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Coopdech 支氣管封堵器在搶救大咯血窒息中的應用

目的 探討Coopdech支氣管封堵器用于大咯血窒息搶救的可行性及療效。方法 在患者發生大咯血窒息時, 特別是無條件行雙腔支氣管插管或雙腔支氣管插管困難時, 在支氣管鏡引導下對2 例患者置入Coopdech 支氣管封堵器。結果 2 例大咯血患者Coopdech 支氣管封堵器置入后, 1 例保守治療成功,1 例為支氣管動脈栓塞術贏得時間。結論 Coopdech 支氣管封堵器可以有效替代雙腔支氣管導管用于搶救大咯血患者, 值得進一步臨床應用。

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.

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。