소아 비출혈의 한약 치료에 대한 임상 연구 동향 - 2000년대 이후 발표된 중국 RCT 연구를 중심으로 -

박용석,신혜진,이지홍,장규태 대한한방소아과학회 2020 대한한방소아과학회지 Vol.34 No.1

목적: 이 연구의 목적은 중국에서 진행되고 있는 소아 비출혈의 한약치료의 효과에 대한 최근의 임상연구를 분석하여, 향후 국내에서 소아 비출혈에 대해 새로운 치료법의 개발 및 후행연구를 할 수 있는 기틀을 마련하기 위함이다. 방법: 중국 전자 데이터베이스 검색사이트인 중국학술정보원 (China National Knowledge Infrastructure, CNKI)을 이용하였으며, 검색어는 ‘鼻出血’, ‘鼻衄’, ‘衄血’, ‘中药’, ‘中医药’, ‘本草’, ‘汤’, ‘丸’, ‘散’, ‘方’,‘颗粒’, ‘胶囊’, ‘自拟’, ‘外用’, ‘膏’를 사용하여 2000년 1월에서 2019년 11월까지의 문헌을 검색하였다. 그 후 각 문헌에 나온 치료방법과 결과에 대해 검토하였다. 결과: 1141개의 연구 중, 12개의 RCT 연구가 선정되어 분석되었다. 대부분의 연구에서, 소아 비출혈에 대한 한약치료의 효과는 유의하게 높았으며, 내복약 중에 가장 많이 사용된 본초는 Rehmanniae Radix (生地黃), Scutellariae Radix (黄芩), Imperatae Rhizoma (白茅根) 이었다. 외용약으로 가장 많이 사용된 본초는 Notoginseng Radix (三七), Bletilla striata (白芨), Crinis Carbonisatus (血餘炭)이었다. 결론: 한약치료는 소아 비출혈을 치료하는데 도움이 될 수 있다는 결론을 얻었으며, 이를 뒷받침하기 위한 후행연구가 필요하다. 치료 경과를 정확히 파악할 수 있는 통일된 평가지표도 필요할 것으로 생각된다. Objectives: The purpose of this study is to investigate recent clinical studies on the effect of herbal medicine for pediatric epistaxis in China, and to seek better methods to treat and study for pediatric epistaxis in Republic of Korea. Methods: We searched the clinical studies from the China Academic Journal (CAJ) in China National Knowledge Infrastructure (CNKI) by key words 鼻出血’, ‘鼻衄’, ‘衄血’, ‘中药’, ‘中医药’, ‘本草’, ‘汤’, ‘丸’, ‘散’, ‘方’,‘颗粒’, ‘胶囊’, ‘自拟’, ‘外用’, ‘膏 from January 2000 to November 2019. We analyzed the literature in regards to the treatment methods and results. Results: Among the 1141 searched studies, 12 randomized controlled trials were selected and analyzed. In most of the studies, the effectiveness of herbal medicine on pediatric epistaxis was significantly high. The most commonly used herbs for oral administration were Rehmanniae Radix (生地黃), Scutellariae Radix (黄芩), Imperatae Rhizoma (白茅根). The most commonly used herbs for external applications were Notoginseng Radix (三七), Bletilla striata (白芨), Crinis Carbonisatus (血餘炭). Conclusions: Herbal medicine treatment can help improve pediatric epistaxis. Additional studies need to be performed to solidify these findings. In addition to that, unified criteria for treatment of pediatric epistaxis should be established in Republic of Korea.

비출혈을 동반한 내경동맥 외상성 가성동맥류 1예 : 분리풍선과 코일에 의한 색전술

김용대,정유선,송시연,변우목 대한이비인후과학회 1999 대한이비인후과학회지 두경부외과학 Vol.42 No.8

비출혈을 동반한 외상성 내경동맥 가성동맥류 1례 : Detachable Coil에 의한 색전술

박동진,이준호,김순곤,Park, Dong-Jin,Lee, Jun-Ho,Kim, Sun-Gon 대한기관식도과학회 2006 大韓氣管食道科學會誌 Vol.12 No.2

Traumatic pseudoaneurysm of the intracavernous internal carotid artery(ICA) is extremely rare, but it is life threatening condition because of massive recurrent epistaxis. Unfortunately, the prompt diagnosis and treatment of this disease are frequently delayed due to its rarity and variable latent period, so this disease is regarded as a challenge to clinicians. Optimal therapy for this diseases demands rapid suspicion for it and is essential in order to give the best functional outcome with minimizing its morbidity and mortality. The authors present a case of male patient with traumatic pseudoaneurysm of intracavernous ICA accompanying severe epistaxis. This patient was a 37-year-old male with unilateral blindness and recurrent massive epistaxis after suffering trauma to head. Computed tomography, MRI and carotid artery angiogram showed pseudoaneurysm of intracavernous ICA with sphenoid bone fracture. The patient was effectively managed with occlusion of the pseudoaneurysmal circulation by endovascular interventional embolization technique utilizing mechanically detachable tungsten coils.

비출혈을 동반한 외경동맥과 내경동맥의 외상성 가성동맥류 3예

이규엽,김현우,이정래,김정수 대한이비인후과학회 2002 대한이비인후과학회지 두경부외과학 Vol.45 No.7

Post-traumatic pseudoaneurysm of the carotid artery is extremely rare but present with progresively severe, often fatal epistaxis. Because temporal course of epistaxis in patients with traumatic pseudoaneurysm of the carotid artery commonly demonstrates a variable latency period, pseudoaneurysm is often a clinical challenge. Optimal management for this diseases demands rapid recognition and treatment to give the best functional outcome. The authors have experienced three cases of traumatic pseudo-aneurysm of the carotid artery resulting in masive epistaxis and showing unusual clinical course that were sucesfully treated artery (ICA). The other one case resulted from the external carotid artery (ECA). (Korean J Otolaryngol 2002;45:725-9)

비출혈을 동반한 감염성 내경 동맥류의 파열 1예

유화종,이범준,박재원,조진희 대한비과학회 2010 Journal of rhinology Vol.17 No.2

Cavernous carotid aneurysms represent fewer than 2% of all intracranial aneurysms and are a rare cause of epistaxis, but rupture of an aneurysm into the sphenoid sinus may result in a massive hemorrhage. Infectious intracranial aneurysms are rare, but can develop as a result of direct extension from bacterial endocarditis or local infection of the head, neck, face, and paranasal sinus. The incidence of infectious intracavernous aneurysm is much lower. Because the sphenoid sinus is located adjacent to the cavernous sinus, sphenoid sinusitis may cause an infectious carotid aneurysm. We have experienced a case of ruptured infectious carotid aneurysm following sphenoid sinusitis presenting with epistaxis. We describe several aspects of the diagnosis and management of this rare case with a review of the literature.

선택적 동맥 색전술을 이용한 난치성 비출혈의 치료 : 임상분석 13예

이주한,최병길,김병준,이준영,김선미,김정은,정혜두,공일규 대한이비인후과학회 부산,울산,경남 지부회 2019 임상이비인후과 Vol.30 No.1

Background and Objectives:We analyzed the clinical data of 13 patients with selective arterial embolization for refractory epistaxis and reported the results. Materials and Methods:Data from 13 patients who underwent selective arterial embolization for refractory epistaxis between 2009 and 2016 at Hallym University Sacred Heart Hospital were retrospectively reviewed. In all patients, initial epistaxis control by cauterization or posterior packing was ineffective. Selective arterial embolization was conducted by intervention specialist of radiology department. Embolization procedure was done at extravascular leakage of contrast sites using PVCs, gelfoams and caligels. Results:The mean age of 13 patients (9 men and 4 women) was 51.2±7.58 years. Success rate of embolization for bleeding control was 92.3% (12 patients). In one patient, epistaxis recurred immediately after embolization, re-embolization was carried out successfully. No serious complications after embolization were reported in our cases. Selective arterial embolization has a success rate of 71-97% as studies and our study showed similar high rate (92.3%) without complications. Conclusions:If readily available, selective arterial embolization can be considered an effective treatment option for intractable nasal bleeding.

재발한 비출혈의 임상양상 분석

임상균,주은정,강기석,위성준,강정한,박정미 대한이비인후과학회 2005 대한이비인후과학회지 두경부외과학 Vol.48 No.9

Background and Objectives:Epistaxis is a frequently seen disease in the field of otorhinolaryngology. However, many patients have to revisit the hospital because of the failure of the initial treatment, in which cases, the inconvenience is greater due to more severe bleeding. We studied epistaxis patients who visited our service during the last 10 years to analyze the causes of visits and the possible countermeasures. Subjects and Method:We studied retrospectively the clinical cases of 616 emmergency patients and 65 patients admitted for the treatment of epistaxis during the last 10 years, from August 1995 to July 2004. The group I, 505 patients (74.2%), improved with only one treatment. The group II, 176 patients (25.8%), showed refractory epistaxis following the initial treatment. Results:In the group I, Kisselbach’s area (68.1%) was the most common site to be treated, followed by Woodruff’s area (13.5%), anterior end of inferior turbinate (8.3%), and superior portion of septum (2.0%). In the group II, the most frequent area to be treated was Woodruff’s area (46.0%), followed by Kisselbach’s area (31.8%), superior portion of septum (4.6%), anterior end of inferior turbinate (4.0%). Conclusion:The most important factor in the failure of primary care was because the precise area of bleeding was not found at the time of initial treatment. Therefore, it is important that we must check the areas by endoscope carefully to decrease the failure of initial treatment of epistaxis.

내시경하 비강내 접형구개동맥의 결찰 또는전기소작을 통한 후방 비출혈의 치료

이현순,노환중 대한이비인후과학회 2005 대한이비인후과학회지 두경부외과학 Vol.48 No.7

비강내 원발한 소엽성 모세혈관종 2예

김보성,김기식,최진수 동국대학교 의학연구소 2009 東國醫學 Vol.15 No.2

소엽성 모세혈관종은 빠르게 자라며 쉽게 출혈하는 경향을 가진 양성 종양이다. 보통 피부나 구강 치은에 흔히 발생하며 비중격에는 드물게 발생한다. 저자들은 반복적인 비출혈과 코막힘을 주소로 내원한 2명의 소아 환자에서 소엽성 모세혈관종을 경험하여 보고하는 바이다. 병변은 완전히 절제하였으며 현재까지 재발의 소견은 없다. The lobular capillary hemangioma is a rapidly growing benign hemorrhagic lesion. This lesion usually affects skin and the oral gingiva but rarely the nasal septum. We report two case of lobular capillary hemangioma in children, who presented with recurrent epistaxis and nasal obstruction. The lesion was completely excised and no evidence recurrence was observed.

비강내 종괴로 진단된 형질세포 골수종

연제엽, 최다빈, 송형근 충북대학교 의과대학 충북대학교 의학연구소 2015 忠北醫大學術誌 Vol.25 No.2

71세 남자 환자가 2주전부터 시작된 우측 비출혈을 주소로 내원하였다. 영상의학검사에서 우측 비강에 서 시작된 종괴가 우측 부비강을 침범하고 전비강의 벽을 따라 연부조직까지 침범한 소견을 보였다. 비 강에서 실시된 조직검사에서 악성종양인 형질세포 골수종으로 진단되었다. 면역조직화학 염색으로 람 다 경쇄의 단클론성 증식을 확인하였다. 비강과 부비동을 침범한 형질세포종은 발생빈도가 낮으나 악성 도가 높은 악성종양으로 비강과 부비동을 흔히 침범하는 악성 소세포 암들과의 감별 진단을 중심으로 증례 보고하는 바이다.