机械通气下经纤维支气管镜气道内球囊压迫治疗大咯血的临床研究

Clinical application of balloon block via bronchofibroscopy under mechanical ventilation for treatment of massive hemoptysis

目的探讨机械通气下气道内球囊压迫治疗大咯血的疗效及安全性。方法选取2002年5月至2011年8月23例大咯血内科药物治疗无效的患者,在机械通气的情况下使用纤维支气管镜通过气管插管,导入新型气道内双腔球囊导管,球囊准确送至出血部位并压迫止血。观察疗效及安全性。结果 23例患者均成功止血,止血时间(1.88±0.70)h,治疗后2 h动脉血氧分压较治疗前明显升高〔(57.31±6.40)vs(100.60±10.40)mm Hg,P<0.01〕,出血停止后2 h拔出球囊导管,球囊导管停留时间为(3.79±1.13)d;机械通气时间为(5.18±1.80)d;并发症如咳嗽、肺不张发生率39.1%(9/23)。结论机械通气下气道内球囊置入术治疗呼吸道大咯血是一种操作简便,疗效迅速可靠的方法,值得进一步推广。

Objective To evaluate the efficacy and safety of balloon block via bronchofibroscopy under mechanical ventilation in treatment of massive bemoptysis. Methods A total of 23 patients with massive hemoptysis and without effect to pharmacotherapy admitted in ICU between May 2002 and August 2011 were selected. Under endotracheal intubation and mechanical ventilation, a new dual luminal balloon catheter（ Bronchus Blocker 1700） was inserted via bronchofibroscopy, and the balloon was imported to bleeding part for hemostasis by compression. The therapeutic effect and safety were observed. Results Hemoptysis was successfully stopped in all the 23 patients, and the time of hemostasis was （ 1.88 ± 0.70） h. Compared with before treatment, the PaO2 was improved obviously two hours after treatment [ （57.31 ± 6.40） vs （100.60 ± 10.40） mm Hg, P 〈 0. 01 ）. The balloon catheter was extracted two days after hemostasis, and the balloon catheter was stayed for （3.79 ±1.13 ） d. The duration of mechanical ventilation was （5.18 ± 1.80） d. The incidence of complications such as cough, atelectasis was 39.1% （9/23）. Conclusions Under the mechanical ventilation, intrabronchial balloon block via bronchofibroscopy for treatment of massive hemoptysis is a safe and effective method, and it is worthy of generalization.