《鼻出血英》PPT课件

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1、EPISTAXISGlenPorter,MDFrancisB.Quinn,MDUTMB-GalvestonGalveston,Texas---吴彦桥主持讲解IntroductionandHistory5-10%ofthepopulationexperienceanepisodeofepistaxiseachyear.10%ofthosewillseeaphysician.1%ofthoseseekingmedicalcarewillneedaspecialist.Mythology:brownpaper,nails,scissors,scarletthreads,

2、“leadthathasnevertouchedtheground”Aconditionwithalonghistory—HippocratestoHenryGoodyear.Anatomy/PhysiologyofEpistaxisAnatomyNasalcavityVascularsupplyPhysiologyVascularnatureMucosaWhybleedingfromthenose?Vascularorgansecondarytoincredibleheating/humidificationrequirementsVasculatureruns

3、justundermucosa(notsquamous)ArterialtovenousanastamosesICAandECAbloodflowAnatomyoftheLateralNasalWallSPF-classI(35%)-classII(56%)-classIII(9%)Sphenopalatineforamen(SPF)ClassClass1:theopeningoftheSPFispurelyintothesuperiormeatusClass2:theSPFspanstheethmoidalcrest(i.eopenstobothsuperior

4、andmiddlemeatiClass3:therearetwoseparateopeningintothesuperiorandmiddlemeatiExternalCarotidArtery-Sphenopalatineartery-Greaterpalatineartery-Ascendingpharyngealartery-Posteriornasalartery-SuperiorLabialarteryInternalCarotidArtery-AnteriorEthmoidartery-PosteriorEthmoidarteryPterygopala

5、tineVasculature--InternalmaxillaryarteryAnatomyoftheNasalCavityandVasculatureSphenopalatineAAEthmoidAAGreaterPalatineAKesselbach’sPlexus/Little’sArea:-AnteriorEthmoid(Opth)-SuperiorLabialA(Facial)-SphenopalatineA(IMAX)-GreaterPalatine(IMAX)Woodruff’sPlexus:-Pharyngeal&Post.NasalAAofSp

6、henopalatineA(IMAX)Anteriorvs.PosteriorMaxillarysinusostiumAnterior:younger,usuallyseptalvs.anteriorethmoid,mostcommon(>90%),typicallylessseverePosterior:olderpopulation,usuallyfromWoodruff’splexus,moreserious.EtiologyLocalfactorsVascularInfectious/InflammatoryTrauma(mostcommon)Iatrog

7、enicNeoplasmDessicationForeignBodies/otherEtiologySystemicfactorsVascularInfection/InflammationCoagulopathyLocalFactors--VascularICAAneurysmsextraduralcavernoussinusLocalFactors-Infection/InflammationRhinitis/SinusitisAllergicBacterialFungalViralLocalFactors-TraumaNosepickingNoseblowi

8、ng/sn