Khan M, Conroy K, Ubayasiri K, Constable J, Smith M E, Williams R J, Kuhn I, Smith M, Philpott C
Department of Otolaryngology,Central Manchester University Hospitals,UK.
Department of Otolaryngology,University Hospitals of South Manchester,UK.
J Laryngol Otol. 2017 Dec;131(12):1035-1055. doi: 10.1017/S0022215117002031.
The initial assessment of epistaxis patients commonly includes: first aid measures, observations, focused history taking, and clinical examinations and investigations. This systematic review aimed to identify evidence that informs how the initial assessment of these patients should be conducted.
A systematic review of the literature was performed using a standardised methodology and search strategy.
Seventeen articles were included. Factors identified were: co-morbidity, intrinsic patient factors, coagulation screening and ice pack use. Hypertension and anticoagulant use were demonstrated to adversely affect outcomes. Coagulation screening is useful in patients on anticoagulant medication. Four studies could not be accessed. Retrospective methodology and insufficient statistical analysis limit several studies.
Sustained ambulatory hypertension, anticoagulant therapy and posterior bleeding may be associated with recurrent epistaxis, and should be recorded. Oral ice pack use may decrease severity and can be considered as first aid. Coagulation studies are appropriate for patients with a history of anticoagulant use or bleeding diatheses.
鼻出血患者的初始评估通常包括：急救措施、观察、重点病史采集、临床检查和调查。本系统评价旨在确定可为这些患者初始评估的实施方式提供依据的证据。
采用标准化方法和检索策略对文献进行系统评价。
纳入17篇文章。确定的因素包括：合并症、患者内在因素、凝血筛查和冰敷使用。高血压和抗凝剂的使用被证明会对预后产生不利影响。凝血筛查对服用抗凝药物的患者有用。四项研究无法获取。回顾性方法和统计分析不足限制了几项研究。
持续性动态高血压、抗凝治疗和后部出血可能与复发性鼻出血有关，应予以记录。口服冰敷可能会减轻严重程度，可作为急救措施考虑。凝血研究适用于有抗凝剂使用史或出血性疾病的患者。
