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著者: Rafael Beck, Martin Sorge, Antonius Schneider, Andreas Dietz
雑誌名: Dtsch Arztebl Int. 2018 Jan 8;115(1-02):12-22. doi: 10.3238/arztebl.2018.0012.
Abstract/Text
BACKGROUND: The lifetime prevalence of epistaxis is approximately 60%, and 6-10% of the affected persons need medical care. In rare cases, severe bleeding calls for the rapid initiation of effective treatment.
METHODS: This review is based on pertinent articles that were retrieved by a selective search PubMed, and on the authors' clinical experience.
RESULTS: There are no German guidelines for the management of epistaxis. The available evidence consists mainly of retro spective analyses and expert opinions. 65-75% of the patients who require treatment can be adequately cared for by their primary care physician or by an emergency physician with baseline measures. If there is persistent anterior epistaxis, an otorhinolaryngologist can control the bleeding sastisfactorily in 78-88% of cases with chemical or electrical cauterization. Nasal packing is used if this treatment fails, or for posterior epistaxis. In a retrospective study, surgical treatment was found to be more effective than nasal packing in the treatment of posterior epistaxis (97% versus 62% treatment success). Percutaneous embolization is an alternative treatment for patients whom general anesthesia would put at high risk.
CONCLUSION: The treatment of severe or recurrent epistaxis requires the interdisciplinary collaboration of the primary care physician, the emergency physician, the practice-based otolaryngologist, and the hospital otolaryngology service. Uniform guidelines and epidemiological studies on this topic would be desirable.
PMID 29345234 Dtsch Arztebl Int. 2018 Jan 8;115(1-02):12-22. doi: 10.3238/arztebl.2018.0012.
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