医源性支气管动脉夹层形成原因分析  

Iatrogenic bronchial artery dissection: analysis of its forming reasons

作　　者：付志刚[1,2] 张晓磷[1,2] 韩强[1,2] 李海涛[1,2] 张志刚[1,2] 亓小虎[1,2] 赵文江[1,2] 

机构地区：[1]三峡大学第一临床医学院 [2]宜昌市中心人民医院介入科,湖北宜昌443003

出　　处：《介入放射学杂志》2015年第8期722-725,共4页Journal of Interventional Radiology

摘　　要：目的探讨支气管动脉栓塞术(BAE)所致医源性支气管动脉夹层形成原因及防治对策。方法连续收集宜昌市中心人民医院2009年2月至2014年6月因大咯血入院患者328例(年龄31~78岁);纳入标准:日咯血量≥200 ml。所有患者均成功接受超选择性插管BAE术,其中7例因术中损伤支气管动脉并发医源性支气管动脉夹层,均感一过性胸痛。结果 7例患者中DSA造影发现8支支气管动脉损伤所致动脉夹层,其中右侧支气管动脉5支,左侧支气管动脉3支;位于支气管动脉开口部(<1 cm)7支,远端1支。动脉夹层大小为1.8 mm×1.9 mm^3.4 mm×3.9 mm。通过BAE术中停止操作、降压等对症治疗,病情没有进一步发展。结论医源性支气管动脉夹层多因BAE术中导丝导管暴力操作或高压力造影所致,停止不良操作、严密观察患者胸痛症状、降压治疗等对症处理措施可有效防止动脉夹层发生及其进展或破裂。Objective To discuss the causes, prevention and treatment of iatrogenic bronchial artery dissection caused by bronchial artery embolization procedure. Methods During the period from February 2009 to June 2014, a total of 328 patients （31-78 years old） were admitted to Yichang Central People＇s Hospital due to massive hemoptysis. The inclusion criteria was the daily hemoptysis amount 〉~200 ml. Bronchial artery embolization with super-selective catheterization was successfully accomplished in all patients. In 7 patients, iatrogenic bronchial artery dissection occurred during the procedure due to bronchial artery injury, and all the 7 patients experienced transient chest pain. Results DSA showed that a total of 8 bronchial artery dissections were detected in the 7 patients, involving right bronchial artery （n=5） or left bronchial artery （n=3）. The dissections were located at the opening （n=7, 〈1 cm） or distal site （n=l） of the bronchial artery. The size of the bronchial artery dissection varied from 1.8~1.9 mm to 1.9xl.9 ram. After stopping operation manipulation, lowering blood pressure and other symptomatic treatment, the disease did not develop further. Conclusion Iatrogenic bronchial artery occurring during the performance of bronchial artery embolization is mainly caused by violent manipulation of the guide wire and catheter. Once it occurs, the operator should stop the operation, adopt medication to lower the blood pressure, closely observe the patient＇s condition, and employ other symptomatic treatment; all these measures can effectively prevent the occurrence and progression of arterial dissection or rupture.

关 键 词：医源性支气管动脉夹层 咯血 支气管动脉栓塞 血管造影 

分 类 号：R654.3[医药卫生—外科学]