words：???? Nosebleed；???? Nasal packing；???? Rhinoscope；???? Microwave thermocoagulation 　　2000年1月至2005年8月，我科收住院鼻出血病人202例，在住院期间均明确诊断且疗效满意。现对其进行回顾性总结分析如下。 　　1???? 资料与方法 　　1.1???? 临床资料:患者202例，其中男141例，女61例；年龄18～89岁，平均年龄45.3岁。已在门诊行前单侧鼻孔填塞128例，双侧前鼻孔填塞47例，行前后鼻孔填塞27例。填塞材料主要有以下几种：油纱、明胶海绵、带麻黄素或肾上腺素棉片。 　　1.2???? 方法：所有病人入院后均予抗菌素、止血药、局部应用薄荷油滴鼻，进行三大常规、凝血功能及心肝肾功能检查及相关的肿瘤检查，并视情况给予补液，适量输血，纠正水及电解质平衡。 　　局部视填塞及再出血情况进行处理，其中，83例单侧鼻孔填塞病人再出血时予置换前鼻孔材料为膨胀海绵或带气囊膨胀海绵，7例病人经置换材料后仍反复出血，且出血量较大，而再次行传统的前后鼻孔填塞。52例病人行鼻内窥镜下微波热凝术，一次热凝后痊愈37例，2次热凝后痊愈13例，有2 例经2次热凝仍再出血而再用传统前后鼻孔填塞法。 　　2???? 结???? 果 　　202例病人中有2例病人为晚期鼻咽癌放疗后鼻腔出血，最后大出血死亡。3例病人经相关检查确诊为白血病而转血液科治疗。余197例均