鼻腔内局部应用氨甲环酸治疗非创伤性前鼻出血：一项双盲随机临床试验。
Intranasal Topical Application of Tranexamic Acid in Atraumatic Anterior Epistaxis: A Double-Blind Randomized Clinical Trial.
机构信息
Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
出版信息
Ann Emerg Med. 2022 Sep;80(3):182-188. doi: 10.1016/j.annemergmed.2022.04.010. Epub 2022 Jun 23.
STUDY OBJECTIVE
To determine the effectiveness of intranasal topical application of tranexamic acid in reducing the need for anterior nasal packing and determine the number of episodes of rebleeding in adult patients presenting with spontaneous atraumatic anterior epistaxis.
METHODS
This study was a double-blind randomized trial conducted from September to November 2021 in the ears, nose, and throat (ENT) emergency department (ED), Khalili Hospital, Shiraz, Iran. Cotton pledgets soaked in either phenylephrine and lidocaine (control group) or tranexamic acid with phenylephrine and lidocaine (intervention group) were inserted into the patients' nostrils for 15 minutes. The primary outcome was the need for anterior nasal packing. The secondary outcomes were staying in the ED for more than 2 hours, needing electrical cauterization, and rebleeding within 24 hours and 1 to 7 days of the first referral to the ED. The trial was registered with the Iranian Registry of Clinical Trials (IRCT20210403050815N1).
RESULTS
A total of 240 patients (120 in each group) were enrolled in this study. Tranexamic acid was associated with a lower rate of need for anterior nasal packing (50.0% versus 64.2%; odds ratio [OR], 0.56; 95% confidence interval [CI], 0.33 to 0.94). There were no significant differences between the 2 groups in terms of the need for electrical cauterization and the rate of rebleeding within 1 to 7 days. Tranexamic acid was associated with a lower rate of stay in the ED for more than 2 hours (9.2% versus 20.8%; OR, 0.38; 95% CI, 0.18 to 0.82) and rebleeding in 24 hours (15.0% versus 30%; OR, 0.41; 95% CI, 0.22 to 0.78) compared with the rates in the control group.
CONCLUSION
Intranasal topical application of tranexamic acid is associated with a lower rate of need for anterior nasal packing and a shortened stay in the ED; it may be considered a part of the treatment for atraumatic anterior epistaxis.
研究目的
确定鼻腔内局部应用氨甲环酸减少成人自发性无创伤性前鼻出血患者需要前鼻腔填塞的效果，并确定再出血发作次数。
方法
本研究为 2021 年 9 月至 11 月在伊朗设拉子 Khalili 医院耳鼻喉科急诊（ED）进行的双盲随机试验。将浸有苯肾上腺素和利多卡因的棉片（对照组）或氨甲环酸与苯肾上腺素和利多卡因的棉片（干预组）插入患者鼻腔 15 分钟。主要结局是需要前鼻腔填塞。次要结局是在 ED 停留超过 2 小时、需要电灼和在 ED 就诊后 24 小时内和 1 至 7 天内再次出血。该试验在伊朗临床试验注册中心（IRCT20210403050815N1）注册。
结果
本研究共纳入 240 例患者（每组 120 例）。与对照组相比，氨甲环酸组需要前鼻腔填塞的比例较低（50.0%比 64.2%；比值比[OR]，0.56；95%置信区间[CI]，0.33 至 0.94）。两组在需要电灼和 1 至 7 天内再出血率方面无显著差异。与对照组相比，氨甲环酸组在 ED 停留超过 2 小时的比例较低（9.2%比 20.8%；OR，0.38；95%CI，0.18 至 0.82）和 24 小时内再出血率较低（15.0%比 30%；OR，0.41；95%CI，0.22 至 0.78）。
结论
鼻腔内局部应用氨甲环酸可降低前鼻腔填塞的需要率和 ED 停留时间；可考虑将其作为无创伤性前鼻出血治疗的一部分。
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