咯血的临床特征及选择性动脉栓塞术治疗咯血效果观察

Clinical characteristics of hemoptysis and effect of selective arterial embolization in the treatment of hemoptysis

目的观察咯血患者的临床特征,评估选择性动脉栓塞术(SAE)治疗咯血的预后。方法回顾性选取2017年7月至2020年7月在江汉大学附属医院呼吸与危重症医学科因咯血接受SAE治疗的住院患者,术后随访2年,分析咯血的病因,血管造影表现,供血血管、手术并发症及术后咯血复发情况。结果共有1211例患者行数字减影血管造影(DSA)及SAE治疗。咯血的主要病因为支气管扩张并感染654例(54.0%),肺结核144例(11.9%),肺恶性肿瘤128例(10.6%),肺部感染116例(9.6%)。血管增粗、迂曲,末梢分支增多紊乱、体动脉-肺循环异常交通、动脉瘤或瘤样扩张为DSA下靶血管的主要病理特征。1211例患者共栓塞6540支责任血管,例均栓塞的血管支数为(5.4±3.7)支,其中栓塞支气管动脉(BA)(2.5±1.0)支,非支气管性体动脉(NBSA)(3.5±2.0)支。SAE总有效率为94.0%(1138/1211)。1026例患者完成随访,208例2年内咯血复发(20.3%)。复发组栓塞的责任血管支数、NBSA支数及其比例均高于未复发组,肺血管介入联合呼吸内镜介入治疗比例低于未复发组(均P<0.05)。481例(39.72%)出现术中及术后并发症,以术后胸背痛385例(31.79%)和发热142例(11.73%)为多见。结论成人咯血的主要病因是支气管扩张合并感染。BA和NBSA均为咯血的主要责任血管。靶血管越复杂,NBSA数量及比例越高,越容易出现咯血复发,SAE是治疗咯血的一种安全有效的方法。

Objective To observe the clinical characteristics of patients with hemoptysis,and to evaluate the prognosis of these patients receiving selective arterial embolization(SAE)treatment.Methods Hospitalized patients with hemoptysis underwent SAE treatment in the Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Jianghan University from July 2017 to July 2020 were selected and followed up for 2 years.The etiology of hemoptysis,angiographic findings,blood supply vessels,surgical complications and postoperative recurrence of hemoptysis were analyzed.Results A total of 1211 patients were treated with digital subtractive angiography(DSA)and SAE.The most frequent underlying disease was bronchiectasis with infection in 654 cases(54.0%),followed by pulmonary tuberculosis in 144 cases(11.9%),pulmonary malignancy in 128 cases(10.6%)and pneumonia in 116 cases(9.6%).The main pathological features of target vessels under DSA were thickening and tortuosity,increasing and disorganization of peripheral branches,abnormal communication between body arteries and pulmonary circulation,aneurysm or aneurysm-like ectasia.A total of 6540 responsible vessels were embolized in 1211 patients,and the average number of embolized vessels was 5.4±3.7,including 2.5±1.0 bronchial arteries(BA)and 3.5±2.0 non-bronchial body arteries(NBSA),respectively.The total effective rate of SAE was 94.0%(1138/1211).A total of 1026 cases completed the follow-up,208 patients had recurrent hemoptysis within 2 years,and the recurrence rate was 20.3%.Compared with the non-recurrence group,the number of responsible vessels,the number and the proportion of NBSA were significantly higher in the recurrence group,while the proportion of pulmonary vascular intervention combined with respiratory endoscopic intervention was significantly lower.Intraoperative and postoperative complications occurred in 481 cases(39.72%),mainly including chest and back pain in 385 cases(31.79%)and fever in 142 cases(11.73%).Conclusions The main cause of hemoptysis in adults is bronchiectasis combined with infection.Both BA and NBSA are the main responsible vessels of hemoptysis.The more complex the target vessel,the higher the number and proportion of NBSA,the more prone to recurrence.SAE is a safe and effective method for the treatment of hemoptysis.