支气管镜检查并发大出血原因分析和救治方法探讨

Causes and cure methods of bronchofiberscope complicated by mass hemoptysis

目的探讨支气管镜检查并发大出血的原因和救治方法。方法回顾性分析1983年12月￣2004年12月内进行的23826例支气管镜检查并发37例大出血患者的临床资料和救治方法。结果支气管镜检查并发大出血比例为1.6‰。37例大出血患者原发病为肺癌18例,肺结核7例,支气管结核3例,支气管扩张并感染5例,支气管息肉2例,支气管结石和支气管异物各1例。37例病人中行病灶或支气管黏膜活检术26例,肺组织活检术8例,刷检术3例,钳取结石和异物各1例。37例大出血患者均经支气管镜下局部灌入4℃冷盐水+1∶10000肾上腺素+凝血酶(500￣20000u)或使用OlympusPSD-30型高频电刀电凝止血成功。结论支气管镜检查并发大出血的原因主要是因为气管内新生物、支气管黏膜或肺组织活检时用力过度引起组织撕裂或血管破裂。经支气管镜局部注入止血药物或高频电刀电凝止血效果显著,并能清除积血,防止窒息,是一种安全有效的止血方法,值得临床推广应用。

[Objective] To discuss the causes, prevention and cure methods of bmnchofiberscope complicated by mass hemoptysis. [Methods] 37 cases of bronchofiberscope complicated by mass hemoptysis were observed in 23 826 patients by bronchofiberscope examination during December 1983-December 2004, whose clinical presentations and prevention and cure methods were retrospectively investigated. [Results] The incidence rate of bronchofiberscope complicated by mass hemoptysis was 1.6‰. The primary decease of 18 cases was lung cancer, the primary disease of 7 cases was pulmonary tuberculosis （TB）; 3 cases were endobronchial tuberculosis; 5 cases were bronchiectasis combines with infestation; 2 cases were bronchial polyp; 1 case was bronchial calculus and 1 case was foreign bodies in the bronchi. 26 cases have taken endobronchial biopsy to do pathology examination; 8 cases have taken lung biopsy; 3 cases have taken brushing biopsy examination; 1 case has taken clipping calculus and 1 case has taken clipping foreign bodies. All of 37 patients were by location injection of 4℃ cold saline plus 1：10000 adrenalin plus thrombin （500-20 000 u） through bronchof fiberscope or by using of Olympus PSD-30 high-frequency electric coagulation to stop blooding successfully. [ Conclusion ] The main reasons of bronch fiberscope combines with hematorrhea were neoplasm in trachea, when endolbronchial and lung biopsy were taking, overstrain revoked to tear apart and rupture of blood vessel, location injection drugs or high-frequenly electric coagulation through bronch fiberscope to stop blooding has significant effect, it can remove hematocele and prevents to apnea, was a safe and effective method, could be used widely in clinical applications.