介入栓塞治疗在临床急症动脉性出血中的应用  

Applications of endovascular embolization therapy for clinical emergency arterial hemorrhage

作　　者：王长彬[1] 刘健 张新毅[1] 刘训伟[3] 杨金永[4] 

机构地区：[1]山东省交通医院医学影像中心,山东济南250031 [2]山东省潍坊市寒亭区寒亭街道卫生院,山东潍坊261100 [3]山东省济南军区总医院医学影像中心,山东济南250031 [4]山东省医学影像学研究所,山东济南250021

出　　处：《医学影像学杂志》2016年第2期296-298,共3页Journal of Medical Imaging

摘　　要：目的探讨急症动脉性出血行介入栓塞治疗的临床应用价值,提高介入放射学在急症医学中的地位。方法回顾性分析2008年7月-2015年4月急症动脉性出血患者30例,其中上消化道出血12例,肝癌破裂出血4例,脾破裂出血3例,肝脏假性动脉瘤出血3例,肾脏穿刺术后出血2例,肾血管平滑肌脂肪瘤破裂出血1例,盆腔动脉出血5例。术后随访观察栓塞疗效、并发症、住院时间、患者恢复情况等。结果技术成功率96.7%,无严重并发症发生,2例上消化道出血患者首次栓塞后仍有出血,2天或3天后再次行介入栓塞治疗后不再出血,1例肝脏假性动脉瘤行两次栓塞后仍有出血,其余27例均一次栓塞良好。结论临床确诊为动脉性出血或怀疑有动脉性出血,内科药物治疗无效或急症出血药物治疗不佳时均可行血管内介入动脉造影,明确出血动脉后随即行介入栓塞治疗以挽救患者生命,或为临床下一步治疗提供帮助。Objective To evaluate the applications of the intravascular embolization therapy for the clinical emergency arterial hemorrhage so as to promote the status of the interventional radiology in emergency medicine. Methods From July 2008 to April2015,a retrospective analysis was performed on 30 patients with accident and emergency arterial bleeding,including 12 cases of upper gastrointestinal bleeding,4 cases of liver tumor rupture,3 cases of splenic rupture bleeding,3 cases of liver bleeding due to pseudoaneurysm,2 cases of postoperative bleeding following kidney puncture,1 case of renal angiomyolipoma rupture,and 5cases of pelvic arterial bleeding. Postoperative follow-up was conducted to observe the embolism efficacy,complications,the duration of hospital stays and patient recovery,and so on. Results The technical success rate was 96. 7%,with no serious complications. Two patients with gastrointestinal hemorrhage were still bleeding after the first embolization and the bleeding was stopped by interventional embolization once more two or three days after the first intervention. One case of hepatic pseudoaneurysm was still bleeding after two times of embolism. The remaining 27 cases were good after embolization. Conclusion For the patients with arterial bleeding diagnosed by clinical manifestation or suspected arterial bleeding,when drug therapy was ineffective or no results,emergency vascular interventional angiography shoud be implemented to find out the target artery for the following embolization.This may save the lives of patients or provide support for further clinical treatment.

关 键 词：动脉出血 血管栓塞 介入治疗 

分 类 号：R543.5[医药卫生—心血管疾病] R815[医药卫生—内科学]