选择性支气管动脉栓塞对大咯血的治疗应用研究  

Applied research of selective bronchial arterial embolization for severe hemoptysis

作　　者：巩曰红[1] 常刚[2] 裴维芳[2] 张晓燕[2] 李洪福[2] 

机构地区：[1]山东省滨州市人民医院医务处,256610 [2]山东省滨州市人民医院介入医学科,256610

出　　处：《中国医师进修杂志》2012年第23期16-18,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的观察选择性支气管动脉栓塞对大咯血患者的临床疗效。方法选择因大咯血住院患者38例，其中反复咯血31例，支气管扩张27例，支气管肺囊肿4例，不明原因4例，肺结核3例。均经胸部影像学检查或纤维支气管镜、支气管动脉造影明确诊断，且均行选择性支气管动脉栓塞治疗。结果患者栓塞次数最多3次，支气管动脉造影均表现为血管畸形，给予选择性支气管动脉栓塞治疗，35例出血立即减少。8例患者治疗后24h再次复发咯血，其中1例患者经保守治疗无效后行右上肺切除术，5例患者经保守治疗后有效，2例患者经保守治疗后无效行再栓塞治疗，1周内咯血完全消失，总有效率97．4％（37／38）。随访1年，再次复发大咯血13例，11例每次咯血及年总咯血量较治疗前减少50％以上，2例再咯血患者经多次栓塞剂栓塞保守治疗无效后行右上肺切除术，总有效率94．7％（36／38）。治疗后3例短时间内轻微胸痛，2例肩痛，3例伴胸闷，3例腹股沟皮下淤血，对症处理后短期内好转。结论选择性支气管动脉栓塞治疗急性或反复发生的大咯血疗效显著，可以避免患者外科手术的风险，对复发患者再次治疗也安全有效，值得临床推广应用。Objective To observe the clinical curative effect of selective bronchial arterial embolization for severe hemoptysis. Methods Thirty-eight hospitalized patients with severe hemoptysis was enrolled in this study. Of which 31 patients were recurrent hemoptysis , 27 patients were with bronchiectasis, 4 patients were with bronchial lung cysts,4 patients had unknown canses,3 patients were with tuberculosis. All patients were diagnosed by chest imaging examination, fiber bronchoseopy, bronchial arteriography, and they were all treated by selective bronchial arterial embolization. Results The most times of embolization was 3, and bronchial arterial imaging were performed for vascular malformation. After having bronchial arterial embolizafion, 35 patients were immediately released of bleeding. Postoperative 24 h, 8 patients had hemoptysis again, of which 1 case was performed with conservative treatment and subsequently had pneumonectomy, 5 patients had effective conservative treatment, 2 cases were performed embolization again after failed conservative treatments. Hemoptysis completely disappeared within 1 week. The total effective rate was 97.4%（37/38）. Patients were followed up for 1 year,of which 13 patients relapsed again, 11 patients＇ annual and each time＇s quantity of hemoptysis reduced 50%. Two patients had pneumonectomy after a number of embolization. The total effective rate was 94.7% （36/38）. After treatment, 3 patients had mild chest pain in short time, 2 patients had shoulder pain, 3 patients had chest tightness,and 3 patients had subcutaneous passive congestion. After being treated for short-term, these symptoms disappeared eventually. Conclusion Selective bronchial arterial embolization for the treatment of acute or recurrent severe hemoptysis is very effective, and can avoid the risk of surgery. It is effective for recurrent cases and worthy of clinical application.

关 键 词：支气管动脉栓塞 咯血 治疗结果 

分 类 号：R56[医药卫生—呼吸系统]