纤维支气管镜引导下双腔球囊漂浮导管气道内置入治疗大咯血的临床研究
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摘要
目的:与纤维支气管镜专用双腔球囊导管气道内置入的方法相对照,探讨经纤维支气管镜引导下气管内置入双腔球囊漂浮导管治疗咯血方法的效果及其安全性。方法
1临床资料:30例咯血患者,其中男性19例,女性11例,年龄24~76岁,平均54.87±14.34岁。病因分类:支气管扩张8例,肺癌13例,肺结核6例,其他如曲菌病等3例。所有患者均符合下列条件:(1)24h咯血量在300ml以上或一次咯血量达100ml;(2)经内科常规治疗一周无效,自愿接受双腔球囊漂浮导管或纤维支气管镜专用导管治疗;(3)无严重心、肺、脑功能疾病;(4)无明显纤维支气管镜检查的禁忌症。将该30例患者随机分为两组,观察组:15例大咯血患者,采用丝线固定、双腔球囊漂浮导管和纤维支气管镜并行气道内置入的方法治疗大咯血;对照组:15例大咯血患者应用纤维支气管镜专用双腔球囊导管治疗大咯血。两组患者在年龄、性别、咯血病因、咯血量、血红蛋白量等方面对比,差异无统计学意义(P>0.05)。
2双腔球囊漂浮导管的置入:用丝线将纤维支气管镜头和球囊导管前端固定到一起,然后经鼻插入气道,在吸引气道内积血同时,循气道内血迹仔细寻找出血部位,在纤维支气管镜引导下将球囊导管推向出血的段或亚段支气管,球囊内注入生理盐水,使球囊膨胀至完全封闭其段或亚段支气管。然后,关闭阀门,放松丝线,用纤维支气管镜吸尽气道残血,证实无再出血后退出纤维支气管镜,记录球囊生理盐水的用量和导管在鼻部的长度,并用T型胶布固定于患者鼻翼旁。
3纤维支气管镜专用双腔球囊导管的置入:患者局麻后经鼻插入纤维支气管镜,循气道内血迹仔细寻找出血部位,确定出血部位后,固定纤维支气管镜,将拆除了阀门系统的球囊导管涂抹利多卡因凝胶和消毒石蜡油,然后将球囊导管插入纤维支气管镜工作通道并准确地送至出血部位,固定球囊导管,缓缓退出纤维支气管镜,在球囊导管尾端装上阀门系统。再次经口腔插入纤维支气管镜达出血部位,在纤维支气管镜直视下,确认球囊位置,注入生理盐水使球囊膨胀至出血停止,记录生理盐水的用量和导管在鼻部的长度,并用T型胶布固定于患者鼻翼旁。
结果
1治疗效果:球囊导管置入后绝大部分患者出血立即停止,观察两组病人术后出血量、出血持续时间和住院总天数,两组之间无明显差异(P>0.05)。观察组咯血治疗有效人数为15例,有效率为100%;对照组咯血治疗有效人数为13人,有效率为86.7%,两组球囊导管置入治疗咯血总有效率为93.3%.
2两组操作时间比较:观察组平均置管操作时间为8.3±1.0分钟;对照组平均置管操作时间为14.5±2.7分钟,观察组的置管操作时间明显较对照组的置管时间短,统计学有差异(P<0.05)。观察组球囊导管留置时间与对照组球囊导管留置时间无统计学差异(P>0.05)。
3两组置管并发症:观察组术中诱发出血或出血加重观察组1例,对照组3例,两组无统计学差异(P>0.05);观察组球囊脱位及阻塞数2例,对照组4例,两组无统计学差异(P>0.05);两组术后均有1例发生阻塞性肺炎,拔管后,经抗生素治疗3~5天治愈。
4球囊导管置入术的安全性
4.1生命体征变化:置管前患者心率、呼吸频率高于术后2小时及拔管后,有统计学差异(P<0.05);置管前及置管术后2小时患者体温高于拔管后,它们之间有统计学差异,(P<0.05)。观察组和对照组两组之间比较,于置管前、置管后2小时、拔管后均无明显变化,统计学无差异(P>0.05) 4.2血气分析变化:患者的氧分压、二氧化碳分压及血氧
饱和度于置管前、置管后2小时、拔管后测量的结果均位于正常值范围内,均无明显变化,无统计学差异(P>0.05)。同时观察组和对照组两组之间于置管前、置管后2小时、拔管后的血气分析也无明显变化,统计学无差异。
结论:本研究显示丝线固定,纤维支气管镜与双腔球囊漂浮导管并行气道内置入,球囊充气,封堵和压迫出血支气管疗效确实。丝线固定双腔球囊导管置入的方法较支气管专用导管方法操作时间短、气道刺激性小、导管不易脱位,对患者的生命体征,血气无明显影响,是一种更加简单、安全、价廉和有效的新方法(P>0.05)。
Objective: To evaluate the efficacy and the safety of endobronchial tamponade technique using Swan-Ganz catheter fixed by surgical thread to bronchofibroscope to treat massive hemoptysis, and compare with Fogarty catheter method.
Method
1. clinic data: 30 hemoptysis cases, 9 men and 11 women, their ages are between 24~76 years old, and average age is 54.87±14.34 years old. All patients including 8 bronchiectasis cases, 13 lung cancer cases 6 pulmonary tuberculosis and others such as aspergillomycosis 3 cases。They conform to the following conditions and were picked out for our research: (1) the total hemoptysis quantity was above 300ml in 24 hours or reached 100ml at one time; (2) all the patients were accepted hematostatic treatment for 1 week but had no effect, and accept the treatment with double-lumen balloon floatation catheter or Fogarty catheter voluntarily; (3 )has no serious heart, lung or brain function diseases or disturbance; (4) without obvious contraindications of bronchofibroscope. We divided the 30 patients into two groups randomly: observe group (15 examples) receive endobronchial tamponade technique of Swan-Ganz catheter fixed with bronchofibroscope by thread and control group (15 examples) were treated by endobronchial tamponade technique with Fogarty catheter. The comparison between two groups in some aspects such as age, sex, hemoptysis quantity, hemoglobin quantity and so on have no statistical significance(P>0.05).
2. The method of placing Swan-Ganz catheter: Fix both tips of bronchofibroscope and the Swan-Ganz catheter with surgical thread, insert them tighter from nostril into trachea,suck the blood and find the bleeding site meanwhile. The catheter is pushed forward, place proximal to bleeding site and is inflated with Sodium Chloride until the bronchus is totally blocked up. Then shut the valve, relax the thread and pull out the bronchofibroscope after ensuring no continuous bleeding is observed. Write down the dosage of Sodium Chloride in the balloon and the length of the catheter from the nose, and then fix the catheter on nosewing with a“T”shape adhesive tape.
3. The method of placing Fogarty catheter: Insert the bronchofibroscope from nostril into trachea under local anesthesia; follow the bloodstain in airway and find the bleeding site, then fix the bronchofibroscope. Deliver the balloon catheter daubed Lidocaine gelatin and disinfectant paraffin oil and removal the valve system to the bleeding site accurately through bronchofibroscope working channel, then withdraw the bronchofibroscope slowly, install the valve system. Insert the bronchofibroscope to the bleeding site once more through the oral cavity, after confirming the position of the balloon of catheter; inject Sodium Chloride until the bronchus is totally blocked up in order to stop the hemorrhage. Write down the dosage of Sodium Chloride in the balloon and the length of the catheter from the nose; fix the catheter on nosewing with a“T”shape adhesive tape at last.
Results
1 Curative effect: The majority of patients stop bleeding immediately after the balloon catheter was inserted. observe the bleeding quantity, the time of bleeding continues after tamponade of all the patients and the total days of patients in hospital of two groups, there is no obvious difference between two groups (P>0.05). 15 patients were effective in observe group, the effectiveness is 100% while 13 patients in control group,and the effectiveness is 86.7%,the total effectiveness of massive hemoptysis treated by double-balloon catheter tamponade technique in two groups is 93.3%.
2 The comparison of two groups’operation time: The average operation time on observe group is 8.3±1.0 minutes while the control group is 14.5±2.7 minutes. The average operation time on observe group is obviously shorter than control group, there is statistics difference(P<0.05), but there is no statistics difference(P>0.05) of balloon catheter keeping time on observe group and control group.
3 One patient of inducing or aggravating bleeding during the operation was observed in the observe group while three in control group, there is no statistics difference(P>0.05), the patients of catheter obstructed or dislodged was observed in the observe group were one and four in the control group, there is no statistics difference yet(P>0.05)Although one patient got obstructive pneumonia after the operation in each group, they all cured by antibiotic therapy for 3 to 5 days after the catheter was pulled out.
4 Security of balloon catheter tamponade technique
4.1 The change of vital signs: the patients’heart rate、respiratory frequency before catheter inserted is higher than the patients two hours after the operation, and higher than which after the catheter was pulled out too,there are statistics difference(P<0.05). Patients’temperature before catheter was inserted and two hours after the operation is higher than that after the catheter was pulled out, there is statistics difference(P<0.05). No obvious change of vital signs before catheter was inserted、two hours after the operation and after the catheter was pulled out was observed between two groups, and there is no statistics difference(P>0.05)
4.2 The change of blood gas analysis: Before catheter was inserted、two hours after the operation and after the catheter was pulled out , all the patients’PO2、PCO2、SaO2 measurement results are all in normal range, there is no obvious change(P>0.05), The blood gas analysis comparison between two groups is no obvious before catheter was introduced, two hours after the operation and after the catheter was pulled out, there is no statistics difference(P>0.05)
Conclusion: It is very good for the Massive hemoptysis therapy by the tamponade technique with Swan-Ganz catheter fixed with bronchofibroscope by surgical thread in airway. The operating time used by endobronchial tamponade technique with Swan-Ganz catheter fixed by surgical thread is shorter than the method Fogarty catheter inserted. Also there is no obvious affection to patients’vital signs, blood gas analysis. It is a kind of more convenient, operating easily, more safety and effective method.
1临床资料:30例咯血患者,其中男性19例,女性11例,年龄24~76岁,平均54.87±14.34岁。病因分类:支气管扩张8例,肺癌13例,肺结核6例,其他如曲菌病等3例。所有患者均符合下列条件:(1)24h咯血量在300ml以上或一次咯血量达100ml;(2)经内科常规治疗一周无效,自愿接受双腔球囊漂浮导管或纤维支气管镜专用导管治疗;(3)无严重心、肺、脑功能疾病;(4)无明显纤维支气管镜检查的禁忌症。将该30例患者随机分为两组,观察组:15例大咯血患者,采用丝线固定、双腔球囊漂浮导管和纤维支气管镜并行气道内置入的方法治疗大咯血;对照组:15例大咯血患者应用纤维支气管镜专用双腔球囊导管治疗大咯血。两组患者在年龄、性别、咯血病因、咯血量、血红蛋白量等方面对比,差异无统计学意义(P>0.05)。
2双腔球囊漂浮导管的置入:用丝线将纤维支气管镜头和球囊导管前端固定到一起,然后经鼻插入气道,在吸引气道内积血同时,循气道内血迹仔细寻找出血部位,在纤维支气管镜引导下将球囊导管推向出血的段或亚段支气管,球囊内注入生理盐水,使球囊膨胀至完全封闭其段或亚段支气管。然后,关闭阀门,放松丝线,用纤维支气管镜吸尽气道残血,证实无再出血后退出纤维支气管镜,记录球囊生理盐水的用量和导管在鼻部的长度,并用T型胶布固定于患者鼻翼旁。
3纤维支气管镜专用双腔球囊导管的置入:患者局麻后经鼻插入纤维支气管镜,循气道内血迹仔细寻找出血部位,确定出血部位后,固定纤维支气管镜,将拆除了阀门系统的球囊导管涂抹利多卡因凝胶和消毒石蜡油,然后将球囊导管插入纤维支气管镜工作通道并准确地送至出血部位,固定球囊导管,缓缓退出纤维支气管镜,在球囊导管尾端装上阀门系统。再次经口腔插入纤维支气管镜达出血部位,在纤维支气管镜直视下,确认球囊位置,注入生理盐水使球囊膨胀至出血停止,记录生理盐水的用量和导管在鼻部的长度,并用T型胶布固定于患者鼻翼旁。
结果
1治疗效果:球囊导管置入后绝大部分患者出血立即停止,观察两组病人术后出血量、出血持续时间和住院总天数,两组之间无明显差异(P>0.05)。观察组咯血治疗有效人数为15例,有效率为100%;对照组咯血治疗有效人数为13人,有效率为86.7%,两组球囊导管置入治疗咯血总有效率为93.3%.
2两组操作时间比较:观察组平均置管操作时间为8.3±1.0分钟;对照组平均置管操作时间为14.5±2.7分钟,观察组的置管操作时间明显较对照组的置管时间短,统计学有差异(P<0.05)。观察组球囊导管留置时间与对照组球囊导管留置时间无统计学差异(P>0.05)。
3两组置管并发症:观察组术中诱发出血或出血加重观察组1例,对照组3例,两组无统计学差异(P>0.05);观察组球囊脱位及阻塞数2例,对照组4例,两组无统计学差异(P>0.05);两组术后均有1例发生阻塞性肺炎,拔管后,经抗生素治疗3~5天治愈。
4球囊导管置入术的安全性
4.1生命体征变化:置管前患者心率、呼吸频率高于术后2小时及拔管后,有统计学差异(P<0.05);置管前及置管术后2小时患者体温高于拔管后,它们之间有统计学差异,(P<0.05)。观察组和对照组两组之间比较,于置管前、置管后2小时、拔管后均无明显变化,统计学无差异(P>0.05) 4.2血气分析变化:患者的氧分压、二氧化碳分压及血氧
饱和度于置管前、置管后2小时、拔管后测量的结果均位于正常值范围内,均无明显变化,无统计学差异(P>0.05)。同时观察组和对照组两组之间于置管前、置管后2小时、拔管后的血气分析也无明显变化,统计学无差异。
结论:本研究显示丝线固定,纤维支气管镜与双腔球囊漂浮导管并行气道内置入,球囊充气,封堵和压迫出血支气管疗效确实。丝线固定双腔球囊导管置入的方法较支气管专用导管方法操作时间短、气道刺激性小、导管不易脱位,对患者的生命体征,血气无明显影响,是一种更加简单、安全、价廉和有效的新方法(P>0.05)。
Objective: To evaluate the efficacy and the safety of endobronchial tamponade technique using Swan-Ganz catheter fixed by surgical thread to bronchofibroscope to treat massive hemoptysis, and compare with Fogarty catheter method.
Method
1. clinic data: 30 hemoptysis cases, 9 men and 11 women, their ages are between 24~76 years old, and average age is 54.87±14.34 years old. All patients including 8 bronchiectasis cases, 13 lung cancer cases 6 pulmonary tuberculosis and others such as aspergillomycosis 3 cases。They conform to the following conditions and were picked out for our research: (1) the total hemoptysis quantity was above 300ml in 24 hours or reached 100ml at one time; (2) all the patients were accepted hematostatic treatment for 1 week but had no effect, and accept the treatment with double-lumen balloon floatation catheter or Fogarty catheter voluntarily; (3 )has no serious heart, lung or brain function diseases or disturbance; (4) without obvious contraindications of bronchofibroscope. We divided the 30 patients into two groups randomly: observe group (15 examples) receive endobronchial tamponade technique of Swan-Ganz catheter fixed with bronchofibroscope by thread and control group (15 examples) were treated by endobronchial tamponade technique with Fogarty catheter. The comparison between two groups in some aspects such as age, sex, hemoptysis quantity, hemoglobin quantity and so on have no statistical significance(P>0.05).
2. The method of placing Swan-Ganz catheter: Fix both tips of bronchofibroscope and the Swan-Ganz catheter with surgical thread, insert them tighter from nostril into trachea,suck the blood and find the bleeding site meanwhile. The catheter is pushed forward, place proximal to bleeding site and is inflated with Sodium Chloride until the bronchus is totally blocked up. Then shut the valve, relax the thread and pull out the bronchofibroscope after ensuring no continuous bleeding is observed. Write down the dosage of Sodium Chloride in the balloon and the length of the catheter from the nose, and then fix the catheter on nosewing with a“T”shape adhesive tape.
3. The method of placing Fogarty catheter: Insert the bronchofibroscope from nostril into trachea under local anesthesia; follow the bloodstain in airway and find the bleeding site, then fix the bronchofibroscope. Deliver the balloon catheter daubed Lidocaine gelatin and disinfectant paraffin oil and removal the valve system to the bleeding site accurately through bronchofibroscope working channel, then withdraw the bronchofibroscope slowly, install the valve system. Insert the bronchofibroscope to the bleeding site once more through the oral cavity, after confirming the position of the balloon of catheter; inject Sodium Chloride until the bronchus is totally blocked up in order to stop the hemorrhage. Write down the dosage of Sodium Chloride in the balloon and the length of the catheter from the nose; fix the catheter on nosewing with a“T”shape adhesive tape at last.
Results
1 Curative effect: The majority of patients stop bleeding immediately after the balloon catheter was inserted. observe the bleeding quantity, the time of bleeding continues after tamponade of all the patients and the total days of patients in hospital of two groups, there is no obvious difference between two groups (P>0.05). 15 patients were effective in observe group, the effectiveness is 100% while 13 patients in control group,and the effectiveness is 86.7%,the total effectiveness of massive hemoptysis treated by double-balloon catheter tamponade technique in two groups is 93.3%.
2 The comparison of two groups’operation time: The average operation time on observe group is 8.3±1.0 minutes while the control group is 14.5±2.7 minutes. The average operation time on observe group is obviously shorter than control group, there is statistics difference(P<0.05), but there is no statistics difference(P>0.05) of balloon catheter keeping time on observe group and control group.
3 One patient of inducing or aggravating bleeding during the operation was observed in the observe group while three in control group, there is no statistics difference(P>0.05), the patients of catheter obstructed or dislodged was observed in the observe group were one and four in the control group, there is no statistics difference yet(P>0.05)Although one patient got obstructive pneumonia after the operation in each group, they all cured by antibiotic therapy for 3 to 5 days after the catheter was pulled out.
4 Security of balloon catheter tamponade technique
4.1 The change of vital signs: the patients’heart rate、respiratory frequency before catheter inserted is higher than the patients two hours after the operation, and higher than which after the catheter was pulled out too,there are statistics difference(P<0.05). Patients’temperature before catheter was inserted and two hours after the operation is higher than that after the catheter was pulled out, there is statistics difference(P<0.05). No obvious change of vital signs before catheter was inserted、two hours after the operation and after the catheter was pulled out was observed between two groups, and there is no statistics difference(P>0.05)
4.2 The change of blood gas analysis: Before catheter was inserted、two hours after the operation and after the catheter was pulled out , all the patients’PO2、PCO2、SaO2 measurement results are all in normal range, there is no obvious change(P>0.05), The blood gas analysis comparison between two groups is no obvious before catheter was introduced, two hours after the operation and after the catheter was pulled out, there is no statistics difference(P>0.05)
Conclusion: It is very good for the Massive hemoptysis therapy by the tamponade technique with Swan-Ganz catheter fixed with bronchofibroscope by surgical thread in airway. The operating time used by endobronchial tamponade technique with Swan-Ganz catheter fixed by surgical thread is shorter than the method Fogarty catheter inserted. Also there is no obvious affection to patients’vital signs, blood gas analysis. It is a kind of more convenient, operating easily, more safety and effective method.
引文
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13 Roberts AC. Bronchial artery embolization therapy. J Thorac Imaging 1990; 5:60~72
14 Gimeno PM, Madariaga B, Alfonso AE,et al. Life-threatening hemoptysis: treatment with transcathetere mbolization[J].Arch Bronconeumol, 1999, 35(8): 379~384
15 Mal H,Rullon I,Mellot F,et al.Immediate and long-term results of Bronchial artery embolization for life-threatening hemoptysis [J]. Chest 1999,115(4): 996~1001
16 Barben J, Robertson D, Olinsky A. Bronchial artery embolization for Hemoptysis in young patients with cystic fibrosis [J]. Radiology, 2002, 224(1):124~130
17 Lampmann LE. Control of massive hemoptysis due to pulmonary tuberculosis with bronchial arterial embolization [J].Radiology,1997,204(3):875~876
18 Rabkin JE,Astafjev VI,GothmanL N, et al. Transcatheter Embolization in the management of pulmonary hemorrhage. Radiology,1987,163:361~365
19 Freitag L,Telolf E,Stmatie G, et al .Three years experience with a New balloon catheter for the management ofhemoptysis. EurRespir J. 1994, 7: 2033~2037
20 Ryoichi K, Makoto S, Masafumi K. et al .massive hemoptysis successfully treated by modified bronchoscopic ballon tamponade technique. Chest.1996; 109:842~843
21 王首红, 陈正贤,高兴林.气道内球囊导管置入术治疗呼吸道大咯血.中华结核和呼吸杂志.2000,23(4):252
22 Ryoichi K., Makoto S.,Masafumi K. et al. Massive hepmoptysis successfully treated by modifiled bronchoscopic balloon tamponade technique. Chest, 1996,109:842~843
23 Lee SM, Kim HY, Ahn YS. Parallel Technique of Endobronchial Balloon Catheter Tamponade for Transient Alleviation of Massive Hemoptysis Korean Med Sci.2002, 17(6):823~825
24 HAN YG. Approach to severe side effects of bronchofiberscopy [J]. A caclemic Journal of Jiangsu University (medicine), 2003, 13(2): 140~143. Chinese
25 金发光,钱桂生,谢永宏等.支气管镜介入在长期顽固性咯 血 患 者 治 疗 中 的 作 用 [J] , 中 国 急 救 医 学 ,2005,25(4):245~247
1 邵孝琪主编.现代急诊医学.北京:北京医科大学协和医科大学联合出版社,1997:419~421
2 S Philips, MST Ruttley .Bronchial artery mobilization: The importance of reliminary thoracic autography. Clinical Radiology 2000, 8: 317~319
3 陈敏章,邵丙扬主编 中华内科学.北京:人民卫生出版社,1999
4 Yeoh CB, Hubaytar RT, Ford JM. Treatment of hemorrhage in pulmonary tuberculosis.Thorac Cardio Surg,1967:54:503~510
5 Yoshiyuki ABE,Masato Nakamura, Kuninori Suzuki, et al. Massive hemoptysis due to mycobacterium fortuium infection controlled with bronchial artery embolization---- A case report.Clinical Imaging,1999,23 (6) :361~363
6 Eddy Jean-Baptiste.Clinical aeeseement and management of massive hemoptysis.Crit Care Med,2000,28(5):1642~1647
7 邵孝琪主编.现代急诊医学.北京:北京医科大学协和医科大学联合出版社,1997:419~421
8 Bustaman toⅢ,Garcia-valtuilleR, AgueroR,etal Bronchial embolization in the treatment of hemoptysis Arch bronconeumal 1998Nov, 34(10):479~483
9 Crocco JA,Rooney JJ, Fankushen DS, et al,Massive hemoptysis.Arch Intern Med 1968 121:495~498
10 Roberta Lenner , Gregory J Schilero, Marvin Lesser.Hemoptysis:Diagnosis and management. Comp Ther.2002, 28 (1) 7~14
11 王今达,王正国主编.通用危急病急救医学.天津:天津科技翻译出版公司。2001:855
12 张孟增主编.介入放射学基础与临床.北京:中国科学技术出版社,2001:90~100
13 Cabil BC, Ingbar DM: Massive hepmoptysis [J]. Clim Chest Med, 1999,15(1): 147~150
14 Shibel EM, Moser KM. Resepiratory emergencies 3rd [M] Saintlouris; Moshby Company.1996:308~312
15 李志东. 缩扩血管联合治疗大咯血疗效分析〔J〕.中华临床杂志.2002,2(3):64~65
16 陈炽贤主编.实用放射学 (第二版).北京:人民卫生出版社,1998:288~289
17 Karen L Swanson, C Michael Johnson, Udaya BS Prakash, et al.Bronchial artery embolization ---Experience with 54 patients.Chest.2002, 121(4):789~795
18 张柏秋,孙义新,李淑荣,等.急诊行支气管动脉栓塞治疗大咯血的临床应用.北华大学学报,2001, 2 (1): 52~53
19 李彦豪,李树新 鱼肝油酸钠动脉栓塞的实验研究.中华放射学杂志,1987, 21(6):357~358
20 王家平,袁曙光,门东,等 选择性支气管动脉栓塞治疗急性大咯血实用医学影像杂志,2001, 2 (4): 254~255
21 Ishibara T,Tnoneh H, Kodayashi K, et al. Selective bronchial arteriographt and hemoptysis in nonmalignant lung diseases. Chest, 1974,66(11):633~636
22 刘一之,倪才方,朱晓黎,等.支气管动脉栓塞一灌注法治疗反复咯血的临床研究.临床放射学杂志,2000, 19(12): 794~796
23 CeorgeM Brinson, Peadar G Noone, Matthew A Mauro, et al Bronchial artery embolization for the treatment of hemoptysis in patientswith cystic fibrosis American Journal of respiratory and critical care medicine ,1998,157(10):1951~1958
24 Gineo PM, Madariaga B, Alfonso AE, et al. Life threatening hemoptysis treatment with transcatheter embolization. Arch Bronconemol 1999,35;397~98
25 Karen L Swanson, C Michael Johnson, Udaya BS Prakash, etal. Bronchial artery embolization ---Experience with54 patients.Chest. 2002, 121(4):789~795
26 Herve Mal, lsablle Rullon, Francois Mellot, et al . Immediate and long-trem results of bronchial artery embolization for life-threatening hemoptysis. Chest.1999,115(4):996~1001
27 Hayakawa K,Tanaka F, Torizuka T, et al. ronchial arterembolization for hemopthysis: immediate and long-term results Cardiorase Intervent Radiology , 1992 ,15(2):154~159
28 rakash UB. Advances in bronchoscopic procedures Chest,1999 ,116 (5) :1403~1408
29 Conlan AA, Hurwitz SS. Management of massive hemoptysis with rigid bronchoscope and cold saline lavage. Thorax 1980; 35:901~904
30 Conlan AA, Hurwitz SS, Krige L et al. Massive hemoptysis: review of 123 cases. J Thorac Cardiovasc Surg 1983; 85:120~124
31 王悦德,范丽君,经纤支镜局部灌注凝血酶治疗大咯血的体会 中国医刊 1999,34(6)17~18
32 王广发. 中心气道狭窄的介入治疗[J].中华结核和呼吸杂,2003,26,(7)387~391
33 陈正贤.激光和电热消融术在治疗气道狭窄中的作用[J].中华结核和呼吸杂志,2003,26(7):391~393
34 LEEP KUPELIE, ETHTA AC. Therapeutic bronchoscopy in lung cancer laser therapy, electrocantery, electrocantery, brachy therapy, stents, and photodynamic inc therapy [J]. Clin Chest Med, 2002,23:241~256
35 VERKINDERE C,BRICET A, MANRAGE CA , et al. Morphological changes induced by extensive endobronchial electrosomtery [J]. Eur Respir J,1999,14:796~799
36 Ernst A , Silvestri GA , Johnstone D, et al. Interventional Pulmonary Procedures. Guidelines from the AmericanCollege of Chest Physicians. Chest , 2003 , 123(5) : 1693~1717
37 Reichle G, Freitag L, Kullmann HJ, et al. Argon plasma coagulation in broncholog; a new method-alternative or comlementay? Pneumologe, 2000,54(11):508~516
38 Gage AA: Cryotherapy for cancer. In Rand R, et al(eds): Cryosurgery. Springfild, Ⅲ . Charles C.Thomeas 1968;376~387
39 Walsh DA, et al: Bronchoscope cryotherapy for advanced bronchial carcinoma. Thorax 1990;45:509
40 Homasson JP, et al: Bronchoscope cryotherapy for airway strictures caused by tumors .Chest 1986;90:159
41 Gilbert JC, et al: Real time ultrasonic monitoring of hepatic cryosurgery. Cryobiology 1985;22:319
42 Dumon JF: YAG Laser Bronchoscopy. New York: Praeger Publishers; 1985
43 Beamis JF Jr, Vergos K, Rebeiz EE, Shapshay S: Endoscopic laser therapy for obstructing tracheobronchial lesions. Ann Otol Rhinol Laryngol 1991;100:413~419
44 Cavaliere S Foccoli P, Toninelli C, Feijo S: Nd: YAG laser therapy in lung cancer: An 11-years experience with 2,253 applications in 1,585 patients. J Bronchol 1994;1:105~111
45 马长城.激光内镜治疗大咯血 26 例.中国激光医学杂志。1994 3(5).297~299
46 Hibert CA Balloon catheter control of life-threatening emoptysis. Chest , 974, 6: 308~309
47 EITAG L,FELOLF E,STAMATIE G, et al.Three years experience with a new balloon catheter for the management of haemoptysis[J].Eur Respir J,1994,7:2033~2037
48 Ryoichi K, Makoto S, Masafumi K. et al .massive hemoptysis successfully treated by modified bronchoscopic ballon tamponade technique. Chest. 1996; 109:842-843
49 王首红,陈正贤,高兴林.气道内球囊导管置入术治疗呼吸道大咯血.中华结核和呼吸杂志.2000,23(4):252
50 金普乐,丁翠敏等. 丝线固定双腔球囊漂浮导管气道内置入治疗大咯血六例. 中华结核和呼吸杂志。2006, 29(6):384
51 Lee SM, Kim HY, Ahn YS. Parallel Technique of Endobronchial Balloon Catheter Tamponade for Transient Alleviation of Massive Hemoptysis. Korean Med Sci.2002, 17(6):823~825
52 汤耀东,吴宏成,何一兵等. 双腔支气管导管用于抢救大咯血窒息(附 7 例报告)[J],中国医师杂志,2005,7(5)672
53 Jougon J. Ballester M, Delcambre F, et al. Massive hemoptysis , what place for medical and surgical treatment [J]. Eur J Cardiothorac sug,2002,22(3),345~351
2 汤耀东,吴宏成,何一兵等. 双腔支气管导管用于抢救大咯血窒息(附 7 例报告)[J],中国医师杂志,2005,7(5)672
3 Hiebert CA. Balloon catheter control of life-threatening emoptysis.Chest,7974,66:308~309
4 FREITAG L,FELOLF E,STAMATIE G, et al.Three years experience with a new balloon catheter for the management of haemoptysis[J].Eur Respir J,1994,7:2033~2037
5 陈敏章,邵丙扬主编,中华内科学.北京:人民卫生出版社,1999
6 陈正贤主编,介入性肺病学.北京:人民卫生出版社,2004
7 邵孝琪主编.现代急诊医学.北京:北京医科大学协和医科大学联合出版社,1997:419~421
8 Crocco. JA, Rooney JJ, Fankushen DS,DiBenedetto RJ, Lyons HA. Massive hemoptysis. Arch Intern Med 1968;[2]: 495~498
9 Sehhat S, Oreizie M, Moinedine K. Massive pulmonary hemorrhage: surgical approach as a choice of treatment. Ann Thorac Surg 1978; 25:12~15
10 Knott-Craig CJ ,Oostuizen G,Rossouw G, etal. Management and prognosis of massive hemoptysis: recent experience with120 patients. J Thorac Cardiovasc Surg 1993; 105:394~397
11 Jougon J. Ballester M, Delcambre F, et al. Massive hemoptysis, what place for medical and surgical treatment [J]. Eur J Cardiothorac sug,2002,22(3),345~351
12 Gineo PM, Madariaga B, Alfonso AE, etal. Lifethreatening hemoptysis treatment with transcatheter embolization. Arch Bronconemol 1999,35;379~384
13 Roberts AC. Bronchial artery embolization therapy. J Thorac Imaging 1990; 5:60~72
14 Gimeno PM, Madariaga B, Alfonso AE,et al. Life-threatening hemoptysis: treatment with transcathetere mbolization[J].Arch Bronconeumol, 1999, 35(8): 379~384
15 Mal H,Rullon I,Mellot F,et al.Immediate and long-term results of Bronchial artery embolization for life-threatening hemoptysis [J]. Chest 1999,115(4): 996~1001
16 Barben J, Robertson D, Olinsky A. Bronchial artery embolization for Hemoptysis in young patients with cystic fibrosis [J]. Radiology, 2002, 224(1):124~130
17 Lampmann LE. Control of massive hemoptysis due to pulmonary tuberculosis with bronchial arterial embolization [J].Radiology,1997,204(3):875~876
18 Rabkin JE,Astafjev VI,GothmanL N, et al. Transcatheter Embolization in the management of pulmonary hemorrhage. Radiology,1987,163:361~365
19 Freitag L,Telolf E,Stmatie G, et al .Three years experience with a New balloon catheter for the management ofhemoptysis. EurRespir J. 1994, 7: 2033~2037
20 Ryoichi K, Makoto S, Masafumi K. et al .massive hemoptysis successfully treated by modified bronchoscopic ballon tamponade technique. Chest.1996; 109:842~843
21 王首红, 陈正贤,高兴林.气道内球囊导管置入术治疗呼吸道大咯血.中华结核和呼吸杂志.2000,23(4):252
22 Ryoichi K., Makoto S.,Masafumi K. et al. Massive hepmoptysis successfully treated by modifiled bronchoscopic balloon tamponade technique. Chest, 1996,109:842~843
23 Lee SM, Kim HY, Ahn YS. Parallel Technique of Endobronchial Balloon Catheter Tamponade for Transient Alleviation of Massive Hemoptysis Korean Med Sci.2002, 17(6):823~825
24 HAN YG. Approach to severe side effects of bronchofiberscopy [J]. A caclemic Journal of Jiangsu University (medicine), 2003, 13(2): 140~143. Chinese
25 金发光,钱桂生,谢永宏等.支气管镜介入在长期顽固性咯 血 患 者 治 疗 中 的 作 用 [J] , 中 国 急 救 医 学 ,2005,25(4):245~247
1 邵孝琪主编.现代急诊医学.北京:北京医科大学协和医科大学联合出版社,1997:419~421
2 S Philips, MST Ruttley .Bronchial artery mobilization: The importance of reliminary thoracic autography. Clinical Radiology 2000, 8: 317~319
3 陈敏章,邵丙扬主编 中华内科学.北京:人民卫生出版社,1999
4 Yeoh CB, Hubaytar RT, Ford JM. Treatment of hemorrhage in pulmonary tuberculosis.Thorac Cardio Surg,1967:54:503~510
5 Yoshiyuki ABE,Masato Nakamura, Kuninori Suzuki, et al. Massive hemoptysis due to mycobacterium fortuium infection controlled with bronchial artery embolization---- A case report.Clinical Imaging,1999,23 (6) :361~363
6 Eddy Jean-Baptiste.Clinical aeeseement and management of massive hemoptysis.Crit Care Med,2000,28(5):1642~1647
7 邵孝琪主编.现代急诊医学.北京:北京医科大学协和医科大学联合出版社,1997:419~421
8 Bustaman toⅢ,Garcia-valtuilleR, AgueroR,etal Bronchial embolization in the treatment of hemoptysis Arch bronconeumal 1998Nov, 34(10):479~483
9 Crocco JA,Rooney JJ, Fankushen DS, et al,Massive hemoptysis.Arch Intern Med 1968 121:495~498
10 Roberta Lenner , Gregory J Schilero, Marvin Lesser.Hemoptysis:Diagnosis and management. Comp Ther.2002, 28 (1) 7~14
11 王今达,王正国主编.通用危急病急救医学.天津:天津科技翻译出版公司。2001:855
12 张孟增主编.介入放射学基础与临床.北京:中国科学技术出版社,2001:90~100
13 Cabil BC, Ingbar DM: Massive hepmoptysis [J]. Clim Chest Med, 1999,15(1): 147~150
14 Shibel EM, Moser KM. Resepiratory emergencies 3rd [M] Saintlouris; Moshby Company.1996:308~312
15 李志东. 缩扩血管联合治疗大咯血疗效分析〔J〕.中华临床杂志.2002,2(3):64~65
16 陈炽贤主编.实用放射学 (第二版).北京:人民卫生出版社,1998:288~289
17 Karen L Swanson, C Michael Johnson, Udaya BS Prakash, et al.Bronchial artery embolization ---Experience with 54 patients.Chest.2002, 121(4):789~795
18 张柏秋,孙义新,李淑荣,等.急诊行支气管动脉栓塞治疗大咯血的临床应用.北华大学学报,2001, 2 (1): 52~53
19 李彦豪,李树新 鱼肝油酸钠动脉栓塞的实验研究.中华放射学杂志,1987, 21(6):357~358
20 王家平,袁曙光,门东,等 选择性支气管动脉栓塞治疗急性大咯血实用医学影像杂志,2001, 2 (4): 254~255
21 Ishibara T,Tnoneh H, Kodayashi K, et al. Selective bronchial arteriographt and hemoptysis in nonmalignant lung diseases. Chest, 1974,66(11):633~636
22 刘一之,倪才方,朱晓黎,等.支气管动脉栓塞一灌注法治疗反复咯血的临床研究.临床放射学杂志,2000, 19(12): 794~796
23 CeorgeM Brinson, Peadar G Noone, Matthew A Mauro, et al Bronchial artery embolization for the treatment of hemoptysis in patientswith cystic fibrosis American Journal of respiratory and critical care medicine ,1998,157(10):1951~1958
24 Gineo PM, Madariaga B, Alfonso AE, et al. Life threatening hemoptysis treatment with transcatheter embolization. Arch Bronconemol 1999,35;397~98
25 Karen L Swanson, C Michael Johnson, Udaya BS Prakash, etal. Bronchial artery embolization ---Experience with54 patients.Chest. 2002, 121(4):789~795
26 Herve Mal, lsablle Rullon, Francois Mellot, et al . Immediate and long-trem results of bronchial artery embolization for life-threatening hemoptysis. Chest.1999,115(4):996~1001
27 Hayakawa K,Tanaka F, Torizuka T, et al. ronchial arterembolization for hemopthysis: immediate and long-term results Cardiorase Intervent Radiology , 1992 ,15(2):154~159
28 rakash UB. Advances in bronchoscopic procedures Chest,1999 ,116 (5) :1403~1408
29 Conlan AA, Hurwitz SS. Management of massive hemoptysis with rigid bronchoscope and cold saline lavage. Thorax 1980; 35:901~904
30 Conlan AA, Hurwitz SS, Krige L et al. Massive hemoptysis: review of 123 cases. J Thorac Cardiovasc Surg 1983; 85:120~124
31 王悦德,范丽君,经纤支镜局部灌注凝血酶治疗大咯血的体会 中国医刊 1999,34(6)17~18
32 王广发. 中心气道狭窄的介入治疗[J].中华结核和呼吸杂,2003,26,(7)387~391
33 陈正贤.激光和电热消融术在治疗气道狭窄中的作用[J].中华结核和呼吸杂志,2003,26(7):391~393
34 LEEP KUPELIE, ETHTA AC. Therapeutic bronchoscopy in lung cancer laser therapy, electrocantery, electrocantery, brachy therapy, stents, and photodynamic inc therapy [J]. Clin Chest Med, 2002,23:241~256
35 VERKINDERE C,BRICET A, MANRAGE CA , et al. Morphological changes induced by extensive endobronchial electrosomtery [J]. Eur Respir J,1999,14:796~799
36 Ernst A , Silvestri GA , Johnstone D, et al. Interventional Pulmonary Procedures. Guidelines from the AmericanCollege of Chest Physicians. Chest , 2003 , 123(5) : 1693~1717
37 Reichle G, Freitag L, Kullmann HJ, et al. Argon plasma coagulation in broncholog; a new method-alternative or comlementay? Pneumologe, 2000,54(11):508~516
38 Gage AA: Cryotherapy for cancer. In Rand R, et al(eds): Cryosurgery. Springfild, Ⅲ . Charles C.Thomeas 1968;376~387
39 Walsh DA, et al: Bronchoscope cryotherapy for advanced bronchial carcinoma. Thorax 1990;45:509
40 Homasson JP, et al: Bronchoscope cryotherapy for airway strictures caused by tumors .Chest 1986;90:159
41 Gilbert JC, et al: Real time ultrasonic monitoring of hepatic cryosurgery. Cryobiology 1985;22:319
42 Dumon JF: YAG Laser Bronchoscopy. New York: Praeger Publishers; 1985
43 Beamis JF Jr, Vergos K, Rebeiz EE, Shapshay S: Endoscopic laser therapy for obstructing tracheobronchial lesions. Ann Otol Rhinol Laryngol 1991;100:413~419
44 Cavaliere S Foccoli P, Toninelli C, Feijo S: Nd: YAG laser therapy in lung cancer: An 11-years experience with 2,253 applications in 1,585 patients. J Bronchol 1994;1:105~111
45 马长城.激光内镜治疗大咯血 26 例.中国激光医学杂志。1994 3(5).297~299
46 Hibert CA Balloon catheter control of life-threatening emoptysis. Chest , 974, 6: 308~309
47 EITAG L,FELOLF E,STAMATIE G, et al.Three years experience with a new balloon catheter for the management of haemoptysis[J].Eur Respir J,1994,7:2033~2037
48 Ryoichi K, Makoto S, Masafumi K. et al .massive hemoptysis successfully treated by modified bronchoscopic ballon tamponade technique. Chest. 1996; 109:842-843
49 王首红,陈正贤,高兴林.气道内球囊导管置入术治疗呼吸道大咯血.中华结核和呼吸杂志.2000,23(4):252
50 金普乐,丁翠敏等. 丝线固定双腔球囊漂浮导管气道内置入治疗大咯血六例. 中华结核和呼吸杂志。2006, 29(6):384
51 Lee SM, Kim HY, Ahn YS. Parallel Technique of Endobronchial Balloon Catheter Tamponade for Transient Alleviation of Massive Hemoptysis. Korean Med Sci.2002, 17(6):823~825
52 汤耀东,吴宏成,何一兵等. 双腔支气管导管用于抢救大咯血窒息(附 7 例报告)[J],中国医师杂志,2005,7(5)672
53 Jougon J. Ballester M, Delcambre F, et al. Massive hemoptysis , what place for medical and surgical treatment [J]. Eur J Cardiothorac sug,2002,22(3),345~351