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支气管扩张症138例

目的 总结支气管扩张症外科治疗的临床诊断和治疗经验. 方法 回顾性分析1985～ 1999年手术治疗138例支气管扩张症患者的诊断和治疗情况. 结果 全组无1例手术死亡,94例单叶或双叶支气管扩张患者症状消失;13例双侧或广泛支气管扩张患者,症状均改善. 结论 把握好手术适应证和肺的切除范围,可降低手术死亡率和并发症发生率,提高治疗效果.肺切除术对治疗单叶或双叶支气管扩张疗效十分显著,尽可能完全切除病灶是获得最佳治疗效果的前提.

Management of massive hemoptysis and application experience of computer tomography in vascular intervention of hemoptysis

Hemoptysis is a common respiratory emergency, and severe cases can lead to death. Patients with massive hemoptysis need emergency management at the bedside, and fully evaluation for indications and timing of tracheal intubation and transtracheal intervention. When a relatively stable state is achieved, emergency vascular intervention is performed to stop bleeding. CT plays an important role in the risk assessment and interventional treatment of hemoptysis, and it is worthy of clinical promotion and more exploratory research. This article introduces the emergency treatment for massive hemoptysis, the vascular interventional procedure, the exploration of clinical application of preoperative CT, and the clinical application value of CT for hemoptysis risk assessment. It aims to provide a better way to deal with massive hemoptysis and to apply CT to the interventional treatment of hemoptysis more reasonably for clinicians.

咯血患儿肺叶切除术麻醉管理一例

Multidetector-Row CT Angiography and Digital Subtraction Angiography of Bronchial Artery in Diagnosis of Hemoptysis: A Comparative Study

Objective To compare the bronchial arteriography through multidetector-row CT (MDCT) with the digital subtraction angiography (DSA) via femoral artery, and evaluate the application value of bronchial arteriography through MDCT in the diagnosis and treatment of hemoptysis. Methods 133 cases complained of hemoptysis were examined by MDCT and DSA via femoral artery respectively to perform bronchial arteriography, and the differences of image results by two methods were compared. Results 129 cases with abnormal bronchial arteries were confirmed by DSA via femoral artery, 117 cases were checked by MDCT [ the positive rate was 90.7% (117/129 ) ] . 117 cases with abnormal bronchial arteries were confirmed by both MDCT and DSA via femoral artery and 4 cases did not detected any abnormal arteries by both methods. The coincidence rate of two methods was 91.0% (121 /133) . MDCT and DSA via femoral artery showed the similar origins of abnormal bronchial arteries. The coincidence rate of two methods was 100% . Conclusions There is a high coincidence rate betweenMDCT and DSA in detecting bronchial artery abnormalities. MDCT shows the origins of abnormal vessels clearly which could be a fist-choice of routine imagination for interventive operation.

Coopdech 支气管封堵器在抢救大咯血窒息中的应用

目的 探讨Coopdech支气管封堵器用于大咯血窒息抢救的可行性及疗效。方法 在患者发生大咯血窒息时, 特别是无条件行双腔支气管插管或双腔支气管插管困难时, 在支气管镜引导下对2 例患者置入Coopdech 支气管封堵器。结果 2 例大咯血患者Coopdech 支气管封堵器置入后, 1 例保守治疗成功,1 例为支气管动脉栓塞术赢得时间。结论 Coopdech 支气管封堵器可以有效替代双腔支气管导管用于抢救大咯血患者, 值得进一步临床应用。

以发热并发气促、咯血为表现的鹦鹉热衣原体肺炎一例报告并文献复习

目的 总结鹦鹉热衣原体感染的临床特征，探讨鹦鹉热衣原体感染出现咯血的发生机制及治疗手段，提高临床对本病的认识。方法 报道国内首例经支气管镜冷冻技术治疗鹦鹉热衣原体感染出现咯血患者的诊疗经过，并回顾国内外数据库建库至今，筛选及总结分析鹦鹉热衣原体感染导致咯血的文献报道。结果 患者为38岁女性，以发热并发气促、咯血为主要表现，经肺泡灌洗液宏基因组二代测序（metagenomics next-generation sequencing，mNGS）检测诊断为鹦鹉热衣原体肺炎。通过药物对症处理以及经支气管镜冷冻治疗后病情好转。结合相关文献和该病例，共10例患者因鹦鹉热衣原体感染出现咯血的表现。结论 鹦鹉热衣原体感染早期临床表现无特异性，临床问诊需追溯鸟类及家禽接触史，mNGS能较为精准鉴定病原体。现鹦鹉热衣原体感染治疗首选四环素类药物，大环内酯类及喹诺酮类抗生素也有效。本例通过支气管镜冷冻技术治疗后病情好转，为临床治疗鹦鹉热衣原体感染出现咯血提供经验参考，但关于发生机制及其他诊疗思路仍值得深入研究。

Clinical comparison of pulmonary lobectomy in patients with massive hemoptysis of pulmonary tuberculosis after bronchial artery embolization

ObjectiveTo compare the clinical data of pulmonary lobectomy in patients with massive hemoptysis of pulmonary tuberculosis after bronchial artery embolization in the short and long term, so as to provide a reference for clinical choices of appropriate operation time.MethodsA retrospective analysis was conducted on 33 patients with massive hemoptysis of pulmonary tuberculosis, who had received pulmonary lobectomy after bronchial artery embolization in Wuhan Pulmonary Hospital from January 2015 to November 2017, including 29 males and 4 females aged of 23-66 (52.64±9.70) years. According to the time interval between bronchial artery embolization and lobectomy, the patients were divided into a short-term group (<2 weeks, 14 patients) and a long-term group (>1 month, 19 patients). The clinical data, such as operation time, intraoperative blood loss, postoperative extubation time and serious postoperative complications, were observed in the two groups for statistical analysis.ResultsThe operative time (297.13±75.69 min vs. 231.32±67.57 min, P=0.013), intraoperative blood loss (685.74±325.51 mL vs. 355.83±259.11 mL, P=0.002), postoperative extubation time (14.07±5.24 d vs. 8.90±3.57 d, P=0.003) of the short-term group were all higher than those in the long-term group.ConclusionFor the patients with massive hemoptysis of pulmonary tuberculosis, who had surgical indications and no risk of early rebleeding after bronchial artery embolization, pulmonary lobectomy should be performed late until the patient's physical condition and the primary disease was stable.

两例大咯血患者手术中麻醉处理的体会

Embosphere 微粒球栓塞大咯血出血靶血管的疗效和安全性研究

目的 观察 Embosphere 微粒球作为栓塞材料治疗大咯血的近远期疗效和安全性。 方法 纳入 2013 年 7 月至 2016 年 3 月收治的 82 例大咯血患者，采用 Embosphere 微粒球为主要的栓塞材料，栓塞支气管动脉以及其他出血靶血管，观察 24 h 内咯血有无停止，7 d 内有无咯血反复，以及围手术期的不良反应。术后随访 1 年观察咯血有无反复。 结果 患者术后 24 h 内咯血停止 78 例，明显减少 3 例，无效 1 例；7 d 内有 1 例出现反复。近期有效率 97.6%（80/82）。随访 1 年，咯血复发 4 例，远期有效率 92.7%（76/82）。围手术期的不良反应主要为胸痛、胸闷和发热，未发生严重并发症。 结论 Embosphere 微粒球经出血靶血管栓塞治疗大咯血的近期和中远期疗效确切，无严重的不良反应，值得临床推广应用。

支气管Dieulafoy 病致大咯血一例

病历摘要 患者男性, 62 岁。因“咯血3 d, 加重1 h”于2010 年3 月23 日凌晨急诊入院。患者于入院3 d 前无诱因出现咯血, 初咯血量较少, 入院前1 h 突然出现大咯血, 鲜红色, 约150 mL; 伴头晕、心悸, 无畏寒、发热, 无胸痛和呼吸困难。既往有两次大咯血病史, 未明确诊断; 否认肺结核和支气管扩张病史。