Lee Cheng-Jung, Seak Chen-June, Liao Pin-Chieh, Chang Chia-Hsun, Tzen I-Shiang, Hou Po-Jen, Lin Chih-Chuan
Linkou Medical Center, Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan.
Chang Gung University College of Medicine Taoyuan Taiwan.
J Acute Med. 2020 Mar 1;10(1):27-39. doi: 10.6705/j.jacme.202003_10(1).0004.
Epistaxis is the most common cause of otorhinolaryngologic emergencies. There is a longstanding controversy regarding the relationship between epistaxis and hypertension (HTN), in terms of blood pressure (BP) control in the emergency department (ED) setting. The objective of this study is to evaluate the association between HTN, BP control, and recurrent epistaxis among patients initially admitted to the ED for epistaxis.
This retrospective cohort study was conducted in the EDs of three different hospitals in Taiwan and included a total of 739 patients admitted for epistaxis.
Among ED patients with epistaxis, older age was significantly associated with a history of HTN, and a statistically significant difference in age was noted between groups classified according to the systolic BP/diastolic BP (SBP/DBP) at triage. Patients with a history of HTN had higher BP values at triage than did patients without a history of HTN (SBP: 175.68 ± 32.30 mmHg vs. 148.00 ± 26.26 mmHg, DBP: 95.04 ± 20.98 mmHg vs. 83.30 ± 16.65 mmHg; < 0.0001). Antihypertensive medications were more commonly administered to patients with a history of HTN ( < 0.0001) and in those patients with SBP/DBP: ≥ 140/≥ 90 mmHg at triage ( < 0.0001). Among patients receiving antihypertensive medications, reductions in SBP by the time of discharge were significantly greater in patients with a history of HTN and in patients with SBP/DBP: ≥ 160/≥ 100 mmHg at triage. ED revisits due to recurrent epistaxis within 72 hours were significantly associated with male sex, a positive history of HTN, level of GOT, observation for recurrent epistaxis at ED, and duration of recurrent bleeding.
A positive history of HTN is related to recurrent epistaxis among ED patients. The effectiveness of administering antihypertensive agents before achieving hemostasis in patients admitted to the ED for epistaxis warrants further study.
鼻出血是耳鼻咽喉科急诊最常见的病因。在急诊科环境下，关于鼻出血与高血压（HTN）之间的关系以及血压（BP）控制方面，长期存在争议。本研究的目的是评估最初因鼻出血入住急诊科的患者中高血压、血压控制与复发性鼻出血之间的关联。
本回顾性队列研究在台湾三家不同医院的急诊科进行，共纳入739例因鼻出血入院的患者。
在急诊科鼻出血患者中，年龄较大与高血压病史显著相关，根据分诊时收缩压/舒张压（SBP/DBP）分类的组间年龄存在统计学显著差异。有高血压病史的患者在分诊时的血压值高于无高血压病史的患者（SBP：175.68±32.30 mmHg对148.00±26.26 mmHg，DBP：95.04±20.98 mmHg对83.30±16.65 mmHg；<0.0001）。有高血压病史的患者（<0.0001）以及分诊时SBP/DBP≥140/≥90 mmHg的患者（<0.0001）更常使用抗高血压药物。在接受抗高血压药物治疗的患者中，有高血压病史的患者以及分诊时SBP/DBP≥160/≥100 mmHg的患者在出院时SBP的降低幅度显著更大。72小时内因复发性鼻出血返回急诊科与男性、高血压阳性病史、谷草转氨酶水平、在急诊科观察复发性鼻出血以及复发性出血持续时间显著相关。
高血压阳性病史与急诊科患者复发性鼻出血有关。对于因鼻出血入住急诊科的患者，在止血前给予抗高血压药物的有效性值得进一步研究。
