支气管动脉栓塞治疗大咯血的临床应用

目的探讨支气管栓塞术在治疗大咯血中的临床价值.方法回顾性析海军安庆医院2009年1月至2011年12月收治的经内科治疗无效的咯血患者29例,在选择性支气管动脉造影下,以聚乙烯醇颗粒或明胶海绵行栓塞治疗,并对术后临床疗效和不良反应进行观察.结果术后治疗总有效率达96.6%,治愈率为79.3%,未见明显的不良反应,术后平均随访5.6个月(3～12个月),未见复发病例.结论支气管栓塞术治疗大咯血具有创伤小、操作简单、疗效可靠、起效快等特点,值得临床推广.     

Hemoptysis Due to Breath-Hold Diving Following Chemotherapy and Lung Irradiation

Breath-hold diving, also known as free-diving, describes the practice of intentional immersion under water without an external supply of oxygen. Pulmonary hemorrhage with hemoptysis has been reported as a complication of immersion and breath-hold diving in young healthy athletes. We report the case of a 60-year-old man with a history of radiation and chemotherapy for breast carcinoma, who developed the abrupt onset of hemoptysis in the setting of swimming and breath-hold diving. A computed tomography (CT) scan of the chest demonstrated an area of ground glass opacification, suggestive of pulmonary hemorrhage, superimposed on a background of reticular opacities within the prior radiation field. A follow-up CT scan of the chest, obtained 2 months after presentation, demonstrated resolution of the ground glass opacification, but persistence of fibrotic features attributable to prior radiation therapy. We postulate that prior irradiation of the chest resulted in lung injury and fibrosis which, in turn, rendered the affected region of the lung susceptible to “stress failure,” due to an increase in the transcapillary pressure gradient arising from immersion and breath-hold diving. Patients with a history of lung injury resulting from chest irradiation should be cautioned about pulmonary hemorrhage and hemoptysis as a potential complication of swimming and breath-hold diving.     

服用华法林而致咯血患者的药学监护

目的探讨服用华法林导致出血不良事件的药学监护内容以及临床药师参与药物治疗的模式。方法对服用华法林而致出血的病例,临床药师协助临床医师寻找出血原因,并对其治疗全过程进行监护。结果经药师仔细询问该患者用药史建立用药与INR时间表后,判断出血受药物相互不良作用影响较大,并进行治疗药物优化建议和密切监护出血情况后,患者康复出院。结论临床药师积极参与临床实践,作为药物治疗团队中的一员,可利用药学特长协助临床医师做出药物相关性疾病的诊断,共同监护药物治疗的有效性、安全性和依从性,体现了临床药师价值。     

138例咯血患者的胸部X线检查与纤维支气管镜检查对照分析

１３８例咯血患者的胸部Ｘ线检查发现异常９０例。经纤维支气管镜（纤支镜）检查主要结果：炎症５９例（４２．８％）、支气管肺癌４１例（２９．７％）、结核１０例（７．２％）及其它２８例（２０．３％）。纤维支气管镜检查对明确病灶性质及咯血原因提供重要依据的有１１６例（８４．１％）。     

双重栓塞支气管动脉治疗大咯血的远期疗效分析

目的评价不同操作程序和材料对栓塞支气管动脉治疗大咯血远期疗效的影响。方法157例大咯血患者,分组采用三步双重栓塞支气管动脉和单纯明胶海绵颗粒栓塞治疗。121例选择经高温处理的明胶海绵微粒、真丝线段、明胶海绵条分三步双重逐级栓塞支气管动脉远端细小分支、小分支及大分子血管,36例患者选择明胶海绵颗粒栓塞治疗。结果两组患者经治疗后随访1~8年,远期止血率为:三步双重栓塞组89.3%,单纯明胶海绵栓塞组72.2%,两组比较有显著性差异(χ2=6.439,P<0.02)。结论采用支气管动脉三步双重栓塞法能明显提高治疗大咯血的远期疗效。     

支气管扩张咳血患者的护理研究

目的：探讨支气管扩张咳血患者的护理方法和效果。方法：将2011年7月至2013年7月收治的46例支气管扩张咳血患者随机分为护理组和对照组,每组23例。对两组患者进行相同的临床治疗,对护理组患者实施全面、规范化的护理,观察并对比临床效果。结果：护理组患者的治疗有效率高于对照组,差异具有统计学意义（ P ＜0．05）。结论：对支气管扩张咳血患者进行临床监护、健康教育、心理指导、生活指导、饮食运动等方面的护理,对提高治疗有效率具有重要作用,值得推广。