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目的:探讨难治性鼻出血的临床出血特点及治疗方法。方法:回顾性地分析了2000至2008年我科收治的鼻出血病例中住院时间在8～20 d,鼻出血次数多达6次以上15例临床病例资料,其中男性10例,女性5例(1例系孕妇,妊娠达5月),男女比例2∶1,其中右侧鼻腔出血5例,左侧出血4例,双侧出血6例,最大年龄64岁,最小年龄17岁,出血次数4～10次,平均7次,鼻内镜下止血次数为2～5次,平均3次,全麻5例,局麻10例,双极电凝止血5例,电凝后行金霉素眼膏2.5 g/支+皮康霜10 g/支混合侵纱条填塞鼻腔5例,明胶海绵+金霉素眼膏2.5 g/支+皮康霜10 g/支混合侵纱条前鼻腔填塞6例,金霉素眼膏2.5 g/支+皮康霜10 g/支纱条前鼻腔填塞+鼻后孔填塞4例,双鼻腔出血处止血纱布碎片贴盖1例,行颈外动脉结扎术5例(右侧3例,左侧2例),住院时间为8～20 d,平均住院12 d,其中输血5人,小量多次输血次数为2～3次,平均2次,输血量为300～900 mL,平均400 mL。结果:15例患者中有明确病因3例,无明确病因12例,全部病例经全身和局部等多种方法综合治疗全部治愈,治愈率100%。结论:难治性鼻出血是一种严重危害人体健康的急症,临床特点:(1)难以明确病因,出血频繁、反复无常,出血范围广泛,无明确的固定出血部位。(2)出血时间长、出血频率高,出血量大,止血次数多,止血方法繁多,止血效果差。(3)住院时间长,医疗费用高,患者痛苦大、紧张焦虑、情绪不稳定。
Objective: To investigate the clinical features and treatment of refractory intranasal hemorrhage. Methods: A retrospective analysis of 2000 to 2008 in our department of nose bleeding admitted to the hospital for 8 to 20 days, the number of epistaxis up to 6 times more than 15 cases of clinical data, including 10 males and 5 females ( 1 case of pregnant women, pregnancy up to May), male to female ratio of 2: 1, of which 5 cases of right nasal bleeding, left bleeding in 4 cases, bilateral bleeding in 6 cases, the maximum age of 64 years old, the youngest age of 17 years, the number of bleeding 4 ~ 10 times, an average of 7 times, the number of endoscopic nasal bleeding was 2 to 5 times, an average of 3 times, 5 cases of general anesthesia, local anesthesia in 10 cases, bipolar coagulation in 5 cases, electrocoagulation line chlortetracycline Cream 2.5 g / stick + Pikang cream 10 g / stick Mixed intrusion gauze 5 cases of nasal congestion, gelatin sponge + chlortetracycline eye ointment 2.5 g / branch + Pikang cream 10 g / Cases, aureomycin eye ointment 2.5 g / branch + Pikang cream 10 g / branch before nasal packing nasal packing + nasal hole in 4 cases, double nasal hemorrhage hemostatic gauze fragments affixed in 1 case, external carotid artery ligation Five patients (3 on the right and 2 on the left) were hospitalized for 8-20 days with an average hospital stay of 12 days, of whom 5 were blood transfusions, 2 to 3 times in a small number of multiple transfusions, with an average of 2 transfusions 300 ~ 900 mL, with an average of 400 mL. Results: Among the 15 patients, there were 3 definite causes, 12 without definite causes, and all the cases were cured by the combination of systemic and local treatments. The cure rate was 100%. Conclusion: Refractory nasal hemorrhage is a kind of emergency that seriously endangers human health. The clinical features are as follows: (1) It is difficult to identify the etiology, frequent hemorrhage, recurrent dysfunction, extensive bleeding, and no fixed bleeding site. (2) bleeding a long time, high frequency of bleeding, bleeding, bleeding and more, stop bleeding a wide range of methods, bleeding is poor. (3) long hospital stay, high medical costs, patients with pain, anxiety, emotional instability.