Department of Emergency Medicine, Kecioren Training and Research Hospital, Ankara, Turkey.
Department of Emergency Medicine, Kecioren Training and Research Hospital, Ankara, Turkey.
Ann Emerg Med. 2019 Jul;74(1):72-78. doi: 10.1016/j.annemergmed.2019.03.030. Epub 2019 May 9.
The primary objective of this study is to compare the effectiveness of 3 treatment protocols to stop anterior epistaxis: classic compression, nasal packing, and local application of tranexamic acid. It also aims to determine the frequency of rebleeding after each of these protocols.
This single-center, prospective, randomized controlled study was conducted with patients who had spontaneous anterior epistaxis. The study compared the effect of 3 treatment options, tranexamic acid with compression but without nasal packing, nasal packing (Merocel), and simple nasal external compression, on the primary outcome of stopping anterior epistaxis bleeding within 15 minutes.
Among the 135 patients enrolled, the median age was 60 years (interquartile range 25% to 75%: 48 to 72 years) and 70 patients (51.9%) were women. The success rate in the compression with tranexamic acid group was 91.1% (41 of 45 patients); in the nasal packing group, 93.3% (42 of 45 patients); and in the compression with saline solution group, 71.1% (32 of 45 patients). There was an overall statistically significant difference among the 3 treatment groups but no significant difference in pairwise comparison between the compression with tranexamic acid and nasal packing groups. In regard to no rebleeding within 24 hours, the study found rates of 86.7% in the tranexamic acid group, 74% in the nasal packing group, and 60% in the compression with saline solution group.
Applying external compression after administering tranexamic acid through the nostrils by atomizer stops bleeding as effectively as anterior nasal packing using Merocel. In addition, the tranexamic acid approach is superior to Merocel in terms of decreasing rebleeding rates.
本研究的主要目的是比较三种治疗方案停止前鼻出血的效果：经典压迫、鼻腔填塞和局部应用氨甲环酸。它还旨在确定这些方案中的每一种方案后再次出血的频率。
这是一项单中心、前瞻性、随机对照研究，纳入了自发性前鼻出血患者。研究比较了三种治疗选择的效果，即氨甲环酸联合压迫但不鼻腔填塞、（Merocel）鼻腔填塞和单纯鼻外压迫，主要结局是在 15 分钟内停止前鼻出血出血。
在纳入的 135 名患者中，中位年龄为 60 岁（四分位距 25%至 75%：48 至 72 岁），70 名患者（51.9%）为女性。氨甲环酸联合压迫组的成功率为 91.1%（45 例患者中的 41 例）；鼻腔填塞组为 93.3%（45 例患者中的 42 例）；盐水溶液压迫组为 71.1%（45 例患者中的 32 例）。三组治疗之间存在总体统计学差异，但氨甲环酸联合压迫与鼻腔填塞组之间的两两比较无显著差异。关于 24 小时内无再次出血，研究发现氨甲环酸组为 86.7%，鼻腔填塞组为 74%，盐水溶液压迫组为 60%。
通过鼻腔喷雾器向鼻腔内给药氨甲环酸后进行外部压迫，与使用 Merocel 进行前鼻填塞同样有效地止血。此外，氨甲环酸方法在降低再出血率方面优于 Merocel。
