鼻内镜术后鼻出血的临床特点及影响因素分析

Analysis of clinical characteristics and influencing factors of epistaxis after endoscopic sinus surgery

摘要:

目的 探讨患者鼻内镜术后鼻出血的临床特点及影响因素，为临床预防和处理术后出血提供依据。方法 将2020年6月—2025年6月中国科学技术大学附属第一医院耳鼻咽喉头颈外科收治的44例鼻内镜术后发生鼻出血的患者作为研究组，同期将诊治的105例鼻内镜术后未发生鼻出血的患者作为对照组。分析研究组患者鼻内镜术后鼻出血的临床特点，对比研究组与对照组的临床资料，并对鼻内镜术后鼻出血进行多因素Logistic回归分析。结果 鼻内镜术后1周内发生鼻出血的概率最高（25.00%）；最常见责任血管为蝶腭动脉（38.64%）；鼻腔、鼻窦肿瘤手术术后出血发生率最高（36.36%）；全麻下电凝止血术为最主要的止血方式（38.64%）；研究组中男性和有抗凝药应用史患者占比均高于对照组（P均<0.05），而术前使用糖皮质激素的患者占比低于对照组(P< 0.05)。多因素 Logistic回归分析显示，男性(95%CI:1.054~5.615,P=0.037)、有抗凝药物应用史(95%CI:1.167~109.846, P=0.036)是鼻内镜术后鼻出血的独立危险因素，术前规范使用糖皮质激素(95%CI:0.145~0.839,P= 0.019)是鼻内镜术后鼻出血的保护性因素。结论 鼻内镜术后鼻出血多发生于术后1周内；蝶腭动脉为最常见责任血管；鼻腔鼻窦肿瘤手术出血风险最高；全麻下电凝止血术是主要疗法；男性、有抗凝药物应用史的患者术后出血风险显著增加；术前规范使用糖皮质激素可有效降低出血风险。因此，对于男性及有抗凝药应用史的高危患者，应加强围手术期管理，并考虑术前规范使用糖皮质激素以降低出血风险。

Abstract:

Objective To investigate the clinical characteristics and influencing factors of epistaxis after endoscopic sinus surgery so as to provide a basis for clinical prevention and treatment of postoperative epistaxis.Methods From June 2020 to June 2025, 44 patients with epistaxis after endoscopic sinus surgery admitted to the Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of University of Science and Technology of China were selected as the experimental group, and 105 patients without postoperative epistaxis during the same period were collected as the control group. The clinical characteristics of postoperative epistaxis in the experimental group were analyzed. Comparative analysis between the experimental and control groups, along with multivariate logistic regression, was performed to identify the influencing factors of postoperative epistaxis.Results The highest incidence of postoperative epistaxis occurred within the first week after surgery (25.00%). The most common responsible vessel was the sphenopalatine artery (38.64%). The highest incidence of bleeding was observed in patients undergoing endoscopic sinus surgery for sinonasal tumors (36.36%). Electrocautery under general anesthesia was the most frequently used hemostatic method (38.64%). The experimental group had a significantly higher proportion of males and a history of anticoagulant use compared to the control group, while the preoperative use of hormones was lower in the experimental group (P<0.05). Multivariate logistic regression analysis indicated that male gender (95%CI: 1.054~5.615, P=0.037) and a history of anticoagulant use (95%CI: 1.167~109.846, P=0.036) were independent risk factors for postoperative epistaxis (P< 0.05), while preoperative standardized use of glucocorticoids (95%CI: 0.145~0.839, P=0.019) was a protective factor (P<0.05).Conclusions The incidence of postoperative epistaxis after endoscopic sinus surgery is the highest within the first week after surgery. The sphenopalatine artery is the most common responsible vessel. Surgery for sinonasal tumors carries the highest risk of bleeding. Electrocautery under general anesthesia is the primary treatment method. Male gender and a history of anticoagulant use increase the risk of bleeding, while preoperative standardized use of glucocorticoids can reduce the risk. Therefore, for high-risk patients such as males and those with a history of anticoagulant use, perioperative management should be enhanced, and preoperative standardized use of glucocorticoids should be considered to reduce the risk of bleeding.