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2 cases of epistaxis after digital replantation treatment and care

-5161 (2001) 05-0053-011992 years, had encountered 2 patients Replantation surgery in the early stages of anticoagulant therapy epistaxis occurred,[link widoczny dla zalogowanych], due to clotting drugs, and can give the local vasoconstrictor replanted fingers survived impact clinical treatment more difficult, treatment and nursing care will now report as follows. 1, 2 cases of clinical data were male, aged 18 to 27 years. No previous history of personal and family emergency check bleeding disorders: a, when asked coagulation were normal. After topical heat lamp irradiation, intravenous dextran 13 500ml each anticoagulant, intramuscular injection of papaverine 30mg] 6 小时 spasm, while 800 million units of intravenous penicillin treatment to prevent infection. 2 patients in the 5 to 9 days after sudden epistaxis, and immediately shutdown anticoagulants, external application of cold water on the forehead and nose bag, but it does not work, Artex cloth and gauze was finally filled the nasal cavity and bleeding, 3 days Remove the gauze and no rebleeding, all of replanted fingers survived 150ml each, about the amount of bleeding. Two main discussion 2.1 nasal bleeding occurs in the nasal septum area,[link widoczny dla zalogowanych], local vascular rich, superficial and meager mucosa and its cartilage and phrenology posted below closely. Therefore,[link widoczny dla zalogowanych], protective effects on vascular cushion poor, self-contraction of vascular capacity is very small, when the dry mucous membrane rupture of blood vessels easily. 2.2 The high metabolic profile in patients with early injury, often fever,[link widoczny dla zalogowanych], sustained heat lamp irradiation in the interior relatively dry, if not there is sufficient water intake, will cause nasal dryness, to the mucosal vascular rupture possible. And solid phase in the anticoagulation therapy, in the event of bleeding. Anastomosis because of worries that their hands thrombosis, causing necrosis of finger replantation can not be used hemostatic, therefore, difficult to control the bleeding. We believe that once this case occurred epistaxis, cold void in the local circumstances, should be immediately nasal gauze packing, bleeding through direct pressure to achieve effective hemostasis purposes. Excessive bleeding on the moment, should pay attention to vital signs monitoring and maintenance. 2.3 replantation of severed fingers in the stage of anticoagulant therapy should be clotting mechanism to monitor changes at any time, to adjust the use of anticoagulants, coagulation disorder caused by vigilance secondary wound bleeding. And epistaxis should be based on prevention, staff from the following aspects: (1) regulating the appropriate indoor temperature (23 ℃ ~ 25 ℃), it also should maintain the necessary humidity. (2) In the heat lamp and set up barriers between the body and avoid directly facing the light source, which will help nasal moisture. (3) nasal dryness and epistaxis were usually well made, 3 times daily nasal drip to the amount of liquid paraffin to maintain mucosal lubrication. (4), epistaxis occurs,[link widoczny dla zalogowanych], the timely application of sedatives to eliminate tension in patients will help stop the bleeding. Received on :2001-0920 El
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