氩等离子体凝固术在支气管镜活检后止血中的应用

The application of argon plasma coagulation in hemostatic treatment after bronchoscopic biopsy

目的观察经支气管镜以氩等离子体凝固术(APC)对活检后出血创面行止血治疗的效果及安全性。方法对合并冠心病、高血压及阵发房颤等接受常规支气管镜检查并行气道内病灶活检且出血较多的患者,行APC止血治疗,观察止血效果和治疗前后患者血压、心率及血氧饱和度变化。结果 62例患者行支气管镜下活检后立即采用APC对活检处行止血治疗,其中60例立即止血成功,2例患者活检后大出血,在气管插管及机械通气支持下以APC止血成功。62例中气道内肿物42例(叶支气管开口26例,段支气管开口16例);叶、段支气管嵴增宽黏膜粗糙16例;叶支气管开口肉芽组织4例。60例行APC治疗后患者平均动脉压及心率与治疗前差异无统计学意义,血氧饱和度较治疗前降低(0.939±0.027 vs.0.956±0.017,P<0.05)。结论经支气管镜对活检后出血部位行APC止血治疗具有迅速、彻底、安全的特点,尤其是对于合并心血管疾病患者,避免了常规止血治疗导致心血管并发症的发生。

Objective To observe the hemostatic efficacy and safety of argon plasma coagulation（APC） through bron-choscope after biopsy. Methods The APC was given to patients suffered from coronary heart disease combined hyperten-sion or paroxysmal auricular fibrillation and accepted bronchoscopy biopsy with much bleeding. The hemostatic effect andchanges of heart rate, blood pressure and SPO2 were observed before and after treatment. Results Sixty-two patients weretreated with endoscopic hemostasis by APC. The hemostasis was successful in 60 cases. The hemostasis was performed withAPC successfully in 2 patients after intubation and mechanical ventilation because of the biopsy hemorrhage. Sixty-two cas-es included 42 cases of airway tumor（26 cases in lobe bronchus and 16 in segmental bronchus）, 16 cases of broadening ofthe trachea ridge and mucosal rough, and 4 cases of granulation tissue of lobe bronchus. There were no significant differenc-es in mean arterial pressure and heart rate before and after treatment in 60 patients（P 0.05）. The oxygen saturation was sig-nificantly lower after treatment than that before treatment（0.939±0.027 vs. 0.956±0.017, P 0.05）. Conclusion Hemosta-sis treatment by APC through bronchoscope has the characteristics of rapid, thorough and safe, especially for patients com-bined with cardiovascular disease. It can avoid the occurrence of cardiovascular system complications caused by convention-al hemostatic treatment.