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Epistaxis

最后审阅: 14 Aug 2025
最后更新: 26 May 2021

小结

定义

病史和体格检查

关键诊断因素

  • blood at both sides of nose
完整详情

其他诊断因素

  • bleeding starting at the nares
  • recurrent epistaxis
  • septal deviation
  • tachycardia
  • bleeding starting in the throat
  • hypotension
  • syncope
  • dizziness or lightheadedness
  • pallor
  • hypoesthesia and pain in the distribution of the second branch of the trigeminal nerve
完整详情

危险因素

  • dry weather and low humidity
  • prior nasal or sinus surgery
  • nasal cannula oxygen or continuous positive airways pressure (CPAP)
  • nasal and other facial fracture
  • other nasal trauma
  • topical nasal drugs
  • primary coagulopathy (e.g., hemophilia)
  • medication (e.g., aspirin, anticoagulant, antiplatelet, nonsteroidal anti-inflammatory drugs)
  • familial hereditary hemorrhagic telangiectasia
  • juvenile nasal angiofibroma
  • chronic kidney or liver disease
  • septal deviation
  • nasal foreign body
  • environmental irritants
  • barotrauma
  • ulceration secondary to infection (e.g., herpes zoster, or bacterial infection)
  • forceful coughing
  • sinonasal neoplasm
  • chronic granulomatous disease
完整详情

诊断性检查

首要检查

  • clinical diagnosis
完整详情

需考虑的检查

  • CBC
  • coagulation studies (prothrombin time, activated partial thromboplastin time, platelet function tests)
  • BUN, serum creatinine
  • LFTs
  • autoimmune screen/autoantibodies
  • CT scan of paranasal sinuses
  • MRI of head
  • internal and external carotid angiography
  • nasal endoscopy and nasopharyngoscopy
  • plain nasal or sinus x-ray
完整详情

治疗流程

初步治疗

active epistaxis: initial measures

急症处理

active epistaxis: persistent bleeding precluding identification of bleeding site

active epistaxis: bleeding site visible

持续性治疗

quiescent but recurrent epistaxis

撰稿人

作者

Darren Pinder, BSc(Hons), MB BChir, MSc(Med Ed), FRCS(ORL)

Consultant ENT Surgeon

Royal United Hospital Bath NHS Trust

Bath

UK

利益声明

DP declares that he has no competing interests.

同行评议者

Ethan Cumbler, MD

Assistant Professor

Department of Internal Medicine

University of Colorado Health Sciences Center

Denver

CO

利益声明

EC declares that he has no competing interests.

Samuel J. Stratton, MD, MPH

Professor

UCLA School of Public Health and David Geffen School of Medicine

Los Angeles

Medical Director

Health Disaster Management/Emergency Medical Services

Orange County Health Care Agency

Santa Ana

CA

利益声明

SJS declares that he has no competing interests.

Janet Wilson, BSc, MD, FRCSEd, FRCSEng

Professor of Otolaryngology - Head and Neck Surgery

Newcastle University

Honorary Consultant Otolaryngologist

Freeman Hospital

Newcastle-Upon-Tyne

UK

利益声明

JW declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Tan L, Calhoun K. Epistaxis. Med Clin North Am. 1999 Jan;83(1):43-56. 摘要

Perretta L, Denslow B, Brown C. Emergency evaluation and management of epistaxis. Emerg Med Clin North Am. 1987 May;5(2):265-77. 摘要

Santos P, Lepore M. Epistaxis. In: Bailey B, Healy G, Johnson J, et al., eds. Head & neck surgery-otolaryngology. Philadelphia: Lippincott, Williams & Wilkins; 2001:415-28.

Massick D, Tobin E. Epistaxis. In: Cummings C, Flint P, Harker L, et al., eds. Otolaryngology-head and neck surgery. Philadelphia: Elsevier Mosby; 2005:942-61.

Santos P, Lepore M. Epistaxis. In: Bailey B, Healy G, Johnson J, et al., eds. Head & neck surgery-otolaryngology. Philadelphia: Lippincott, Williams & Wilkins; 2001:415-428.

Massick D, Tobin E. Epistaxis. In: Cummings C, Flint P, Harker L, et al., eds. Otolaryngology-head and neck surgery. Philadelphia: Elsevier Mosby; 2005:942-961.

Tunkel DE, Anne S, Payne SC, et al. Clinical practice guideline: nosebleed (epistaxis). Otolaryngol Head Neck Surg. 2020 Jan;162(1 suppl):S1-S38.全文  摘要

Pond F, Sizeland A. Epistaxis: strategies for management. Aust Fam Physician. 2000 Oct;29(10):933-8. 摘要

Randall DA. Epistaxis packing. Practical pointers for nosebleed control. Postgrad Med. 2006 Jun-Jul;119(1):77-82. 摘要

Ruddy J, Proops DW, Pearman K, et al. Management of epistaxis in children. Int J Paediatr Otorhinolaryngol. 1991 Apr;21(2):139-42. 摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Epistaxis images
  • 鉴别诊断

    • Hemoptysis
    • Hematemesis
    更多 鉴别诊断
  • 指南

    • Clinical practice guideline: nosebleed (epistaxis)
    • Clinical guideline: epistaxis
    更多 指南
  • 患者教育信息

    Nosebleeds in children

    Nosebleeds (epistaxis) in adults

    更多 患者教育信息
  • Videos

    Venepuncture and phlebotomy: animated demonstration

    Insertion of an anterior nasal pack

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