可弯曲支气管镜介入诊疗并发气道大出血的临床分析

Clinical Analysis of Airway Massive Hemorrhage Complicated by Flexible Bronchoscope Interventional diagnosis and Treatment

目的探讨可弯曲支气管镜介入诊疗并发气道大出血的原因及防治措施。方法分析9例可弯曲支气管镜介入诊疗并发气道大出血患者的临床资料。结果 9例患者均抢救成功,无一死亡。结论支气管镜介入诊疗致气道黏膜下血管破裂是并发气道大出血的主要原因,呼吸内镜医师应提高对气道介入诊疗并发大出血的警惕和预防,操作时应胆大心细,积极的支气管镜下处理联合垂体后叶素及支气管动脉介入栓塞止血能取得满意的止血效果。

Objective To discuss the reasons and prevention measures of airway massive hemorrhage complicated by bronchoscopic interventional diagnosis and treatment. Methods Retrospective analysis of the clinical data of 9 cases of patients with airway massive hemorrhage complicated by flexible bronchoscope interventional diagnosis and treatment. Results All 9 patients were rescued successfully, and no death. Etiology：bronehiectasis hemoptysis clot obstruc- tive atelectasis for bronchoscopic blood clot removing the hemorrhage in 3 cases,3 cases of Dieulafoy＇s disease of the bronchus, pulmonary cavity bleeding after forceps biopsy in 1 cases, pulmonary aspergilloma after forceps biopsy in 1 cases, bronchial calculus hemorrhage in 1 cases. 9 patients were treated with topical hemostatie bronchoseopy combined with intravenous pituitrin hemostasis. 7 cases of endoscopic hemostasis, 1 cases of endoscopic hemostasis still bleeding obvious for emergent bronchial artery interventional embolization successfully. 1 cases of endoscopic hemostasis success after 3 days of recurrent large hemoptysis treated by tracheal intubation and invasive mechanical ventilation portable fiberoptic bronchoscope bronchial lavage successful hemostasis. Conclusions Interventional bronehoscopy airway submucosal blood vessels rupture is the main cause of hemorrhage complicated with airway, Respiratory endoscopy doctors should raise vigilance and prevention of airway interventional diagnosis and treatment of severe hemorrhage, the operation should be bold but cautious, hemostatic effects of bronchoscopy positive treatment combined with pituitrin could obtain satisfactory factor and bronchial artery embolization hemostasis.