CAJ | 학술논문

目的探讨纤维支气管镜治疗肺大咯血几种不同介入方法选择时机与安全性.方法总结我科2010年1月至2012年11月大咯血21例,其中男19例,女2例,通过对比观察大咯血即刻控制率、手术过程难易程度、耗费时间、并发症的发生等指标,对微导管置入止血法(方法A)、氧化再生纤维素止血纱条置r止血法(方法B)、氩等离子凝固术(方法C)等三种肺大咯血的介入技术,重点在该三项技术介入选择时机的把握与安全性等方面作出评价.结果在21例患者中,方法A完成12例,方法B完成6例,方法C完成3例,大咯血即刻控制率分别是方法A为75％,方法B为83.3％,方法C为100％;三种不同方法操作顺利,操作时间3～10 min,方法A、B中均有病例出现鼻腔出血、声音嘶哑,方法C则无；方法A、B、C均出现不同程度发热、胸闷气短,但三种方法中均无明显胸痛、肺不张、阻塞性肺炎、肺脓肿、局部黏膜压迫坏死和烧灼伤.方法A发生导管滑脱3例,方法B发生氧化再生纤维素止血纱条咳出1例,方法C发生纤维支气管燃烧导致气管镜前端损坏1例.结论对于经纤维支气管镜介入治疗肺大咯血应选择术者较熟练掌握、费时短,疗效较可靠,且患者意愿较易接受的介入治疗方法.但是,各种方法均有其限制,需要严格掌握.
목적 탐토섬유지기관경치료폐대각혈궤충불동개입방법선택시궤여안전성.방법 총결아과2010년1월지2012년11월대각혈21례,기중남19례,녀2례,통과대비관찰대각혈즉각공제솔、수술과정난역정도、모비시간、병발증적발생등지표,대미도관치입지혈법(방법A)、양화재생섬유소지혈사조치r지혈법(방법B)、아등리자응고술(방법C)등삼충폐대각혈적개입기술,중점재해삼항기술개입선택시궤적파악여안전성등방면작출평개.결과 재21례환자중,방법A완성12례,방법B완성6례,방법C완성3례,대각혈즉각공제솔분별시방법A위75％,방법B위83.3％,방법C위100％;삼충불동방법조작순리,조작시간3～10 min,방법A、B중균유병례출현비강출혈、성음시아,방법C칙무；방법A、B、C균출현불동정도발열、흉민기단,단삼충방법중균무명현흉통、폐불장、조새성폐염、폐농종、국부점막압박배사화소작상.방법A발생도관활탈3례,방법B발생양화재생섬유소지혈사조해출1례,방법C발생섬유지기관연소도치기관경전단손배1례.결론 대우경섬유지기관경개입치료폐대각혈응선택술자교숙련장악、비시단,료효교가고,차환자의원교역접수적개입치료방법.단시,각충방법균유기한제,수요엄격장악.
Objective Discussion of timing and safety about different interventional methods of fiberoptic bronchoscopy for massive pulmonary haemoptysis.Methods Twenty one patients with massive pulmonary haemoptysis were recruited from Jan 2010 to Nov 2012 in our Department (19 males,2females).All patients were randomized to an interventional method of fiberoptic bronchoscopy with micro-catheter imbedding hemostasia (method A),oxidized regenerated cellulose (ORC) hemostatic gauze imbedding hemostasia (method B),and argon plasma coagulation (APC) hemostasia (method C).Evaluation of the timing and safety of these three methods was performed based on the instant control rate of massive hemoptysis,degree of difficulty of the surgical procedure,consumed time,and the incidence of complications.Results In all patients,12 cases were performed with method A,6 cases were performed with method B,and 3 cases were performed with method C.The instant control rates of massive hemoptysis were 75％,83.3％,and 100％,respectively.All the procedures were performed successfully,and the consumed time was from 3 to 10 min.Nasal bleeding,and a hoarse voice were appeared in groups with method A and B,but not method C.Varying degrees of fever,chest tightness and shortness of breath were appeared in all groups,but obvious chest pain,atelectasis,obstructive pneumonia,lung abscess,local mucosal of oppression necrosis and burns were disappeared in all groups.1 case was appeared catheter slippage in group with method A,1 case was appeared expectoration of ORC hemostatic gauze in group with method B,and 1 case was appeared the front of the bronchoscope damage due to fiberoptic bronchoscopy burning in group with method C.Conclusions For the interventional methods of fiberoptic bronchoscopy for massive pulmonary haemoptysis,the interventional methods with more expert,simpler,shorter time-consuming,more reliable effective were willing to accepted by the patients.However,each method has its own limitation,it need to be mastered strictly.