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Epistaksisli Hastaya Tedavi Yaklaşımımız

Yıl 2017, Cilt: 2 Sayı: 3, 21 - 28, 15.12.2017

Öz

Amaç

Epistaksli hastaların
epidemiyolojisini, etiyolojik faktörlerini ve tedavi protokollerini değerlendirmeyi
amaçladık.

Gereç
ve Yöntem

Çalışma, Ocak 2015 ile
Haziran 2017 tarihleri arasında geriye dönük olarak planlandı. Hastaların
kayıtları incelendi ve gerekli bilgiler elde edildi. Tüm hastalar yaş,
cinsiyet, ilişkili tıbbi hastalıklar, ilaçlar, travma ve doğrudan
tanımlanabilen nedenler açısından değerlendirildi. Tedavi protokolleri
incelendi.

Bulgular

Çalışma 3-86 yaş
arasındaki 2248 hastayı içermektedir. 0-20 yaş arasında 764 vaka (% 34), 20-50
yaş aralığında 540 vaka (% 24) ve 50 yaşın üzerinde 944 (% 42) vaka
bulunmaktadır. 1163 olgu (% 51.73) erkek, 1085 olgu (% 48.27) kadındı. En sık
görülen lokal etyolojik faktör, Little bölgesinde yüzeyel dilate damarlardı.
Çalışmada görülen ilk üç predispozan faktör; 910 olgu (% 40.48) idiyopatik, 786
olguda (% 34.96) kardiyovasküler nedenler (hipertansiyon, arteryoskleroz vb.),
284 olguda (12.63) travma vardı. Tedavi protokolleri arasında en sık kullanılanlar
kimyasal veya elektro koagülasyon (% 54.04), anterior tampon (% 43), adrenalin
ve pantokain pamuk tampon (% 18) idi. Dokuz hastaya (% 0,36) cerrahi tedavi
uygulandı.

Sonuç















Episaksis yönetiminde en
basit yöntemin uygulanması hastanın yaşam kalitesini asgari düzeyde
etkilemektedir. Nadiren hayatı tehdit edici derecede yoğun olmasına rağmen
nazal kompresyon ve adrenalin pantokainli pamuklu bez gibi birincil tedavi
yöntemleriyle tedavi edilebilir.

Kaynakça

  • Viehweg T, Rogerson J, Hudson JW. Epistaxis: diagnosis and treatment. J Oral Maxillofac Surg. 2006;64:511-8.
  • Okafor BC. Epistaxis: a clinical study of 540 cases. Ear Nose Throat J 1984;63:153–9.
  • Davies K, Batra K, Mehanna R, et al. Pediatric epistaxis: Epidemiology, management & impact on quality of life. International journal of pediatric otorhinolaryngology. 2014;78:1294-7.
  • O.H. Shaheen. Epistaxis. In: Mackay I.S, Bull T.R. (Eds.), Scott Brown’s Otolaryngology, 5th ed, vol. 4. Butterworths, London, pp.272-82.
  • Shargorodsky J, Bleier BS, Holbrook EH et al. Outcomes analysis in epistaxis management: development of a therapeutic algorithm. Otolaryngol Head Neck Surg 2013;149(3):390-8.
  • Krempl GA, Noorily AD. Use of oxymetazoline in the management of epistaxis. Ann Otol Rhinol Laryngol 1995;104:704-6.
  • Pallin DJ, Chng YM, McKay MP, Emond JA, Pelletier AJ, Camargo CA Jr. Epidemiology of epistaxis in US emergency departments, 1992 to 2001. Ann Emerg Med 2005;46:77-81.
  • Mathiasen RA, Cruz RM. Prospective, randomized, controlled clinical trial of a novel matrix hemostatic sealant in patients with acute anterior epistaxis. Laryngoscope 2005;115:899-902. 8.
  • Badran K, Malik TH, Belloso A, Timms MS. Randomized controlled trial comparing Merocel and RapidRhino packing in the management of anterior epistaxis. Clin Otolaryngol. 2005;30:333-7.
  • Viducich RA, Blanda MP, Gerson LW. Posterior epistaxis: clinical features and acute complications. Ann Emerg Med 1995;25:592-6.
  • Kotecha B, Fowler S, Harkness P, Walmsley J, Brown P, Topham J. Management of epistaxis: a national survey. Ann R Coll Surg Engl 1996;78:444-6.
  • Barnes ML1, Spielmann PM, White PS. Epistaxis: a contemporary evidence based approach. Otolaryngologic clinics of North America 2012;1005-17.
  • Lehmann P, Saliou G, Page C, et al. Epistaxis revealing the rupture of a carotid aneurysm of the cavernous sinus extending into the sphenoid: treatment using an uncovered stent and coils. Review of literature. Eur Arch Otorhinolaryngol 2009;266:767–72.
  • Valentine R, Boase S, Jervis-Bardy J, et al. The efficacy of hemostatic techniques in the sheep model of carotid artery injury. Int Forum Allergy Rhinol 2011;1:118–22.
  • Asanau A, Timoshenko AP, Vercherin P, et al. Sphenopalatine and anterior ethmoidal artery ligation for severe epistaxis. Ann Otol Rhinol Laryngol 2009;118:639–44.
  • Abdelkader M, Leong SC, White PS. Endoscopic control of the sphenopalatine artery for epistaxis: long-term results. J Laryngol Otol 2007;121:759–62.
  • Smith TP. Embolization in the external carotid artery. J Vasc Interv Radiol 2006;17:1897–912.

Our Therapeutic Approach to Patients with Epistaxis

Yıl 2017, Cilt: 2 Sayı: 3, 21 - 28, 15.12.2017

Öz

Purposes

We aimed to evaluate
epidemiology, etiologic factors and treatments protocols of patients with epistaxis.

Material
and Method

The trial was planned
retrospectively between January 2015 and June 2017. Records of the patients
were examined and the necessary information was obtained. All patients were
evaluated for age, sex, associated medical diseases, medications, trauma, and
directly identifiable causes. Treatment protocols were examined.

Results

The study includes 2248
patients between
3-86
years. 764 cases (%34) were between 0-20 age, 540 cases (%24) between 20-50 age

and 944 (%42) case were ≥50 age. 1163 cases
(51.73%) were males and 1085 (48.27%) females. The most common local
etiological factor was superficial dilated vessels in Littles area. In the
study first three predisposing factor; 910 cases (40.48%) idiopathic, 786 cases
(34.96%) cardiovascular causes (hypertension, arteriosclerosis, etc.),284 cases
(12.63) were trauma. Among the treatment protocols, chemical or electro
coagulation (54.04%) anterior packaging (43%), adrenalin cotton pad and
pantocaine (18%) were the most commonly used. Nine patients (0,04%) underwent
surgical treatment.

Conclusion















Management of
epistaxis, the implementation of the simplest method, minimally affecting the
life quality of the patient. Rarely, though it can be so intense as to be life
threatening, it can often be treated with primary treatment modalities such as
nasal compression and adrenalin cotton pad with pantocaine.

Kaynakça

  • Viehweg T, Rogerson J, Hudson JW. Epistaxis: diagnosis and treatment. J Oral Maxillofac Surg. 2006;64:511-8.
  • Okafor BC. Epistaxis: a clinical study of 540 cases. Ear Nose Throat J 1984;63:153–9.
  • Davies K, Batra K, Mehanna R, et al. Pediatric epistaxis: Epidemiology, management & impact on quality of life. International journal of pediatric otorhinolaryngology. 2014;78:1294-7.
  • O.H. Shaheen. Epistaxis. In: Mackay I.S, Bull T.R. (Eds.), Scott Brown’s Otolaryngology, 5th ed, vol. 4. Butterworths, London, pp.272-82.
  • Shargorodsky J, Bleier BS, Holbrook EH et al. Outcomes analysis in epistaxis management: development of a therapeutic algorithm. Otolaryngol Head Neck Surg 2013;149(3):390-8.
  • Krempl GA, Noorily AD. Use of oxymetazoline in the management of epistaxis. Ann Otol Rhinol Laryngol 1995;104:704-6.
  • Pallin DJ, Chng YM, McKay MP, Emond JA, Pelletier AJ, Camargo CA Jr. Epidemiology of epistaxis in US emergency departments, 1992 to 2001. Ann Emerg Med 2005;46:77-81.
  • Mathiasen RA, Cruz RM. Prospective, randomized, controlled clinical trial of a novel matrix hemostatic sealant in patients with acute anterior epistaxis. Laryngoscope 2005;115:899-902. 8.
  • Badran K, Malik TH, Belloso A, Timms MS. Randomized controlled trial comparing Merocel and RapidRhino packing in the management of anterior epistaxis. Clin Otolaryngol. 2005;30:333-7.
  • Viducich RA, Blanda MP, Gerson LW. Posterior epistaxis: clinical features and acute complications. Ann Emerg Med 1995;25:592-6.
  • Kotecha B, Fowler S, Harkness P, Walmsley J, Brown P, Topham J. Management of epistaxis: a national survey. Ann R Coll Surg Engl 1996;78:444-6.
  • Barnes ML1, Spielmann PM, White PS. Epistaxis: a contemporary evidence based approach. Otolaryngologic clinics of North America 2012;1005-17.
  • Lehmann P, Saliou G, Page C, et al. Epistaxis revealing the rupture of a carotid aneurysm of the cavernous sinus extending into the sphenoid: treatment using an uncovered stent and coils. Review of literature. Eur Arch Otorhinolaryngol 2009;266:767–72.
  • Valentine R, Boase S, Jervis-Bardy J, et al. The efficacy of hemostatic techniques in the sheep model of carotid artery injury. Int Forum Allergy Rhinol 2011;1:118–22.
  • Asanau A, Timoshenko AP, Vercherin P, et al. Sphenopalatine and anterior ethmoidal artery ligation for severe epistaxis. Ann Otol Rhinol Laryngol 2009;118:639–44.
  • Abdelkader M, Leong SC, White PS. Endoscopic control of the sphenopalatine artery for epistaxis: long-term results. J Laryngol Otol 2007;121:759–62.
  • Smith TP. Embolization in the external carotid artery. J Vasc Interv Radiol 2006;17:1897–912.
Toplam 17 adet kaynakça vardır.

Ayrıntılar

Konular Sağlık Kurumları Yönetimi
Bölüm Makale
Yazarlar

İbrahim Hıra 0000-0002-1654-8690

Mehmet Tofar Bu kişi benim

Mustafa Sahin

Altan Kaya

Cemil Mutlu

İbrahim Özcan

Yayımlanma Tarihi 15 Aralık 2017
Kabul Tarihi 15 Aralık 2017
Yayımlandığı Sayı Yıl 2017 Cilt: 2 Sayı: 3

Kaynak Göster

Vancouver Hıra İ, Tofar M, Sahin M, Kaya A, Mutlu C, Özcan İ. Epistaksisli Hastaya Tedavi Yaklaşımımız. JAMER. 2017;2(3):21-8.