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支氣管Dieulafoy 病致大咯血一例

病歷摘要 患者男性, 62 歲。因“咯血3 d, 加重1 h”于2010 年3 月23 日凌晨急診入院。患者于入院3 d 前無誘因出現咯血, 初咯血量較少, 入院前1 h 突然出現大咯血, 鮮紅色, 約150 mL; 伴頭暈、心悸, 無畏寒、發熱, 無胸痛和呼吸困難。既往有兩次大咯血病史, 未明確診斷; 否認肺結核和支氣管擴張病史。

Multidetector-Row CT Angiography and Digital Subtraction Angiography of Bronchial Artery in Diagnosis of Hemoptysis: A Comparative Study

Objective To compare the bronchial arteriography through multidetector-row CT (MDCT) with the digital subtraction angiography (DSA) via femoral artery, and evaluate the application value of bronchial arteriography through MDCT in the diagnosis and treatment of hemoptysis. Methods 133 cases complained of hemoptysis were examined by MDCT and DSA via femoral artery respectively to perform bronchial arteriography, and the differences of image results by two methods were compared. Results 129 cases with abnormal bronchial arteries were confirmed by DSA via femoral artery, 117 cases were checked by MDCT [ the positive rate was 90.7% (117/129 ) ] . 117 cases with abnormal bronchial arteries were confirmed by both MDCT and DSA via femoral artery and 4 cases did not detected any abnormal arteries by both methods. The coincidence rate of two methods was 91.0% (121 /133) . MDCT and DSA via femoral artery showed the similar origins of abnormal bronchial arteries. The coincidence rate of two methods was 100% . Conclusions There is a high coincidence rate betweenMDCT and DSA in detecting bronchial artery abnormalities. MDCT shows the origins of abnormal vessels clearly which could be a fist-choice of routine imagination for interventive operation.

支氣管擴張癥138例

目的 總結支氣管擴張癥外科治療的臨床診斷和治療經驗. 方法 回顧性分析1985～ 1999年手術治療138例支氣管擴張癥患者的診斷和治療情況. 結果 全組無1例手術死亡,94例單葉或雙葉支氣管擴張患者癥狀消失;13例雙側或廣泛支氣管擴張患者,癥狀均改善. 結論 把握好手術適應證和肺的切除范圍,可降低手術死亡率和并發癥發生率,提高治療效果.肺切除術對治療單葉或雙葉支氣管擴張療效十分顯著,盡可能完全切除病灶是獲得最佳治療效果的前提.

A Clinical Comparison on the Treatment of lntractable Hemoptysis Tubentolosis by Using Thrombin Combined with Phentolamine and Pituitrin

目的:觀察凝血酶霧化吸入聯用酚妥拉明治療肺結核頑固性咯血的臨床效果。方法:將47例住院肺結核頑固性咯血患者隨機分為兩組,治療組采用凝血酶超聲霧化吸入聯用酚妥拉明靜滴,對照組采用垂體后葉素靜滴。結果:治療組總有效率87.50%,對照組總有效率86.96%。結論:在常規止血治療無效的基礎上,加用凝血酶超聲霧化吸入聯用酚妥拉明止血快,副作用少,是治療肺結核頑固性咯血的有效藥物。

Embosphere 微粒球栓塞大咯血出血靶血管的療效和安全性研究

目的 觀察 Embosphere 微粒球作為栓塞材料治療大咯血的近遠期療效和安全性。 方法 納入 2013 年 7 月至 2016 年 3 月收治的 82 例大咯血患者，采用 Embosphere 微粒球為主要的栓塞材料，栓塞支氣管動脈以及其他出血靶血管，觀察 24 h 內咯血有無停止，7 d 內有無咯血反復，以及圍手術期的不良反應。術后隨訪 1 年觀察咯血有無反復。 結果 患者術后 24 h 內咯血停止 78 例，明顯減少 3 例，無效 1 例；7 d 內有 1 例出現反復。近期有效率 97.6%（80/82）。隨訪 1 年，咯血復發 4 例，遠期有效率 92.7%（76/82）。圍手術期的不良反應主要為胸痛、胸悶和發熱，未發生嚴重并發癥。 結論 Embosphere 微粒球經出血靶血管栓塞治療大咯血的近期和中遠期療效確切，無嚴重的不良反應，值得臨床推廣應用。

支氣管鏡聯合胸腔鏡手術治療大咯血32例臨床體會

目的探討支氣管鏡聯合胸腔鏡手術治療大咯血的可行性、安全性和有效性。 方法回顧性分析九江市第一人民醫院胸外科自2009年5月至2013年4月完成的32例經支氣管鏡聯合胸腔鏡手術治療大咯血患者的臨床資料。其中男19例、女13例，年齡24～60（40.2±9.1）歲；因支氣管擴張致大咯血24例，肺癌合并咯血6例，肺結核咯血2例。 結果2例（6%）因胸腔粘連嚴重而中轉開胸。1例因氣管內出血量大，纖維支氣管鏡無法準確定位，終止手術，最終死亡。余29例在全胸腔鏡下完成肺葉切除術，包括右肺上葉切除4例，右肺下葉12例，左肺下葉10例，左肺上葉3例。其中6例術中冰凍病理檢查提示癌，加做淋巴結清掃術；1例右肺上葉支氣管擴張行右肺上葉切除術后第3 d再次出現大咯血，手術證實為右肺中葉再次出血，行右肺中葉切除術；其余22例術后均無咯血。 結論支氣管鏡聯合胸腔鏡手術治療大咯血是一種安全有效的方法。

Therapeutic Evaluation of Selective Bronchial Artery Embolization in Massive Hemoptysis of Bronchiectasis

目的:對選擇性支氣管動脈栓塞術(SBAE) 治療支氣管擴張大咯血的療效做客觀評價,并就該技術的操作要點、注意事項等諸方面的技術問題做進一步探討總結。方法:對32例內科保守治療無危急生命的支氣管擴張大咯血患者行介入法供血支氣管動脈栓塞, 其中男18例, 女14例, 平均年齡46歲.結果:所有病例都成功實施了供血動脈栓塞, 術后除1例無效外均出血停止, 無嚴重并發癥發生。結論:SBAE作為治療支氣管擴張大咯血的急救手段之一,具有創傷輕微、可重復性強、療效高、見效快、并發癥少、簡便易行等特點,極具推廣應用價值。

Management of massive hemoptysis and application experience of computer tomography in vascular intervention of hemoptysis

Hemoptysis is a common respiratory emergency, and severe cases can lead to death. Patients with massive hemoptysis need emergency management at the bedside, and fully evaluation for indications and timing of tracheal intubation and transtracheal intervention. When a relatively stable state is achieved, emergency vascular intervention is performed to stop bleeding. CT plays an important role in the risk assessment and interventional treatment of hemoptysis, and it is worthy of clinical promotion and more exploratory research. This article introduces the emergency treatment for massive hemoptysis, the vascular interventional procedure, the exploration of clinical application of preoperative CT, and the clinical application value of CT for hemoptysis risk assessment. It aims to provide a better way to deal with massive hemoptysis and to apply CT to the interventional treatment of hemoptysis more reasonably for clinicians.

兩例大咯血患者手術中麻醉處理的體會

Efficacy of Bronchial Arterial Embolization in Treatment of Massive Hemoptysis due to Bronchiectasis: 205 Cases Analysis

Objective To evaluate the clinical effects of bronchial artery embolization ( BAE) for massive hemoptysis due to bronchiectasis.Methods 205 patients with massive hemoptysis were treated with bronchial artery embolization using coils, polyvinyl alcohol ( PVA) microspheres, line segmen, and gelatin sponge after the site of bleeding or the abnormal arteries were identified by arteriography. Super selective bronchial artery embolization was performed with a coaxial microcatheter inserted into the bronchial artery. Results BAE was successfully performed in 205 cases with massive hemoptysis ( left and right bronchial artery embolization in 35 cases, left bronchial artery embolization in 20 cases, right bronchial artery embolization in 126 cases, common bronchial artery embolization in 22 cases, right inferior phrenic artery embolization in 2 cases) . Of 205 patients, 169 were cured, 24 were relieved with a success rate of 94.1% . Long termcumulative hemoptysis nonrecurrence rates was 82.4% . 23 patients developed post embolization syndrome characterized by mild fever and chest pain and ended with spontaneous recovery without special management. No severe complications including spinal cord injury or dystopia embolization were observed. Conclusions Bronchial arterial embolization interventional therapy is a rapid, safe and effective method in the treatment of massive hemoptysis due to bronchiectasis.