致命性大咯血的病因及其选择性支气管动脉栓塞的疗效分析  

Etiology of life-threatening massive hemoptysis and therapeutic effect of selective bronchial artery embolization

作　　者：王素美[1] 杨松[2] 

机构地区：[1]解放军第174医院/厦门大学附属成功医院呼吸内科,福建厦门361003 [2]重庆市公共卫生医疗救治中心结核科,重庆400036

出　　处：《临床肺科杂志》2016年第10期1791-1794,共4页Journal of Clinical Pulmonary Medicine

基　　金：南京军区科研基金课题(No 2008MA080)

摘　　要：目的了解致命性大咯血的病因及其选择性支气管动脉栓塞（bronchial artery embolization,BAE）的疗效。方法对2007年1月至2012年1月期间84例致命性大咯血患者进行病因分类,对2009年8月至2012年1月期间的30例致命性大咯血患者进行选择性支气管动脉栓塞治疗,观察其即刻、近期和远期疗效。结果致命性大咯血的病因分别为肺结核（63例,75.0%）、支气管扩张症（11例,13.1%）、肺曲霉病（6例,7.1%）、肺癌（2例,2.4%）和肺动静脉瘘（2例,2.4%）。对其中30例致命性大咯血患者（肺结核25例,肺曲霉病和肺动静脉瘘各2例,支气管扩张症1例）进行选择性支气管动脉栓塞治疗,即刻止血率达90.0%（27/30）。术后随访5~29个月（平均16个月）,近期止血率93.3%（28/30）,远期止血率达96.7%（29/30）。结论致命性大咯血的病因主要为肺结核,其次为支气管扩张症和肺曲霉病,BAE是治疗致命性大咯血的首选措施,具有安全、有效、高成功率优点,为基础肺疾病的治愈提供了条件。Objective To explore the etiology of life-threatening massive hemoptysis and to analyze its therapeutic effect of selective bronchial artery embolization（ BAE）. Methods 84 cases of life-threatening massive hemoptysis from January 2007 to January 2012 were classified according to the causes. 30 patients from August 2009 to January 2012 were underwent selective bronchial artery embolization for life-threatening massive hemoptysis. The immediate,short-term or long-term effectiveness was observed respectively. Results The nosogenesis for life-threatening massive hemoptysis included 63 cases of pulmonary tuberculosis（ 75. 0%）, 11 cases of bronchiectasis（ 13. 1%）,lung aspergillosis（ 7. 1%）,2 cases of lung cancer（ 2. 4%） and 2 cases of pulmonary arteriovenous fistulas（ 2. 4%）. 30 cases were treated with selective bronchial artery embolization,including 25 cases of pulmonary tuberculosis,2 cases of lung aspergillosis,2 cases of pulmonary arteriovenous fistulas and 1 case of aspergillosis,and the immediate hemostasis rate was 90. 0%（ 27 /30）. The postoperational patients were available for follow-ups from5 to 29 months（ mean 16 months）. The short-term effective rate of hemostasis was 93. 3%（ 28 /30）,and the longterm effective rate of hemostasis was 96. 7%（ 29 /30）. Conclusion The primary cause of life-threatening massive hemoptysis is pulmonary tuberculosis. The second common cause is bronchiectasis and lung aspergillosis. Bronchial artery embolization is a safe and effective method for life-threatening massive hemoptysis with a high initial rate of success. BAE provides advantage for the recovery of underlying lung diseases.

关 键 词：致命性大咯血 选择性支气管动脉栓塞 疗效 

分 类 号：R459.7[医药卫生—急诊医学]