经鼻腔气管插管相关鼻出血危险因素分析及头颅影像学在风险预测中的应用价值

doi:10.19438/j.cjoms.2025.04.010

摘要/Abstract

摘要： 目的：分析经鼻腔气管插管相关鼻出血的危险因素,探讨头颅影像资料在预测鼻出血风险中的作用,以优化经鼻腔气管插管策略。方法：回顾2020年6月—2021年12月于上海交通大学医学院附属第九人民医院经鼻腔气管插管行口腔颌面部手术的患者614例,根据是否鼻出血分为鼻出血阳性组和鼻出血阴性组。收集患者的术前基线资料、插管相关资料及头颅影像学数据,分析鼻出血的危险因素,探讨头颅影像学在风险预测中的应用价值。结果：614例患者中,鼻出血阳性组113例,阴性组501例。男性患者鼻出血风险显著高于女性,年龄和体重指数增加也加大鼻出血风险,放化疗史及吸烟酗酒史在鼻出血阳性组比例显著高于鼻出血阴性组。鼻出血阳性组的平均鼻腔进管时间和鼻插管阻力显著高于鼻出血阴性组。头颅CT显示,鼻中隔偏曲值与鼻出血的发生具有显著相关性,特别是冠状面鼻中隔最大偏曲值和横截面鼻中隔最大偏曲部位。基于横截面及冠状面最大偏曲值构建的预测模型显示,其曲线下面积分别为0.704和0.742。结论：年龄、鼻腔进管时间、冠状面最大偏曲值、放化疗史、鼻腔插管阻力、横截面鼻中隔最大偏曲部位、冠状面鼻中隔最大偏曲部位是经鼻腔气管插管相关鼻出血的独立危险因素。头颅CT影像学参数在预测鼻出血风险中具有应用价值。

关键词: 口腔颌面部手术, 经鼻腔气管插管, 鼻出血, 危险因素, 鼻中隔偏曲

Abstract: PURPOSE: To analyze the risk factors associated with nasal bleeding during nasal tracheal intubation and to explore the role of cranial imaging data in predicting the risk of nasal bleeding, in order to optimize nasal tracheal intubation strategies. METHODS: A total of 614 patients who underwent oral and maxillofacial surgery through nasotracheal intubation in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from June 2020 to December 2021 were selected. The patients were divided into a positive nasal bleeding group and a negative nasal bleeding group according to whether they had nasal bleeding. Preoperative baseline data, intubation-related information, and cranial imaging data were collected to analyze the risk factors for nasal bleeding and to explore the application value of cranial imaging in risk prediction. RESULTS: A total of 614 patients were included, with 113 in the positive nasal bleeding group and 501 in the negative group. Male patients had a higher risk of nasal bleeding than female patients, and increased age and body mass index also elevated the risk of nasal bleeding. Histories of radiotherapy and chemotherapy, as well as smoking and alcohol abuse, were significantly more prevalent in the positive nasal bleeding group compared to the negative group. The mean nasal tube insertion time and nasal intubation resistance were significantly higher in the positive nasal bleeding group. Cranial CT scans revealed a significant correlation between nasal septal deviation values and the occurrence of nasal bleeding, particularly the maximum septal deviation value in the coronal plane and the maximum deviation site in the cross-sectional plane. The prediction models based on the maximum deviation values in the cross-sectional and coronal planes showed areas under the curve of 0.704 and 0.742, respectively. CONCLUSIONS: Age, nasal intubation time, the maximum deviation value in coronal plane, radiotherapy and chemotherapy history, nasal intubation resistance, the maximum deviation of nasal septum in transverse section, and the maximum deviation of nasal septum in coronal plane are independent risk factors for nasal tracheal intubation related epistaxis. Cranial CT imaging parameters have application value in predicting the risk of nasal bleeding.

Key words: Oral and maxillofacial surgery, Nasal tracheal intubation, Nasal bleeding, Risk factors, Nasal septal deviation

中图分类号:

R782.05.4

范颢, 朱宇航, 周韧, 王宇星. 经鼻腔气管插管相关鼻出血危险因素分析及头颅影像学在风险预测中的应用价值[J]. 中国口腔颌面外科杂志, 2025, 23(4): 377-383.

Fan Hao, Zhu Yuhang, Zhou Ren, Wang Yuxing. Analysis of risk factors for nasal bleeding associated with nasal endotracheal intubation and evaluation of the role of cranial imaging in risk prediction[J]. China J Oral Maxillofac Surg, 2025, 23(4): 377-383.

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