Viducich R A, Blanda M P, Gerson L W
Department of Emergency Medicine, Akron City Hospital, Ohio, USA.
Ann Emerg Med. 1995 May;25(5):592-6. doi: 10.1016/s0196-0644(95)70169-9.
To describe the clinical features, evaluate the incidence of serious complications, and identify factors associated with rebleeding in adults with acute posterior epistaxis.
Retrospective chart review.
University-affiliated community teaching hospital.
We studied 88 episodes of posterior epistaxis in 81 patients (mean age, 64.3 years; range, 27 to 96 years) who were treated in the emergency department and hospitalized during a 6-year period. Inclusion criterion was active hemorrhage into the posterior pharynx without identifiable anterior bleeding or severe nasal hemorrhage refractory to anterior packing. Patients with anterior epistaxis were excluded.
Posterior epistaxis accounted for 5% of all cases of epistaxis. The most common factors associated with posterior epistaxis were a history of hypertension in 39 patients (48%) and previous epistaxis in 30 (37%). Of 57 patients who reported duration of epistaxis, 39 (68.4%) had nasal hemorrhage for less than 12 hours before ED presentation, and 13 patients (22.8%) had nasal bleeding that lasted more than 24 hours. Bleeding was recorded as moderate or severe for 88% of patients. All patients were treated with posterior nasal packing in the ED (73% with traditional gauze packing, 15% with balloon, and 12% with tampon). After admission, 16 patients (19.8%) required surgical intervention, 17 (21%) experienced acute sinusitis, 10 (12.3%) received blood transfusions, and 3 (3.7%) were intubated. Rebleeding occurred in 24 patients (29.6%), with 13 episodes (44.1%) occurring less than 24 hours after admission. Factors associated with rebleeding were posterior epistaxis described as "severe" (OR, 2.53; 95% CI, .88 to 7.39; chi 2 = 2.84, 1 df, P = .92) and pack removal within 48 hours after admission (OR, 3.07; 95% CI, .98 to 9.88; chi 2 = 3.66, 1 df, P = .056). Factors that failed to predict rebleeding included age, prior hypertension, anticoagulant use, vital signs, and type of posterior pack used (gauze or balloon).
Although posterior epistaxis is an uncommon otolaryngologic emergency, many patients experience clinically significant complications. Rebleeding was associated with severe posterior epistaxis and pack removal within 48 hours after admission.
描述急性后鼻孔出血成人患者的临床特征，评估严重并发症的发生率，并确定与再出血相关的因素。
回顾性病历审查。
大学附属医院社区教学医院。
我们研究了81例患者（平均年龄64.3岁；范围27至96岁）在6年期间急诊科就诊并住院治疗的88次后鼻孔出血事件。纳入标准为后咽部有活动性出血且无前庭可识别出血或对前鼻孔填塞难治的严重鼻出血。排除前鼻孔出血患者。
后鼻孔出血占所有鼻出血病例的5%。与后鼻孔出血相关的最常见因素是39例患者（48%）有高血压病史，30例（37%）有既往鼻出血史。在57例报告鼻出血持续时间的患者中，39例（68.4%）在急诊就诊前鼻出血少于12小时，13例患者（22.8%）鼻出血持续超过24小时。88%的患者出血记录为中度或重度。所有患者在急诊科均接受后鼻孔填塞治疗（73%采用传统纱布填塞，15%采用球囊填塞，12%采用棉塞填塞）。入院后，16例患者（19.8%）需要手术干预，17例（21%）发生急性鼻窦炎，10例（12.3%）接受输血，3例（3.7%）需要插管。24例患者（29.6%）发生再出血，13次事件（44.1%）发生在入院后24小时内。与再出血相关的因素为后鼻孔出血描述为“严重”（比值比，2.53；95%置信区间，0.88至7.39；卡方 = 2.84，1自由度，P = 0.92）以及入院后48小时内取出填塞物（比值比，3.07；95%置信区间，0.98至9.88；卡方 = 3.66，1自由度，P = 0.056）。未能预测再出血的因素包括年龄、既往高血压、抗凝剂使用、生命体征以及所用后鼻孔填塞物类型（纱布或球囊）。
尽管后鼻孔出血是一种不常见的耳鼻喉科急症，但许多患者会出现具有临床意义的并发症。再出血与严重后鼻孔出血以及入院后48小时内取出填塞物有关。
