Chiang Cheng-Ying, Lin Jen-Shyang, Tsai Tou-Yuan, Tu Yu-Kang, Tsai Ming-Jen
Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.
Department of Emergency Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
Acad Emerg Med. 2023 Oct;30(10):1047-1058. doi: 10.1111/acem.14680. Epub 2023 Feb 27.
The best initial strategy for managing epistaxis is unclear. We performed a systematic review and network meta-analysis (NMA) to compare the effectiveness of various noninvasive treatments for patients with epistaxis.
We searched PubMed, Embase, and the Cochrane Library from inception to September 2022 without language restrictions. Randomized controlled trials (RCTs) assessing immediate hemostasis, 2-day and 7-day rebleeding outcomes, as well as the use of noninvasive interventions for the treatment of epistaxis were selected. Frequentist NMA was performed.
The systematic review included 20 RCTs (2994 participants) involving 12 different interventions. The NMA demonstrated that topical treatment with tranexamic acid (TXA) significantly reduced the odds of 2-day rebleeding compared with the control conservative treatment (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.21-0.61) and traditional anterior nasal packing (OR 0.45, 95% CI 0.26-0.76). The sensitivity analysis yielded robust results, and the overall evidence was high. Topical TXA significantly reduced the odds of 7-day rebleeding compared with traditional nasal packing (OR 0.33, 95% CI 0.15-0.70), with moderate evidence owing to the heterogeneous results. Despite the significant effects of topical TXA on achieving immediate hemostasis and Rapid Rhino nasal packing on preventing 2-day rebleeding compared to the control and traditional nasal packing, the evidence is low to very low due to heterogeneity, inconsistency, and within-study bias.
In the treatment of epistaxis, topical TXA may be superior to conservative treatment or traditional nasal packing, particularly in preventing 2-day rebleeding.
鼻出血最佳的初始治疗策略尚不清楚。我们进行了一项系统评价和网状Meta分析（NMA），以比较各种非侵入性治疗方法对鼻出血患者的有效性。
我们检索了从创刊至2022年9月的PubMed、Embase和Cochrane图书馆，无语言限制。选择评估即时止血、2天和7天再出血结局以及使用非侵入性干预措施治疗鼻出血的随机对照试验（RCT）。进行了频率学派NMA。
该系统评价纳入了20项RCT（2994名参与者），涉及12种不同的干预措施。NMA表明，与对照保守治疗相比，氨甲环酸（TXA）局部治疗显著降低了2天再出血的几率（优势比[OR]0.36，95%置信区间[CI]0.21-0.61）和传统前鼻孔填塞（OR 0.45，95%CI 0.26-0.76）。敏感性分析得出了可靠的结果，总体证据质量高。与传统鼻腔填塞相比，局部TXA显著降低了7天再出血的几率（OR 0.33，95%CI 0.15-0.70），由于结果异质性，证据质量为中等。尽管与对照和传统鼻腔填塞相比，局部TXA对实现即时止血有显著效果，而快速犀牛鼻腔填塞对预防2天再出血有显著效果，但由于异质性、不一致性和研究内偏倚，证据质量为低至极低。
在鼻出血的治疗中，局部TXA可能优于保守治疗或传统鼻腔填塞，特别是在预防2天再出血方面。
