Hemoptysis is a common respiratory emergency, and severe cases can lead to death. Patients with massive hemoptysis need emergency management at the bedside, and fully evaluation for indications and timing of tracheal intubation and transtracheal intervention. When a relatively stable state is achieved, emergency vascular intervention is performed to stop bleeding. CT plays an important role in the risk assessment and interventional treatment of hemoptysis, and it is worthy of clinical promotion and more exploratory research. This article introduces the emergency treatment for massive hemoptysis, the vascular interventional procedure, the exploration of clinical application of preoperative CT, and the clinical application value of CT for hemoptysis risk assessment. It aims to provide a better way to deal with massive hemoptysis and to apply CT to the interventional treatment of hemoptysis more reasonably for clinicians.
Objective To evaluate the clinical effects of bronchial artery embolization ( BAE) for massive hemoptysis due to bronchiectasis.Methods 205 patients with massive hemoptysis were treated with bronchial artery embolization using coils, polyvinyl alcohol ( PVA) microspheres, line segmen, and gelatin sponge after the site of bleeding or the abnormal arteries were identified by arteriography. Super selective bronchial artery embolization was performed with a coaxial microcatheter inserted into the bronchial artery. Results BAE was successfully performed in 205 cases with massive hemoptysis ( left and right bronchial artery embolization in 35 cases, left bronchial artery embolization in 20 cases, right bronchial artery embolization in 126 cases, common bronchial artery embolization in 22 cases, right inferior phrenic artery embolization in 2 cases) . Of 205 patients, 169 were cured, 24 were relieved with a success rate of 94.1% . Long termcumulative hemoptysis nonrecurrence rates was 82.4% . 23 patients developed post embolization syndrome characterized by mild fever and chest pain and ended with spontaneous recovery without special management. No severe complications including spinal cord injury or dystopia embolization were observed. Conclusions Bronchial arterial embolization interventional therapy is a rapid, safe and effective method in the treatment of massive hemoptysis due to bronchiectasis.
Objective To compare the bronchial arteriography through multidetector-row CT (MDCT) with the digital subtraction angiography (DSA) via femoral artery, and evaluate the application value of bronchial arteriography through MDCT in the diagnosis and treatment of hemoptysis. Methods 133 cases complained of hemoptysis were examined by MDCT and DSA via femoral artery respectively to perform bronchial arteriography, and the differences of image results by two methods were compared. Results 129 cases with abnormal bronchial arteries were confirmed by DSA via femoral artery, 117 cases were checked by MDCT [ the positive rate was 90.7% (117/129 ) ] . 117 cases with abnormal bronchial arteries were confirmed by both MDCT and DSA via femoral artery and 4 cases did not detected any abnormal arteries by both methods. The coincidence rate of two methods was 91.0% (121 /133) . MDCT and DSA via femoral artery showed the similar origins of abnormal bronchial arteries. The coincidence rate of two methods was 100% . Conclusions There is a high coincidence rate betweenMDCT and DSA in detecting bronchial artery abnormalities. MDCT shows the origins of abnormal vessels clearly which could be a fist-choice of routine imagination for interventive operation.
目的:观察凝血酶雾化吸入联用酚妥拉明治疗肺结核顽固性咯血的临床效果。方法:将47例住院肺结核顽固性咯血患者随机分为两组,治疗组采用凝血酶超声雾化吸入联用酚妥拉明静滴,对照组采用垂体后叶素静滴。结果:治疗组总有效率87.50%,对照组总有效率86.96%。结论:在常规止血治疗无效的基础上,加用凝血酶超声雾化吸入联用酚妥拉明止血快,副作用少,是治疗肺结核顽固性咯血的有效药物。