臺灣博碩士論文加值系統

研究目的：下鼻甲肥大為耳鼻喉科常見之問題。微型吸絞器下鼻甲整形術為治療下鼻甲肥大有效手術之一。由於手術術野極小，少量出血對於術野有極大影響。導致手術困難度增加、時間延長，甚至增加併發症之可能。目前有許多方法被提出，以降低術中之出血量。近來，有文獻指出改變手術姿勢為一簡單，有效降低手術出血量,且尚無併發症的方法。此篇文章目的為比較head up position 15度與平躺體位姿勢，是否能有效降低微型吸絞器下鼻甲整形術術中出血量及改善手術術野。
研究方法及資料：本研究採回溯性病例回顧，收集自2014年5月至2014年10月間，於中山醫學大學附設醫院耳鼻喉頭頸外科接受手術的病患。手術適應症為雙側下鼻甲肥大合併或不合併鼻中膈彎曲、慢性鼻竇炎、鼻息肉、黴菌性鼻竇炎且對藥物治療無效者。統計並比較兩組病患Boezaart score、總出血量、每分鐘出血量、手術時間、平均動脈壓。
研究結果：共計納入27名患者，在Boezaart score、每分鐘出血量、手術時間、總出血量部分有達統計上顯著差異(P<0.05)，平均動脈壓則沒有達統計上顯著差異(P>0.05)。
結論與建議：本研究顯示，head up position 15度施行微型吸絞器下鼻甲整形術，能夠有效降低術中出血量、手術時間及改善手術術野。為一安全、簡單，且無明顯併發症之方法。

Objective：To determine whether the 15-degree head-up position during microdebrider-assisted inferior turbinoplasty reduces intra-operative blood loss and improves surgical field of view when compared with the conventional supine position.
Methods and Materials：Patients with hypertrophy of bilateral inferior turbinates, with or without nasal septal deviation and chronic rhinosinusitis, receiving microdebrider-assisted inferior turbinoplasty were included. Patients were excluded if there was obvious asymmetry of inferior turbinates due to septal deviation, previous surgery of inferior turbinates, severe ischemic heart disease, pulmonary or renal disease, continued use of anticoagulants, impaired coagulation, and vascular anomalies. Operation was carried out on the left nasal cavity with 15-degree head-up position (experimental arm) and on the right nasal cavity with horizontal position (control arm). Boezaart and vander Merwe Grading System, total blood loss, surgery time, mean arterial pressure, and blood loss per minute were recorded respectively and the data was analyzed.
Results：From May 2014 to October 2014, 27 patients were recruited in the study. There was a significant difference in the Boezaart scoring between 15-degree head-up position and horizontal position, with 15-degree head-up position producing a better operative field of view (P <.05). There was also a lower total blood loss and blood loss per minute with 15-degree head-up position (P <.05). There was no significant difference in the time of surgery and mean arterial pressure between the 2 surgical positions.
Conclusion and Suggestion：The 15-degree head-up position may facilitate the surgical procedures during microdebrider-assisted inferior turbinoplasty by reducing intra-operative blood loss and improving the operative field of view.

第一章 緒論
第一節 研究背景與動機-----------------------------------5
第二節 研究目的-----------------------------------------7
第二章 文獻探討
第一節 過敏性鼻炎之盛行率-------------------------------8
第二節 過敏性鼻炎的致病機轉-----------------------------9
第三節 傳統鼻中膈鼻道成形手術--------------------------10
第四節 微型吸絞器下鼻甲手術----------------------------12
第五節 傳統鼻中膈鼻道成形手術與微型吸絞器輔助之手術的比較--------------------------------------------------------14
第六節 改變手術姿勢對功能性鼻竇手術的手術效益----------15
第七節 改變手術姿勢對鼻整形手術的手術效益--------------16
第三章 研究設計
第一節 實驗設計----------------------------------------17
第二節 病人選擇----------------------------------------18
第三節 實驗手術前--------------------------------------19
第四節 實驗手術步驟------------------------------------20
第五節 實驗手術中評估與資料收集------------------------21
第六節 統計方法----------------------------------------22
第四章 研究結果
第一節 病人基本資料統計分析----------------------------23
第二節 研究資料之統計分析------------------------------24
第五章 討論-----------------------------------------------25
第六章 結論與建議
第一節 研究假設之結論與建議----------------------------31
第二節 研究限制----------------------------------------32
參考文獻--------------------------------------------------34
附錄一----------------------------------------------------36
附錄二----------------------------------------------------37
表目錄
表一 病人資料---------------------------------------------38
表二 相關參數---------------------------------------------39
圖目錄
圖一 Reverse Trendelenburg posi-tion(RTP)-----------------40
圖二 Head up postion 15度---------------------------------41

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