238例咯血患者支气管镜下特点与病因分析  

Characteristics under bronchoscopy and etiology of 238 hemoptysis patients

作　　者：张聪 杨雅吉[2] 邢西迁[2] Zhang Cong;Yang Yaji;Xing Xiqian(Department of Critical Care Medicifte, the People's Hospital of Chuxiong Yi Autonomous Prefecture, Chujciong 675000, China;The First Department of Respiratory Medicine, Yan' an Hospital affiliated to Kunming Medical University, Kunming 650051, China)

机构地区：[1]楚雄彝族自治州人民医院重症医学科,675000 [2]昆明医科大学附属延安医院呼吸内一科,650051

出　　处：《国际呼吸杂志》2019年第13期990-994,共5页International Journal of Respiration

基　　金：云南省科技惠民计划(2014RA020);云南省中青年学术和技术带头人后备人选培养计划(2017HB053);云南省医学学科带头人培养计划(201627).

摘　　要：目的通过对咯血患者的常见病因、支气管镜下表现及出血部位的分析,探讨支气管镜检查对咯血病因诊断的价值。方法对238例咯血患者的临床资料、病因进行分析,总结归纳引起咯血的常见疾病在支气管镜下的表现及出血部位。结果引起咯血的主要病因是呼吸系统炎症(149/238,62.6%),包括支气管炎(26/238,10.9%)、肺炎(66/238,27.7%)、支气管扩张(42/238,17.6%)、肺结核(15/238,6.3%),其次是支气管肺癌(34/238,14.3%)、肺血管畸形(23/238,9.7%)。238例咯血患者的病因阳性诊断率达95.8%。支气管镜下表现为:炎症性疾病以支气管黏膜充血水肿为主,支气管色素沉着纤维化与其有一定的相关表现;支气管肺癌以新生物多见,Dieulafoy病等血管畸形可表现出支气管黏膜的光滑突起。结论引起咯血的常见疾病在支气管镜下有一定的特征改变,总结分析支气管镜下表现,有助于咯血病因的鉴别诊断。Objective To evaluate the value of bronchoscopy in the diagnosis of hemoptysis by analyzing the common pathogeny, the characteristic performances and the location of bleeding under bronchoscopy. Methods The clinical data and etiological factors of 238 patients with hemoptysis were analyzed, and the manifestations and the location of bleeding under bronchoscopy were summarized. Results The main causes induced hemoptysis were respiratory inflammation (149/238, 62.6%), including bronchitis (26/238, 10.9%), pneumonia (66/238, 27.7%), bronchiectasis (42/238, 17.6%), tuberculosis (15/238, 6.3%), followed by bronchopulmonary carcinoma (34/238, 14.3%) and pulmonary vascular malformation (23/238, 9.7%). The positive diagnosis rate of 238 cases of hemoptysis was 95.8%.The characteristic performances of bronchoscopy were as follows: respiratory inflammation was characterized by bronchial congestion and edema, and was possibly correlated with bronchial anthracofibrosis.Bronchopulmonary carcinoma was marked by the neoformation observed through bronchoscope, and vascular malformations such as Dieulafoy′s disease showed smooth protrusion of tracheal mucosa. Conclusions The prevalent diseases causing hemoptysis have certain characteristic changes under bronchoscopy.Bronchoscopy is useful for the differential diagnosis of hemoptysis.

关 键 词：咯血 支气管镜检查 特点 病因 

分 类 号：R56[医药卫生—呼吸系统]