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我院于1997年8月30日收治1例支气管结石大咯血的患者,经过积极抢救,精心护理,治疗26天,治愈出院.现将救护体会介绍如下:1 病例介绍患者 女,51岁.因反复咯血26年再发4天伴右侧胸痛、高热于1997年8月30日急诊入内科治疗,经止血、抗感染、输血等治疗,咯血未得到控制,住院期间先后咯血3次,每次量为300ml～500ml,经CT扫描为右下肺支气管扩张伴感染,建议手术治疗,于1997年9月9日转入外科.检查:体温37.6℃,脉搏96次/分,呼吸23次/分,血压16/12KPa,贫血貌,锁骨上淋巴结无肿大,气管居中,右下肺呼吸音减弱,无明显干湿性罗音,腹平坦,肝脾无肿大,两手均可见杆状指.实验室检查:白细胞4.4×10~9/L,红细胞2.81×10~12/L,血红蛋白65g/L,肝肾功能正常,给予绝对卧床休息,抗炎、补液、止血、输血治疗,于9月11日在全麻下行剖胸探查术,术中见右肺下叶与膈肌及侧胸壁粘连,形成众多的侧支循环,右肋膈角闭塞.右下叶内扪及4cm×4cm×4cm包块,行右肺下叶切除.因炎症粘连,渗血偏多,剖开右肺下叶,见下叶段支气管内有一枚2cm×1cm×1cm的结石,支气管扩张,粘膜坏死、出血.术后加强抗感染,支持治疗,于9月17日,拔除胸腔引流管,9月25日两肺呼吸音清晰,生命体征平稳,胸壁切口一期愈合,痊愈出院.
Our hospital on August 30, 1997 admitted to a case of patients with bronchial calcification and hemoptysis, after active rescue, meticulous care, treatment for 26 days, cured and discharged. Now the ambulance will be described as follows: 1 case description Female patient, 51 years old Repeated hemoptysis 26 years and then recurrent for 4 days with right chest pain, fever on August 30, 1997 emergency medical treatment, after hemostasis, anti-infective, blood transfusions and other treatment, hemoptysis uncontrolled, during hospitalization has hemoptysis 3 times, each time Volume of 300ml ~ 500ml, CT scan for the right lower lung bronchiectasis with infection, the proposed surgical treatment, was transferred to the surgery on September 9, 1997. Examination: body temperature 37.6 ℃, pulse 96 beats / min, breathing 23 beats / min , Blood pressure 16 / 12KPa, anemia, supraclavicular lymph nodes without swelling, tracheal center, lower right lung breath sounds weakened, no obvious wet and dry rales, flat belly, liver and spleen without swelling, both hands can be seen rod-shaped fingers. Laboratory tests: white blood cells 4.4 × 10 ~ 9 / L, erythrocytes 2.81 × 10 ~ 12 / L, hemoglobin 65g / L, liver and kidney function was normal, given absolute bed rest, anti-inflammatory, rehydration, bleeding, blood transfusions, in September On the 11th under general anesthesia thoracotomy exploration, intraoperative see the right lower lobe and diaphragm and chest wall adhesions, the formation of numerous collateral circulation, Right marginal angiosarpharia occlusion .And the right lower lobe within the palpable and 4cm × 4cm × 4cm mass, right lower lobe resection .Because of inflammatory adhesions, excessive bleeding, cut open the right lower lobe, see the lower lobe of the bronchus has a A 2cm × 1cm × 1cm stones, bronchiectasis, mucosal necrosis, bleeding.After the surgery to strengthen the anti-infective, supportive treatment, on September 17, removal of the chest drainage tube, September 25 both lungs breath sounds clear, stable vital signs , Chest wall incision healed, discharged.