目的观察经纤维支气管镜局部灌洗注药治疗大咯血的效果。方法选择2006年7月—2012年6月经纤维支气管镜治疗的大咯血患者47例,采用Olympus-BF-1T40型纤维支气管镜,均在床边进行治疗。麻醉后,在明视下边观察边用肾上腺素4℃冰盐水(1:10 000)灌洗,每次注入10-15 ml,随后反复抽吸,直到回收液变淡或基本澄清,平均每人每次灌洗肾上腺素冰盐水100-500 ml。结果 29例有血凝块阻塞,26例有活动性出血。32例经一次纤维支气管镜治疗后于24 h内出血量减少,48-72 h完全止血;9例经纤维支气管镜治疗后再发大咯血,再次给予灌洗,此后未再出血;4例于第1次治疗后出血减少50%,48 h后经第2次灌洗后未再出血;1例因无法到达血块远端而未予灌洗,1例止血效果不好,以上2例行手术治疗。灌洗注药治疗时无一例出现因纤维支气管镜操作导致咯血加重,无一例出现缺氧加重及发生意外。结论经纤维支气管镜治疗大咯血简便、安全、效果确切,值得临床应用。 Objective To observe the effect of local irrigation with bronchoscopy on hemoptysis. Methods Forty-seven patients with massive hemoptysis who were treated with bronchofibroscopy from July 2006 to June 2012 were treated with Olympus-BF-1T40 fiberoptic bronchoscopy. After anesthesia, the rats were drenched with epinephrine ice-cold water (1: 10,000) at 4 ° C and 10-15 ml each time under light vision, followed by repeated aspiration until the recovery solution became pale or almost clear, averaging Each lavage epinephrine ice saline 100-500 ml. Results 29 cases had blood clots and 26 cases had active bleeding. Thirty-two patients died of hemorrhage within 24 hours after a fiberoptic bronchoscope treatment, and stopped bleeding completely within 48-72 hours. Nine patients had massive hemoptysis after fibrobronchoscopy and were given lavage again. One treatment reduced hemorrhage by 50% and no bleeding after 48 h after the second lavage. One patient failed to reach the distal end of the blood clot and did not have lavage. . No case of lavage injection therapy due to fibrobronchial operation led to increased hemoptysis, no case of increased hypoxia and the accident occurred. Conclusion The treatment of hemoptysis by bronchoscopy is simple, safe and effective and worthy of clinical application.