Rhinorrhea is one of the common emergencies in otorhinolaryngology, which can be caused by nasal disorders or systemic diseases. The most common cause of hypertension and rhinorrhea is hypertensive arteriosclerosis, which manifests itself clinically as a large amount of bleeding that is not easy to stop, the site of bleeding is not easy to find, and it is difficult to stop bleeding. In addition, the atrophy of the nasal mucosa, the thinning of the blood vessel wall and the degeneration of the muscle layer fibers in the elderly are manifested by poor vascular elasticity, brittle quality, easy to rupture and lack of contraction, so once the bleeding is stopped, it is difficult to stop itself.
Patients do not know about the disease, and when bleeding, they are nervous and afraid, which makes the sympathetic adrenal axis excited, increases the secretion of adrenaline, increases the heart beat output, constricts the small arteries of the body, and increases blood pressure, which aggravates or triggers bleeding. Therefore, medical personnel should pay attention to using their professional knowledge and patience to relieve patients and family members of impatience, tension and fear to make them emotionally stable, which is conducive to hemostasis, and give sedatives if necessary.
Observe the bleeding of the patient. After the blood backflow to the nasopharynx, ask the patient to vomit in the curved tray in order to correctly estimate the amount of bleeding, and at the same time, it can avoid the discomfort caused by stimulating the gastric mucosa by swallowing into the stomach. Observe the vital signs. Observe the presence of shock symptoms such as irritability, increased pulse rate, decreased pulse pressure difference and decreased urine volume in those with heavy bleeding, and give symptomatic treatment in case of the above conditions. Since these patients have a history of hypertension for many years, on the basis of effective drug control, we should closely monitor its changes. In addition to regular blood pressure measurement, we should also pay attention to the patient’s complaints, as these patients often have head discomfort before bleeding. When the bleeding is given a sitting position, the bleeding point is found by gentle operation with the nasal endoscope, the bleeding site is closely observed, and the bleeding point is determined. Nasal cavity filling can lead to lower partial pressure of oxygen and higher partial pressure of carbon dioxide, so oxygen saturation and cardiac monitoring should be given, insist on taking antihypertensive drugs, control blood pressure steadily, prevent possible complications, and give low-flow oxygen if necessary. Note that ventilation keeps indoor air fresh and increases indoor humidity to keep it at about 70%. Apply compound peppermint paraffin oil drops 3 to 4 times/day to prevent dryness of nasal mucosa. Take appropriate measures when the patient has head discomfort. Avoid emotional excitement and strenuous exercise, avoid digging and blowing the nose in general, avoid sneezing, excessive activity and prevent constipation to reduce the possibility of rebleeding. After the nasal cavity and posterior nostril are filled, the patient needs to breathe through the mouth, which will easily cause dryness of the mucous membrane of the mouth and throat, so the patient is advised to drink more water. Pay attention to rinse the mouth with oral tylenol every day to prevent infection. Pay attention to the dislodgement of the stuffing at any time.
In conclusion, during the diagnosis and treatment of patients with hypertension and nasal bleeding, both patients and their families should be calm, do not panic and cooperate closely with the doctor; the best choice for examination is to use nasal endoscopy, carefully search for bleeding points, and take effective local hemostatic measures after finding the bleeding points, while not forgetting the systemic antihypertensive, sedation, hemostasis, anti-infection, rehydration (or whole blood) and other symptomatic and supportive treatments.