Bronchial artery embolization for the treatment of hemoptysis in patients with cystic fibrosis
Bronchial artery embolization for the treatment of hemoptysis in patients with cystic fibrosis
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DOI：
10.1164/ajrccm.157.6.9708067
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发表时间：
1998-06-01
影响因子：
24.7
通讯作者：
Jaques, PF
中科院分区：
文献类型：
--
作者：
Brinson, GM;Noone, PG;Jaques, PF
咯血在囊性纤维化（CF）患者中很常见。出血的严重程度可能不同，从痰中的轻微血痕到咳出大量的血。大咯血，定义为出血大于240 ml/24 h，代表医疗紧急情况。支气管动脉栓塞（BAE）是咯血的治疗选择之一。我们回顾了北卡罗来纳州大学医院使用BAE治疗咯血的10年经验。18例CF患者住院29次，接受了36次BAE手术以控制咯血。大多数患者（n = 11）患有非常严重的肺部疾病（FEV 1 < 35%），多重耐药细菌的发生率较高（n = 9，50%）。对15例患者（n = 33例手术）进行了随访，平均随访时间与BAE后22个月相似。BAE初始控制咯血的总体有效性在1次治疗后为75%（n = 22），2次治疗后为89%（n = 26），3次治疗后为93%（n = 27）。每次发作的总复发率为46%（4例患者中有12/26例），平均复发时间为12个月。在既往接受过BAE的患者（n = 7）中，非支气管系统侧支血管出血的发生率较高（75%）。尽管有BAE，但仍有2例死亡与大咯血相关。3例患者在BAE期间出现一过性神经功能缺损。我们得出的结论是，BAE是治疗CF患者严重咳血的一种相对安全有效的方法。
Hemoptysis is common in patients with cystic fibrosis (CF). Bleeding may vary in severity, ranging from minor blood-streaking of sputum to expectoration of significant quantities of blood. Major hemoptysis, defined as bleeding greater than 240 ml/24 h, represents a medical emergency. Bronchial artery embolization (BAE) is one of the treatment options for hemoptysis. We reviewed the 10-yr experience at the University of North Carolina Hospitals in the treatment of hemoptysis by BAE. Eighteen patients with CF were hospitalized on 29 occasions and underwent 36 BAE procedures for the control of hemoptysis. Most patients (n = 11) had very severe lung disease (FEV1 < 35%) with a high incidence (n = 9, 50%) of multi-drug-resistant bacteria. Fifteen patients (n = 33 procedures) were followed for a mean of similar to 22 mo after BAE. The overall efficacy of BAE for initial control of hemoptysis was 75% (n = 22) after one session, 89% (n = 26) after two sessions, and 93% (n = 27) after three sessions. The overall recurrence rate per episode was 46% (12/26 presentations in four patients) with a mean time for recurrence of similar to 12 mo. There was a high incidence (75%) of bleeding from nonbronchial systemic collateral vessels among patients (n = 7) who had undergone a previous BAE. There were two deaths associated with massive hemoptysis despite BAE. Three patients had transient neurologic deficits during BAE. We concluded that BAE is a relatively safe and effective means of treating significant hemoptysis in patients with CF.