2025 年第 5 期 第 20 卷

不同抗血小板治疗方案对鼻出血患者预后的影响分析

Analysis of the effects of different antiplatelet therapy regimens on the prognosis of patients with epistaxis

作者：贾弘光吴昊饶远生王建宏

英文作者：Jia Hongguang Wu Hao Rao Yuansheng Wang Jianhong

单位：首都医科大学附属北京安贞医院耳鼻咽喉头颈外科，北京100029

英文单位：Department of Otorhinotaryngology Head and Neck Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：鼻出血；抗血小板；治疗方案；影响因素

英文关键词：Epistaxis;Antiplatelet;Treatmentregimen;Influencefactors

• 摘要：

• 目的 探讨不同抗血小板治疗方案对鼻出血患者预后的影响。方法 收集2020年1月至2023年12月因鼻出血就诊于首都医科大学附属北京安贞医院的243例患者的临床资料进行回顾性研究。根据鼻出血发作前抗血小板药物使用情况分组，因冠心病（冠状动脉粥样硬化性心脏病）持续规律服用阿司匹林联合替格瑞洛或氯吡格雷的78例患者作为双抗组，服用单一抗血小板药物的83例患者作为单抗组，未使用抗血小板药物的82例患者作为对照组。比较3组患者临床及实验室检查指标、鼻出血治疗效果及并发症发生情况，分析影响鼻出血预后的相关因素。结果 双抗组多次鼻出血（1个月内鼻出血≥3次）及持续性鼻出血（24 h内鼻出血时间≥30 min）的比例高于单抗组和对照组（均P<0.05）。双抗组患者痊愈率低于对照组和单抗组，复发率显著高于对照组［67.9%（53/78）比91.5%（75/82）、81.9%（68/83），9.0%（7/78）比1.2%（1/82）］（均P<0.05）。双抗组并发症总发生率高于对照组和单抗组［25.6%(20/78)比8.5%(7/82)、10.8%(9/83)］（均P<0.05）。Logistic回归分析结果显示双联抗血小板治疗后鼻出血1个月内痊愈的可能性较对照组显著降低(比值比=1.759, 95%置信区间：1.032～5.925，P=0.034)。结论 双联抗血小板治疗显著增加了严重鼻出血的风险，并对鼻出血患者的预后产生不良影响，应给予高度关注。

• Objective To investigate the effect of different antiplatelet therapy on the prognosis of patients with epistaxis. Methods The clinical data of 243 patients with epistaxis who were admitted to Beijing Anzhen Hospital, Capital Medical University from January 2020 to December 2023 were retrospectively analyzed. According to the use of antiplatelet drugs before epistaxis, 78 patients with coronary atherosclerotic heart disease who took aspirin combined with ticagrelor or clopidogrel were divided into dual antibody group, 83 patients who took single antiplatelet drugs were divided into single antibody group, and 82 patients who did not use antiplatelet drugs were divided into control group. The clinical and laboratory indexes, therapeutic effects and complications of epistaxis were compared among the three groups, and the related factors affecting the prognosis of epistaxis were analyzed. Results The proportions of multiple epistaxis (≥3 times within 1 month) and persistent epistaxis (≥30 minutes within 24 hours) in the dual antibody group were higher than those in the single antibody group and the control group (all P<0.05). The cure rate of the double antibody group was lower than those of the control group and the single antibody group, and the recurrence rate was significantly higher than that of the control group ［67.9%(53/78) vs 91.5%(75/82), 81.9%(68/83); 9.0%(7/78) vs 1.2%(1/82)］(all P<0.05). The total incidence of complications in the dual antibody group was higher than those in the control group and the single antibody group ［25.6%(20/78) vs 8.5%(7/82), 10.8%(9/83)］(both P<0.05). Logistic regression analysis showed that the possibility of healing of epistaxis within 1 month after dual antiplatelet therapy was significantly lower than that of the control group (odds ratio=1.759, 95% confidence interval: 1.032-5.925, P=0.034). Conclusions  Dual antiplatelet therapy significantly increases the risk of severe epistaxis and has adverse effects on the prognosis of patients with epistaxis, which should be paid more attention.