Loftus B C, Blitzer A, Cozine K
Department of Otolaryngology, Kaiser Foundation Hospital, Santa Clara, CA.
Otolaryngol Head Neck Surg. 1994 Apr;110(4):363-9. doi: 10.1177/019459989411000403.
Posterior epistaxis and its management are associated with increased morbidity and sudden death. A "nasopulmonary reflex," changes in pulmonary function induced by packing, has been postulated to cause hypoxia and lead to the reported morbidities. However, no study has followed patients prospectively to associate complications with oxygen status. Continuous pulse oximetry monitoring of 19 patients hospitalized with posterior packing was undertaken to document the incidence and extent of oxygen desaturation, and to correlate complications with O2 status and historical factors. A further aim was to clarify the clinical relevance of the nasopulmonary reflex. In 1200 hours of monitoring, desaturations to less than 90% were observed on only two occasions: one self-limited episode in an actively bleeding patient and one major hypoxic event with respiratory arrest in an alcoholic patient under sedation for delirium tremens. Complications, while uncommon, were more appropriately ascribed to rebleeding or underlying medical problems than to primary O2 status. The nasopulmonary reflex, as previously described in terms of a primary drop in O2, therefore seems clinically irrelevant. Early surgery for posterior epistaxis is not warranted on the basis of maintenance of adequate oxygenation alone.
后鼻孔出血及其处理与发病率增加和猝死相关。一种“鼻肺反射”，即由填塞引起的肺功能变化，被认为可导致缺氧并引发所报道的各种发病情况。然而，尚无研究对患者进行前瞻性随访以将并发症与氧状态相关联。对19例因后鼻孔填塞住院的患者进行持续脉搏血氧饱和度监测，以记录氧饱和度降低的发生率和程度，并将并发症与氧状态及既往因素相关联。另一个目的是阐明鼻肺反射的临床相关性。在1200小时的监测中，仅在两次情况下观察到饱和度降至90%以下：一次是在一名活动性出血患者中出现的自限性发作，另一次是在一名因震颤谵妄接受镇静的酒精性患者中出现的伴有呼吸骤停的严重缺氧事件。并发症虽然不常见，但更应归因于再出血或潜在的医疗问题，而非原发性氧状态。因此，如先前根据氧的原发性下降所描述的鼻肺反射在临床上似乎并无关联。仅基于维持充足氧合，不建议早期进行后鼻孔出血手术。
