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鼻衄

  • 概述
  • 理论
  • 诊断
  • 治疗
  • 随访
  • 资源
最后审阅： 4 Apr 2025
最后更新： 05 Mar 2020

小结

定义

病史和体格检查

关键诊断因素

  • 存在的危险因素
  • 双侧鼻腔出血
完整详情

其他诊断因素

  • 始于鼻孔的出血
  • 复发性鼻衄
  • 鼻中隔偏曲
  • 心动过速
  • 始于喉部的出血
  • 低血压
  • 晕厥
  • 头晕或眩晕
  • 苍白
  • 三叉神经第二分支分布的皮肤感觉减退和疼痛
完整详情

危险因素

  • 干燥的天气和较低的湿度
  • 氧依赖
  • 鼻中隔偏曲
  • 鼻部和其他面部骨折
  • 其他鼻部创伤
  • 鼻腔内异物
  • 鼻炎
  • 鼻息肉
  • 环境刺激物
  • 鼻腔局部药物
  • 原发性凝血功能障碍（如血友病）
  • 获得性凝血功能障碍（例如使用阿司匹林、抗凝药、非甾体抗炎药）
  • 家族遗传性出血性毛细血管扩张症
  • 气压伤
  • 感染（如带状疱疹或细菌性感染）引起的溃疡
  • 用力咳嗽
  • 鼻腔鼻窦肿瘤
  • 青少年鼻腔血管纤维瘤
  • 慢性肉芽肿病
完整详情

诊断性检查

首要检查

  • 临床诊断
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需考虑的检查

  • 全血细胞计数 (FBC）
  • 凝血功能检查（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、血肌酐
  • 肝功能检查 (LFT)
  • 自身免疫筛查/自身抗体
  • 鼻旁窦 CT 扫描
  • 头部 MRI
  • 颈内、颈外动脉血管造影术
  • 鼻内镜检查和鼻咽内镜检查
  • 鼻腔或鼻窦 x 光平片
完整详情

治疗流程

急症处理

活动性鼻衄：初步治疗

活动性鼻衄：初步治疗后仍持续出血

持续性治疗

当前无症状的复发性鼻衄

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.

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; 2001:415-428.

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.

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.

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