CAJ | 학술논문

目的：探讨老年严重鼻出血解剖定位、疾病特点及治疗策略。方法对134例严重的老年鼻出血患者进行鼻内镜下分区探查,定位出血点,采用分级治疗的方法止血。结果出血部位在鼻腔前上区2例(1.49%)、前下区44例(32.84%)、后上区18例(13.43%)、后下区22例(16.42%)、鼻咽部3例(2.24%),出血部位不明的45例(33.58%)。全部患者一次住院均完全治愈,最终治疗方式采用药物保守治疗及局部微创烧灼或电凝止血(Ⅰ~Ⅲ级)46例(34.33%),应用前鼻孔填塞(Ⅳ级)88例(65.67%),后鼻孔填塞(Ⅴ级)9例(6.72%),血管栓塞(Ⅵ级)1例(0.75%)。前部、后部以及出血部位不明的患者在采用初次止血方式即获成功82例(61.19%),采用升级治疗获得成功52例(38.81%)。不同区域出血采取的止血方式以及是否有升级治疗均存在显著性差异(止血方式：χ2=16.35,P=0.00；升级治疗：χ2=16.35,P=0.00)。结论对于老年人难治性鼻出血,鼻内镜下分区定位,分级治疗可快速定位出血部位,止血效果好,创伤小,并可减少患者痛苦及降低治疗费用。
목적：탐토노년엄중비출혈해부정위、질병특점급치료책략。방법대134례엄중적노년비출혈환자진행비내경하분구탐사,정위출혈점,채용분급치료적방법지혈。결과출혈부위재비강전상구2례(1.49%)、전하구44례(32.84%)、후상구18례(13.43%)、후하구22례(16.42%)、비인부3례(2.24%),출혈부위불명적45례(33.58%)。전부환자일차주원균완전치유,최종치료방식채용약물보수치료급국부미창소작혹전응지혈(Ⅰ~Ⅲ급)46례(34.33%),응용전비공전새(Ⅳ급)88례(65.67%),후비공전새(Ⅴ급)9례(6.72%),혈관전새(Ⅵ급)1례(0.75%)。전부、후부이급출혈부위불명적환자재채용초차지혈방식즉획성공82례(61.19%),채용승급치료획득성공52례(38.81%)。불동구역출혈채취적지혈방식이급시부유승급치료균존재현저성차이(지혈방식：χ2=16.35,P=0.00；승급치료：χ2=16.35,P=0.00)。결론대우노년인난치성비출혈,비내경하분구정위,분급치료가쾌속정위출혈부위,지혈효과호,창상소,병가감소환자통고급강저치료비용。
Objective To explore the common bleeding location, disease features, and the management strategies of intractable aged epistaxis. Methods 134 serious epistaxis patients were examined step by step according to nasal anatomic structure and treated by a stepwise way under endoscopy. Results The bleeding location of the intractable aged epistaxis were found as follows:2 cases (1. 49%) in anterosu-perior area, 44 cases (32. 84%) in anteroinferior area, 18 cases (13. 43%) in posterosuperior area, 22 cases (16. 42%) in posteroinferi-or area, 3 cases (2. 24%) in nasopharynx, and the bleeding site of the other 45 cases (33. 58%) were not found. All the patients were healed. The final treatment way were:46 cases (34. 33%) with pharmacotherapy or cauterization (grade Ⅰ~Ⅲ), 88 cases (65. 67%) with anterior nasal packing (grade Ⅳ), 9 cases (6. 72%) with posterior packing(gradeⅤ),1 case (0. 75%) with selective angiographic embolization (grade Ⅵ). There were 82 cases (61. 19%) succeed with the initial hemostasis methods while 52 cases (38. 81%) succeed with the upgrade therapy. Both hemostasis methods and upgrade therapy had statistical significance in different nasal position groups ( hemo-stasis methods:χ2 =16. 35,P=0. 00; upgrade therapy: χ2 =16. 35,P=0. 00). Conclusion Compartmental examination and classified treatment steps by using endoscope may locate and stop nose bleeding promptly while decrease patients' pain and medical cost.