Patients with rhinorrhea are often encountered in clinical work, and the age range of patients with rhinorrhea varies from 20 to 80 years. The etiology of rhinorrhea is caused by hypertension in most cases, in addition to factors such as nasal trauma, nasal mucosa, nasal masses and systemic diseases. Most young people suffer from transient hypertensive rhinorrhea caused by prolonged exertion and lack of sleep, while elderly people generally suffer from hypertensive rhinorrhea caused by hypertension.
The causes of rhinorrhea can be broadly divided into two categories: systemic factors and local factors.
1. Local factors: nasal trauma, benign nasal diseases (such as deviated nasal septum, bleeding necrotic polyps), nasal tumors (such as hemangioma, malignant tumors), nasal mucosa erosion, etc.
According to the characteristics of nasal bleeding and the age of the patient, the cause of nasal bleeding can be roughly inferred. For example, if middle-aged and elderly people have a large amount of nasal bleeding and it is not easy to stop by itself, before bleeding, there is a pulsating sensation in the nose and there is a previous history of hypertension, it can be initially judged as nasal bleeding caused by hypertension. If middle-aged and elderly people have a small amount of nasal bleeding or blood in the nose, which lasts longer and does not heal itself, they should consider whether there is nasal mucosal erosion or nasal tumor growth.
2. Systemic factors: hypertension, vascular sclerosis (mostly seen in middle-aged and elderly people); hematological system diseases, such as hemophilia, thrombocytopenic purpura, leukemia, aplastic anemia; coagulation dysfunction of liver disease; hypersplenism; fever; high-altitude work; premenstruation of women, etc.
The normal range of blood pressure in adults is less than or equal to 140 mmHg systolic and less than or equal to 90 mmHg diastolic. hypertension is determined if the adult systolic blood pressure is greater than or equal to 160 mmHg and the diastolic blood pressure is greater than or equal to 95 mmHg. However, clinically, we often encounter elderly patients with nosebleeds who complain that they have no history of hypertension. These elderly patients generally insist that their blood pressure is very normal and say, “The doctor will say that my blood pressure is standard 120/80 mmHg after taking my blood pressure. However, doctors and patients themselves overlook the question of what the patient’s basal blood pressure is, which is often low, even with a history of hypotension, and some people have familial hypotension, with genetic factors. If the basal blood pressure is between 90-80/70-60 mmHg in young age and reaches 140/95 mmHg in old age, it is individual hypertension for the patient himself. Therefore, an elderly patient with nasal bleeding, except for nasal trauma, nasal mucosa, nasal mass and systemic disease factors, should first consider whether the nasal bleeding is caused by hypertension.
To treat hypertensive rhinorrhea, after dealing with nasal hemostasis, the most important thing is to actively control blood pressure. If the blood pressure is too high, active blood pressure control can be taken first, followed by nasal hemostasis, which aims to prevent the appearance of cerebral hemorrhage. In hypertensive rhinorrhea, the bleeding is large and not easily self-stopped, and nasal astringent treatment often fails to completely stop the bleeding, and often requires nasal cavity filling and compression with expanding hemostatic sponges and oil gauze strips to stop the bleeding. Along with local treatment, antihypertensive drugs should be used to control the blood pressure at an appropriate level. Because of the poor visual field during nasal bleeding, to prevent missed diagnosis, patients are advised to undergo another nasal examination after the bleeding has stopped to exclude bleeding caused by other nasal diseases (such as tumors).
To prevent hypertensive rhinorrhea, the following five points should be noted: 1. Blood pressure should be well controlled, especially when fatigue, lack of sleep, cold and flu, and temperature changes, more attention should be paid to monitoring blood pressure to prevent excessive fluctuations.
2.Patients with hypertension should try to drink less liquor and smoke less.
3, try to do less breath-holding action (such as blowing the horn, etc.), constipation should be treated early to prevent excessive breath-holding leading to rupture of nasal blood vessels.
4, do not consume too much warm and dry tonic products.
5, careful use of drugs with elevated pressure, such as furosemide nasal drops, epinephrine, etc., to prevent blood pressure rupture and bleeding of the nasal vessels.