介入治疗在脏器大出血中的临床应用

Clinical Application of Interventional Treatment in Organ Hemorrhage

【目的]探讨动脉栓塞术在临床急诊大出血中的应用价值。【方法]45例出血患者均行选择性数字减影血管造影（DSA）和介入治疗，其中妇产科大出血19例、肾脏术后出血11例、支气管扩张大咯血15例。通过显示造影剂外溢、假性动脉瘤、病理血管和肿瘤染色确定出血原因及部位，对出血动脉超选择插管行动脉内介入栓塞或药物灌注加栓塞治疗。栓塞材料为明胶海绵颗粒、聚乙烯醇微粒（PVA）、钢圈，栓塞过程在X线影像监视下完成。【结果]45例患者行供血动脉栓塞术或药物灌注加栓塞治疗止血成功率为100％，其中有2例支气管扩张患者分别在6个月、13个月再发出血，但量较栓塞治疗前明显减少，经内科保守治疗后出血停止，其他病例随访均未再发出血，中远期疗效为95．6％。【结论】介入治疗对急性脏器大出血效果明确，在保守治疗无效或效果不明显的情况下应列为首选，能达到止血迅速、彻底、复发率低、副作用小，不影响脏器功能。

[Objective] To explore the application value of arterial embolism in clinical emergency of massive hemorrhage. [Methods]Forty five patients with hemorrhage which included 19 obstetric and gynecological bleeding, 11 renal postoperative hemorrhage and 15 bronchiectasis hemoptysis underwent selective digital sub- traction angiography（DSA） and interventional treatment. The causes and location of bleeding were determined by displaying contrast media, false aneurysm, pathological blood vessels and tumor staining. Arterial embolism or drug infusion and embolization by superselective catheterization were used to deal with bleeding artery. Gelatin sponge granules, polyvinyl alcohol particles（PVA） and steel rings were used as embolic materials. The embolization procedure was completed under the monitoring of X ray imaging. [Results] The success rate of immediate hemostasis for 45 patients with artery embolism was 100%. Among them, 2 cases with bronchiee- tasis had bleeding again after 6 and 13 months, respectively, but the amount of blood decreased significantly. After medical conservative treatment, the 2 cases stopped bleeding. There was no recurrence of bleeding in all the other cases in a follow-up visit, and the mid- and long-term efficacy was 95.6%. [Conclusion]Interven- tional treatment is effective for acute organ hemorrhage. It has immediate and thorough hemostasis, low recur- rence and side effects and little impact on organ function, so it should be considered as the first choice if the conservative treatment fails or the effect is not obvious.