Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Am Fam Physician. 2018 Aug 15;98(4):240-245.
Epistaxis is a common emergency encountered by primary care physicians. Up to 60% of the general population experience epistaxis, and 6% seek medical attention for it. More than 90% of cases arise from the anterior nasal circulation, and most treatments can be easily performed in the outpatient setting. Evaluation of a patient presenting with epistaxis should begin with assessment of vital signs, mental status, and airway patency. When examining the nose, a nasal speculum and a good light source, such as a headlamp, can be useful. Compressive therapy is the first step to controlling anterior epistaxis. Oxymetazoline nasal spray or application of cotton soaked in oxymetazoline or epinephrine 1: 1,000 may be useful adjuncts to compressive therapy. Directive nasal cautery, most commonly using silver nitrate, can be used to control localized continued bleeding or prominent vessels that are the suspected bleeding source. Finally, topical therapy and nasal packing can be used if other methods are unsuccessful. Compared with anterior epistaxis, posterior epistaxis is more likely to require hospitalization and twice as likely to need nasal packing. Posterior nasal packing is often associated with pain and a risk of aspiration if it is dislodged. After stabilization, patients with posterior packing often require referral to otolaryngology or the emergency department for definitive treatments.
鼻出血是初级保健医生常见的急症。多达 60%的普通人群会经历鼻出血，其中 6%会因此寻求医疗帮助。超过 90%的病例源于前鼻循环，大多数治疗方法都可以在门诊轻松进行。评估出现鼻出血的患者应首先评估生命体征、神志和气道通畅情况。检查鼻子时，鼻窥镜和良好的光源（如头灯）可能会有所帮助。压迫疗法是控制前鼻出血的第一步。羟甲唑啉鼻腔喷雾剂或用羟甲唑啉或肾上腺素 1:1000 浸湿的棉花进行填塞可能是压迫疗法的有用辅助手段。指示性鼻腔烧灼术，最常用的是硝酸银，可以用于控制局部持续出血或疑似出血源的突出血管。如果其他方法无效，最后可以使用局部治疗和鼻腔填塞。与前鼻出血相比，后鼻出血更有可能需要住院治疗，且需要鼻腔填塞的可能性是前者的两倍。如果后鼻出血填塞物脱落，常常会引起疼痛和吸入风险。稳定后，后鼻出血填塞的患者通常需要转耳鼻喉科或急诊部门进行明确的治疗。
