頭位抬高姿勢對微型吸絞器輔助下鼻甲成形術術中出血之影響

The Effect of Head-up Position on Intra-Operative Bleeding in Microdebrider-Assisted Inferior Turbinoplasty

黃承楨(Cheng-Chen Huang) ； 林煌斌(Huang-Pin Lin) ； 辛宗翰(Chung-Han Hsin) ； 林淑貞(Shu-Chen Lin)

《台灣耳鼻喉頭頸外科雜誌》 51卷3期 (2016/09) Pp. 135-141

https://doi.org/10.6286/2016.51.3.135

摘要

背景：下鼻甲肥大為鼻部常見疾病，微型吸絞器輔助下鼻甲成形術為治療此疾病有效手術之一。由於空間狹小，少量術中出血會明顯影響手術視野。本文章目的為比較head-up position 15度姿勢與傳統平躺手術姿勢，是否能降低術中出血量並改善手術術野。方法：自2014年5月至2014年10月間，病患診斷為雙側下鼻甲肥大，合併或不合併鼻中膈彎曲、慢性鼻竇炎，皆納入此研究。微型吸絞器輔助下鼻甲成形術head-up position 15度姿勢施行於左側鼻腔，而平躺姿勢用於右側鼻腔。統計同病患不同手術姿勢Boezaart score、總出血量、每分鐘出血量、手術時間及平均動脈壓。結果：本研究共納入27名患者。Boezaart score、每分鐘出血量、手術時間及總出血量，在這2組手術姿勢間達到統計上顯著差異(p ＜ 0.05)，而平均動脈壓在這2組間則沒有達到統計上顯著差異(p＞ 0.05)。結論：本研究顯示，head-up position 15度姿勢在微型吸絞器輔助下鼻甲成形術中，能夠降低術中出血量、手術時間及改善手術術野。

關鍵字

microdebrider ； inferior turbinoplasty ； head-up position ； bleeding（微型吸絞器 ； 下鼻甲成形術 ； 頭高姿勢 ； 出血）

並列摘要

BACKGROUND: Inferior turbinate hypertrophy is a common nasal disease, and microdebrider-assisted inferior turbinoplasty is one of the effective treatments for this entity. Because of limited space, small amount of intra-operative blood can remarkably interfere the surgical visualization. The current study is to determine whether 15-degree head-up position reduces intra-operative blood loss and improves surgical field when compared to the conventional supine position. MATERIALS: From May 2014 to October 2014, patients who were diagnosed with hypertrophy of bilateral inferior turbinates, with or without nasal septum deviation and/ or chronic rhinosinusitis, were enrolled in the study. For surgery of the left nasal cavity, microdebrider-assisted inferior turbinoplasty was performed using 15-degree head-up position; while for the right nasal cavity, surgery was performed using supine position. Boezaart score, total blood loss, blood loss per minute, surgical time, and mean arterial pressure were recorded respectively and the data for both sides was compared. RESULTS: Twenty-seven patients were enrolled in the study. There was a statistically significant difference in the Boezaart score, blood loss per minute, surgical time, and total blood loss between the 2 surgical positions (p ＜0.05), while there was no significant difference in the mean arterial pressure between the 2 groups (p ＞ 0.05). CONCLUSIONS: Our data showed that 15-degree head-up position can reduce intra-operative blood loss, surgical time, and improve surgical field during microdebrider-assisted inferior turbinoplasty.

並列關鍵字

microdebrider ； inferior turbinoplasty ； head-up position ； bleeding