Diagnosis and Treatment of Hemoptysis
Diagnosis and Treatment of Hemoptysis
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DOI：
10.1016/j.arbres.2015.12.002
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发表时间：
2016-07-01
影响因子：
8
通讯作者：
Jimenez Merchan, Rafael
中科院分区：
文献类型：
--
作者：
Cordovilla, Rosa;Bollo de Miguel, Elena;Jimenez Merchan, Rafael
咯血是从气管、支气管树排出的血液。它通常由支气管扩张、慢性支气管炎和肺癌引起。咳出的血通常来自支气管动脉。当怀疑咯血时，必须确认并按严重程度分类，并确定出血的来源和原因。侧位和AP胸片是第一项研究，尽管正常的胸片不能排除恶性肿瘤或其他潜在病理的可能性。所有有咯血、咯血、怀疑有支气管扩张或肺癌危险因素的患者，以及胸部X线片有病理征象的患者，都必须进行多层计算机体层摄影(MDCT)。多层螺旋CT血管造影术已经取代了动脉造影术，用来识别出血的来源动脉。多层螺旋CT血管造影术是一种非侵入性成像技术，可以精确定位全身胸腔(支气管和非支气管性)和肺动脉出血源的存在、来源、数量和进程。血管内栓塞术是治疗大咯血或反复咯血最安全、最有效的方法。所有有危及生命或反复咯血的患者，如MDCT血管造影显示有动脉疾病，均需行栓塞术。纤维支气管镜在咯血或咯血患者的咯血诊断中起着关键作用。该程序可以在床边(重症监护病房)快速进行；它可以用于立即控制出血，也可以有效地定位出血的来源。柔性支气管镜检查是血液动力学不稳定、有危及生命的咯血患者首选的一线检查方法，其中控制出血至关重要。在这些情况下，手术与极高的死亡率相关，目前仅当出血是手术后的继发性出血并且其来源可以准确和可靠地定位时才被指征。(C)2016年SEPAR。由Elsevier Espana，S.L.U出版。版权所有。
Hemoptysis is the expectoration of blood from the tracheobronchial tree. It is commonly caused by bronchiectasis, chronic bronchitis, and lung cancer. The expectorated blood usually originates from the bronchial arteries. When hemoptysis is suspected, it must be confirmed and classified according to severity, and the origin and cause of the bleeding determined. Lateral and AP chest X-ray is the first study, although a normal chest X-ray does not rule out the possibility of malignancy or other underlying pathology. Multidetector computed tomography (MDCT) must be performed in all patients with frank hemoptysis, hemoptoic sputum, suspicion of bronchiectasis or risk factors for lung cancer, and in those with signs of pathology on chest X-ray. MDCT angiography has replaced arteriography in identifying the arteries that are the source of bleeding. MDCT angiography is a non-invasive imaging technique that can pinpoint the presence, origin, number and course of the systemic thoracic (bronchial and non-bronchial) and pulmonary arterial sources of bleeding. Endovascular embolization is the safest and most effective method of managing bleeding in massive or recurrent hemoptysis. Embolization is indicated in all patients with life-threatening or recurrent hemoptysis in whom MDCT angiography shows artery disease. Flexible bronchoscopy plays a pivotal role in the diagnosis of hemoptysis in patients with hemoptoic sputum or frank hemoptysis. The procedure can be performed rapidly at the bedside (intensive care unit); it can be used for immediate control of bleeding, and is also effective in locating the source of the hemorrhage. Flexible bronchoscopy is the first-line procedure of choice in hemodynamically unstable patients with life-threatening hemoptysis, in whom control of bleeding is of vital importance. In these cases, surgery is associated with an extremely high mortality rate, and is currently only indicated when bleeding is secondary to surgery and its source can be accurately and reliably located. (C) 2016 SEPAR. Published by Elsevier Espana, S.L.U. All rights reserved.