大咯血行支气管动脉栓塞的栓塞材料研究进展

支气管动脉栓塞术（BAE）是将栓塞材料定向注入支气管动脉,封闭责任血管,达到迅速止血的效果,现已成为针对大咯血内科保守治疗无效时的首选治疗手段,目前临床上所使用的栓塞材料种类繁多,可以适应不同的部位、不同的病因、不同的病变基础,种类包括机械栓塞材料弹簧圈、液体栓塞材料氰基丙烯酸正丁酯（NBCA）、广泛应用的明胶海绵（GSA）和聚乙烯醇（PVA）颗粒以及逐渐推广的各型微球。该文旨在对栓塞材料的种类、特性、应用范围以及各自的优缺点做一综述。     

比较隐源性咯血和慢性肺结核咯血动脉造影表现及栓塞治疗效果

目的比较顽固性隐源性咯血(CH)和慢性肺结核(CTB)咯血的动脉造影表现特点及介入栓塞治疗效果。方法对17例顽固性CH患者(CH组)及20例CTB咯血患者(TB组)行责任血管栓塞,比较两组责任血管数目、非支气管体循环动脉(NBSA)参与供血血管数目、血管造影表现及栓塞后中远期效果。结果 TB组人均责任血管数目、NBSA参与供血血管数目多于CH组(t'=5.469,t=5.212,P0.01);TB组血管增粗、纡曲、富血管化、BP分流及动静脉瘘的发生率均高于CH组(P均0.05)。TB组术后2年复发率高于CH组(P0.01)。CH组和TB组并发症发生率分别为64.71%(11/17)、95.00%(19/20),差异无统计学意义(P0.05)。结论支气管动脉是CH的主要责任血管。CTB咯血因存在大量NBSA供血,责任血管复杂。CTB咯血复发率高,与栓塞不彻底有关。根据造影特点选择栓塞剂及决定栓塞程度可预防严重并发症。     

普鲁卡因联合化疗治疗肺癌咯血的临床观察

目的观察普鲁卡因联合化疗治疗肺癌咯血的效果。方法将52例肺癌咯血患者随机分为观察组28例及对照组24例．观察组采用普鲁卡因联合化疗治疗,对照组采用单纯化疗,比较两组疗效。结果观察组有效率为89.3％,对照组有效率为62．5％,差异有统计学意义（P〈0．05）。结论普鲁卡因联合化疗可明显改善肺癌患者的咯血症状,值得推广应用。     

支气管动脉栓塞术后肺结核再咯血的综合治疗

目的探讨肺结核大咯血行支气管动脉栓塞术(BAE)后再次出现咯血的综合治疗方法。方法总结1997年8月至2006年2月间289例肺结核大咯血行BAE治疗失败后再次出现咯血的42例患者,根据咯血量的多少,采用不同的治疗措施,20例小量咯血应用云南白药和止血芳酸治疗,22例中至大量咯血患者联合应用蛇毒血凝素和人工冬眠治疗。结果20例小量咯血经云南白药和止血芳酸治疗后,有效止血率95.0%,22例中至大量咯血联合应用蛇毒血凝素和人工冬眠治疗,有效止血率为86.4%。结论肺结核大咯血行BAE后再次出现小量咯血可以采取常规治疗,中至大量咯血联合应用蛇毒血凝素和人工冬眠不失为有效的治疗手段。     

Patient and Procedure-related Characteristics Correlated With Severity of Hemoptysis Following Percutaneous Transthoracic Needle Biopsy: Results of a 10-year Retrospective Review

PurposeA risk of percutaneous transthoracic needle biopsy (PTNB) is hemoptysis, which can range from mild to life-threatening. The reported occurrence of hemoptysis is 1.7% to 14.5%, and the demographic, patient, and procedure characteristics have not been extensively described. The purpose of this study was to assess the associations of demographic, patient, and procedure characteristics with the severity of hemoptysis.Materials and MethodsA single institution, single group, retrospective, electronic medical record (EMR) review was performed on all hemoptysis events occurring between 2008 and 2018. Demographic, clinical, and procedure variables were extracted from EMRs. Outcome of hemoptysis events was graded using Common Terminology Criteria for Adverse Events (CTCAE). Mild-moderate and severe hemoptysis were defined as CTCAE classifications of 1-2 and 3-5, respectively. Associations were generated using logistic regressions and Likelihood Ratio Chi-Square tests.ResultsIn 10 years, 14,665 PTNB resulted in 231 hemoptysis events occurring in 229 patients; 12.7% (n = 29) of those were severe. The strongest and statistically significant variables associated with an increased likelihood of a severe event, if an event occurred, were cigarette pack years (OR = 1.02, 95% C.I. = 1.01-1.04, p = .020); history of chronic obstructive pulmonary disease (COPD) (OR = 3.68, 95% C.I. = 1.53-8.82, p = .003); core biopsy technique (OR = 8.13, 95% CI = 1.07, 61.40, p = .042), and larger diameter needle (20 g vs. 18 g: OR = 2.60, 95% CI 1.09, 6.17, p = .031).ConclusionsPTNB-associated hemoptysis was an uncommon event that was rarely life-threatening. The extent of the patient’s smoking history, the diagnosis of COPD, and core biopsy technique were associated with an increased likelihood of severe hemoptysis.     

垂体后叶素治疗肺结核咯血引起低钠血症52例临床分析

目的探讨垂体后叶素治疗肺结核咯血引起低钠血症的机制、临床特点及治疗。方法对2000年1月．2007年4月住院286例肺结核咯血患者静滴垂体后叶素治疗过程中引起低钠血症52例的临床资料进行回顾性分析。结果52例患者中，30例无临床症状，血清钠为（128±3）mmol／L，22例出现临床症状，血清为（116±8）mmol／L：恶心、呕吐12例，肌无力8例，肌痉挛7例，精神错乱6例，嗜睡6例，抽搐5例，昏迷误诊为结核性脑膜炎5例。结论肺结核咯血应用垂体后叶素治疗时，应动态监测血清钠浓度变化，注意低钠血症发生，以便及时纠正，防止严重并发症发生。     

Successful modified Fontan procedure in an adolescent after left pneumonectomy

Summary We performed a Waterston's anastomosis on a patient with complicated tricuspid atresia when she was two months of age. At age 14 years she required left pneumonectomy for massive, idiopathic hemoptysis. Four months after the pneumonectomy we substituted a modified Fontan anastomosis for the Waterston anastomosis. Restudy when she was 17 years of age showed continued satisfactory function.     

肺结核大咯血支气管动脉栓塞治疗的远期疗效观察

目的评价支气管动脉栓塞治疗肺结核大咯血的远期疗效。方法42例均为继发性肺结核，双侧肺结核27例，单侧肺结核15例。采用支气管动脉插管造影，证实为出血动脉后，将PVA微粒或丝线段缓慢注入靶血管内，直至血流停止。结果一次栓基后34例达到立即止血的目的，7例咯血明显减少，1例无效，近期有效率97．6％，无严重并发症：术后随访6月～7年，24例达临床治愈，显效7例，有效5例，复发6例，远期有效率85．7％结论支气管动脉栓塞治疗肺结核大咯血是一安全、迅速有效的治疗方法，远期止血效果好，并发症少，结合抗痨治疗有利于巩固疗效。     

扩血管与缩血管药物联用治疗大咯血临床观察

目的 探讨联用扩血管与缩血管药物治疗大咯血疗效。方法 82例大咯血病人随即分为观察与对照组, 观察组联用扩血管药物与缩血管药物治疗,对照组用其中的一种。结果 观察组显效率为78．0％,总有效率 88．6％;对照组显效率56．1％,总有效率为75．6％,两组比较差异有显著性(P<0．05)。结论 联用扩血管药物与 缩血管药物治疗大咯血疗疗效更好。     

支气管扩张伴咯血的DSA表现及栓塞治疗

目的:探讨支气管扩张伴咯血患者供血动脉的数字减影血管造影(DSA)表现及栓塞治疗的价值、血管造影对支气管扩张患者出现咯血的病因分析.方法:对42例支气管扩张患者行选择性动脉造影,分析其DSA表现,确定供血动脉,选择合适的栓塞剂行栓塞治疗并判断疗效.结果:支气管扩张伴咯血患者的DSA表现主要为供血动脉增粗、支气管动脉肺循环分流.行栓塞治疗的总有效率为97.6%,无严重的并发症发生.结论:支气管扩张患者咯血和动脉的异常有关.经动脉栓塞术前仔细分析DSA表现对栓塞治疗有指导意义.