小结
定义
病史和体格检查
关键诊断因素
- 一侧鼻孔或双侧鼻腔出血
- 存在的危险因素
其他诊断因素
- 始于鼻孔的出血
- 复发性鼻衄
- 鼻中隔偏曲
- 始于喉部的出血
- 血液动力学受损的征象
- 鼻内息肉
- 毛细血管扩张
危险因素
- 干燥的天气和较低的湿度
- 鼻中隔偏曲
- 轻微鼻外伤
- 鼻腔内异物
- 鼻息肉
- 鼻腔局部药物
- 原发性凝血功能障碍(如血友病)
- 药物治疗(例如,阿司匹林、抗凝药、非甾体抗炎药)
- 家族遗传性出血性毛细血管扩张症
- 青少年鼻腔血管纤维瘤
诊断性检查
首要检查
- 临床诊断
需考虑的检查
- FBC 及“血型鉴定和抗体筛查
- 凝血检查(INR、凝血酶原时间、活化部分凝血活酶时间、血小板功能检查)
- 尿素、电解质和血清肌酐
- 肝功能检查(LFT)
- 鼻旁窦 CT 扫描
- 心电图(ECG)
治疗流程
活动性鼻衄:大出血
活动性鼻衄:无大出血
尽管采取了初步措施,但仍有持续性鼻衄
鼻衄已止
复发性鼻衄
撰稿人
专家顾问
Alexander Alexiou, MB, BS, BSc, DCH, FRCEM, DipIMC RSEd
Flight Doctor
Greater Sydney Area Helicopter Emergency Medical Services
New South Wales
Australia
利益声明
AA declares that he has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:
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
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.
编辑
Susan Mayor
Lead Section Editor, BMJ Best Practice
利益声明
SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.
Celia Pincus
Section Editor, BMJ Best Practice
利益声明
CP declares that she has no competing interests.
Jo Haynes
Head of Editorial, BMJ Knowledge Centre
利益声明
JH declares that she has no competing interests.
Rachel Wheeler
Lead Section Editor, BMJ Best Practice
利益声明
RW declares that she has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
鉴别诊断
- 咯血
- 呕血
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