肺大咯血纤维支气管镜几种不同介人治疗方法选择时机探讨与安全性评价

陈辉民 卢晔 叶惠龙等.肺大咯血纤维支气管镜几种不同介人治疗方法选择时机探讨与安全性评价[J].国际呼吸杂志,2013,33(5):358-361.

肺大咯血;纤维支气管镜;微导管置人;氧化再生纤维素止血纱条;氩等离子凝固术;选 择时机;安全性

陈辉民 卢晔 叶惠龙 崔会芳 黄文侨 陈旭君 林勇 黄溢华 崔晓 苏桂琴 夏爱芳

361100 福建中医药大学附属厦门市第三医院ICU(陈辉民),呼吸二科(卢晔、崔会芳、黄文侨、陈旭

2014

358-361

万方

目的 探讨纤维支气管镜治疗肺大咯血几种不同介入方法选择时机与安全性。方法 总结我科2010年1月至2012年11月大咯血21例,其中男19例,女2例,通过对比观察大咯血即刻控制率、手术过程难易程度、耗费时间、并发症的发生等指标,对微导管置人止血法(方法A)、氧化再生纤维素止血纱条置人止血法(方法D、氩等离子凝固术(方法C)等三种肺大咯血的介入技术,重点在该三项技术介入选择时机的把握与安全性等方面作出评价。结果 在21例患者中,方法A完成12例,方法B完成6例,方法C完成3例,大咯血即刻控制率分别是方法A为75%,方法B为83.3%,方法C为100%; 三种不同方法操作顺利,操作时间3~10mh,方法A、B中均有病例出现鼻腔出血、声音嘶哑,方法C则无;方法A、B、C均出现不同程度发热、胸闷气短,但三种方法中均无明显胸痛、肺不张、阻塞性肺炎、肺脓肿、局部黏膜压迫坏死和烧灼伤。方法A发生导管滑脱3例,方法B发生氧化再生纤维素止血纱条咳出 1例,方法C发生纤维支气管燃烧导致气管镜前端损坏1例。结论 对于经纤维支气管镜介入治疗肺大咯血应选择术者较熟练掌握、费时短,疗效较可靠,且患者意愿较易接受的介入治疗方法。但是,各种方法均有其限制,需要严格掌握。 　　Objective Discussion oftiming and safety about differcnt intervcntiona1 mcthods of fibcropticbronchoscopy for massive pulmonary haemoptysis Methods Twenty one patients withmassive pulmonary haemoptysis wcrc rccruited from Jan 2010 to Nov 2012 in ourDepartmcnt (19 malcs,2 femalcs)。 A11 paticnts wererandon1ized to an intcrventiona1 mcthod of fiber。pticbronchoscopy with micro_catheter imbedding hemostasia (mcthod A), oxldizedregenerated ce11ulose (ORc) hemostatic gauze imbcdding hemostasia(method B),andargon plasma coagulation(APC)hemostasia(mcthod C), Eva1uation of the tinming andsafety of thcsc three methods was pcrformed based on the instant control rateof massive hernoptysis, degree of difficultyof the surgical procedurc, consumed time, and the incidcnce of comphcationsResults In a11patients,12 cases were pcrformcd with method A,6cascs werepcrformed Mith metho B, and 3 cases wcre performed with method C The instantcontro1 rates of massive hemoptysis were75%,83.3%,and 100%,respectively All theplocedures wcre performed succcssfully, and thc consumed ti1ne was fron 3 to 10min,Nasa1 b1eeding, and a hoarse voice were appeared in groups with method A and B,but not method C。 Varying degrees of fever, chesttightness and shortncss of brcath were appearcd in all groups, but obviouschest pain, atelectasis, obstructivc pneumonia, lung abscess, local mucosa1 ofoppression necrosis and burns were disappeared in all groups。 1 case was appcared catheter shppage in group Xsith mcthod A,1 casewas appearcd expectoration of ORC hcmostatic gauze in group with method B, and1 case was appcarcd thc front of thc bronchoscope damage due to fibcropticbronchoscopy burning in group with method C,Conclusions For thc interventionalmethods of fiberoptic bronchoscopy for massive pu1monary haemoptysis, thcintcrventional methods with more expert, sirnplcr, shorter tinlc_consuming, morerehablc effectivc were wi1hng to accepted by the paticnts However, each methodhas its own linilitation, it need to be mastered strictly。