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支气管Dieulafoy 病致大咯血一例

病历摘要 患者男性, 62 岁。因“咯血3 d, 加重1 h”于2010 年3 月23 日凌晨急诊入院。患者于入院3 d 前无诱因出现咯血, 初咯血量较少, 入院前1 h 突然出现大咯血, 鲜红色, 约150 mL; 伴头晕、心悸, 无畏寒、发热, 无胸痛和呼吸困难。既往有两次大咯血病史, 未明确诊断; 否认肺结核和支气管扩张病史。

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.

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

目的:观察凝血酶雾化吸入联用酚妥拉明治疗肺结核顽固性咯血的临床效果。方法:将47例住院肺结核顽固性咯血患者随机分为两组,治疗组采用凝血酶超声雾化吸入联用酚妥拉明静滴,对照组采用垂体后叶素静滴。结果:治疗组总有效率87.50%,对照组总有效率86.96%。结论:在常规止血治疗无效的基础上,加用凝血酶超声雾化吸入联用酚妥拉明止血快,副作用少,是治疗肺结核顽固性咯血的有效药物。

Clinical comparison of pulmonary lobectomy in patients with massive hemoptysis of pulmonary tuberculosis after bronchial artery embolization

ObjectiveTo compare the clinical data of pulmonary lobectomy in patients with massive hemoptysis of pulmonary tuberculosis after bronchial artery embolization in the short and long term, so as to provide a reference for clinical choices of appropriate operation time.MethodsA retrospective analysis was conducted on 33 patients with massive hemoptysis of pulmonary tuberculosis, who had received pulmonary lobectomy after bronchial artery embolization in Wuhan Pulmonary Hospital from January 2015 to November 2017, including 29 males and 4 females aged of 23-66 (52.64±9.70) years. According to the time interval between bronchial artery embolization and lobectomy, the patients were divided into a short-term group (<2 weeks, 14 patients) and a long-term group (>1 month, 19 patients). The clinical data, such as operation time, intraoperative blood loss, postoperative extubation time and serious postoperative complications, were observed in the two groups for statistical analysis.ResultsThe operative time (297.13±75.69 min vs. 231.32±67.57 min, P=0.013), intraoperative blood loss (685.74±325.51 mL vs. 355.83±259.11 mL, P=0.002), postoperative extubation time (14.07±5.24 d vs. 8.90±3.57 d, P=0.003) of the short-term group were all higher than those in the long-term group.ConclusionFor the patients with massive hemoptysis of pulmonary tuberculosis, who had surgical indications and no risk of early rebleeding after bronchial artery embolization, pulmonary lobectomy should be performed late until the patient's physical condition and the primary disease was stable.

两例大咯血患者手术中麻醉处理的体会

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.

Coopdech 支气管封堵器在抢救大咯血窒息中的应用

目的 探讨Coopdech支气管封堵器用于大咯血窒息抢救的可行性及疗效。方法 在患者发生大咯血窒息时, 特别是无条件行双腔支气管插管或双腔支气管插管困难时, 在支气管镜引导下对2 例患者置入Coopdech 支气管封堵器。结果 2 例大咯血患者Coopdech 支气管封堵器置入后, 1 例保守治疗成功,1 例为支气管动脉栓塞术赢得时间。结论 Coopdech 支气管封堵器可以有效替代双腔支气管导管用于抢救大咯血患者, 值得进一步临床应用。

咯血患者无痛纤维支气管镜检查的麻醉一例

Embosphere 微粒球栓塞大咯血出血靶血管的疗效和安全性研究

目的 观察 Embosphere 微粒球作为栓塞材料治疗大咯血的近远期疗效和安全性。 方法 纳入 2013 年 7 月至 2016 年 3 月收治的 82 例大咯血患者，采用 Embosphere 微粒球为主要的栓塞材料，栓塞支气管动脉以及其他出血靶血管，观察 24 h 内咯血有无停止，7 d 内有无咯血反复，以及围手术期的不良反应。术后随访 1 年观察咯血有无反复。 结果 患者术后 24 h 内咯血停止 78 例，明显减少 3 例，无效 1 例；7 d 内有 1 例出现反复。近期有效率 97.6%（80/82）。随访 1 年，咯血复发 4 例，远期有效率 92.7%（76/82）。围手术期的不良反应主要为胸痛、胸闷和发热，未发生严重并发症。 结论 Embosphere 微粒球经出血靶血管栓塞治疗大咯血的近期和中远期疗效确切，无严重的不良反应，值得临床推广应用。

巨大甲状腺血管肉瘤合并咯血患者的气道管理