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目的探讨纤维支气管镜(纤支镜)下一次性置入2根新型双腔微导管在治疗肺大咯血中的价值及安全性。方法 10例患者均先行X线胸片、胸部HRCT检查,初步明确出血部位及病因,按纤支镜操作常规准备。术前30min无水吞服30mg可待因,尽可能在大咯血间歇期进行。操作过程中边插入纤支镜边止血,直至找到目标支气管,随即沿工作通道放入引导导丝,在纤支镜直视下沿导丝放入第1根双腔微导管。判定球囊所能寻求支撑的着力点后,依据管径大小向球囊导管工作通道分别注入不等量冰生理盐水固定球囊。随后观察另一段或亚段支气管是否仍在持续出血,再继续按上述方法置入第2根球囊导管。纤支镜下观察3～5min,确定封堵目标支气管已停止出血后退出纤支镜。每隔1～2h向球囊的工作通道注入凝血酶500U,并回抽以观察微球囊封堵支气管内出血情况,以确定球囊导管放置时间。每6～8h回抽固定球囊液体量的一半,避免完全放松固定球囊而导致导管在气管内随呼吸发生移位。如在此期间或之后再次出现大咯血,则立即进行支气管动脉栓塞或手术治疗。以术后患者咯血量等症状的减轻,并结合从工作通道回抽吸液体颜色深浅的改变情况,分为出血完全停止、明显减少、有所减少、失败无效等4个层次进行疗效的判断。并通过该项技术与支气管动脉栓塞术(BAE)治疗肺大咯血对作比观察。结果 10例患者纤支镜下一次置入2根新型微导管操作顺利,操作时间约20～30min。大咯血即刻控制率达80%。术后出血即刻完全停止4例、明显减少3例、有所减少1例、失败无效2例。出血有所减少的1例术后4h经BAE术疗出血完全停止。失败无效的2例中,1例后经外科手术切除右肺中叶,出血完全停止。另外1例随即行BAE,但术后24h再次出现大咯血窒息死亡。结论一次性置入2根新型微导管治疗肺大咯血为有条件的患者和可能需要进一步行BAE,及外科手术治疗的患者创造了诊断和气道准备条件的时间。具有一定临床应用价值及可靠的安全性,值得在临床进一步推广应用。
Objective To investigate the value and safety of two new double-microcatheter catheters in the treatment of massive pulmonary hemoptysis under fiberoptic bronchoscopy (bronchofibroscopy). Methods All 10 patients underwent X-ray and chest CT examination. The bleeding site and etiology were preliminarily determined, and routine preparation was performed according to the bronchoscopic operation. Anhydrous swallow 30 mg of codeine 30 minutes before surgery, as far as possible in the period of large hemoptysis. During operation, hemostasis was inserted into the bronchoscope edge until the target bronchus was found. Then the guide wire was placed along the working channel. The first double-lumen microcatheter was placed along the guide wire under the direct view of the bronchoscope. Determine the balloon can seek the focus of support, according to the size of the diameter of the balloon catheter into the working channel are not equal to the amount of ice saline fixed balloon. Followed by observation of another segment or sub-segment bronchus is still bleeding, and then continue as described above into the second balloon catheter. Bronchoscopy observed 3 ~ 5min, to determine the target bronchus has stopped bleeding after leaving the bronchoscopy. Every 1 ~ 2h into the working channel of the balloon into the thrombin 500U, and back to observe the microsphere balloon occlusion bronchial hemorrhage, to determine the balloon catheter placement time. Every 6 ~ 8h retraction fixed balloon fluid volume of half, to avoid completely loosen the balloon and lead to the catheter in the trachea with the respiratory displacement. If, during or after the recurrence of massive hemoptysis, bronchial artery embolization or surgery immediately. In order to reduce the amount of postoperative hemoptysis and other symptoms, combined with the withdrawal from the working channel to absorb liquid color depth changes, divided into completely stop the bleeding, significantly reduced, decreased, failed to determine the efficacy of the four levels. And through the technology and bronchial artery embolization (BAE) treatment of pulmonary hemoptysis on the observation. Results 10 patients with bronchoscope were placed under a new microcatheter operation smoothly, the operation time is about 20 ~ 30min. Hemoptysis immediate control rate of 80%. Bleeding immediately after surgery in 4 cases completely stopped, significantly reduced in 3 cases, a decrease of 1 case, 2 cases of failure. Bleeding was reduced in 1 case 4h after surgery by BAE bleeding completely stopped. In 2 cases of failed failure, one case was surgically removed from the middle of the right lung and the bleeding stopped completely. In another case, BAE was performed immediately, but again, massive hemoptysis died after 24h. Conclusions The time to diagnosis and airway preparation conditions was established in patients who were eligible for treatment of massive pulmonary hemoptysis with one of the new microcatheters and those who may require further BAE and surgery. Has a certain clinical value and reliable safety, it is worth further promotion in clinical application.