本文選題：咯血 + TAE�。� 參考：《山西醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的強(qiáng)調(diào)責(zé)任NBSA(nonbr onchi al systemic arteries,非支氣管性體動(dòng)脈)的發(fā)現(xiàn)與栓塞對(duì)咯血治療的意義,分析責(zé)任NBSA與病變側(cè)胸膜增厚是否有相關(guān)性,以提示有無責(zé)任NBSA的存在,提高咯血治療的療效。 方法收集自2008年11月至2013年4月就診于我院急診科或呼吸科,為治療咯血入我科行介入治療的40例患者。統(tǒng)計(jì)咯血患者中責(zé)任NBSA出現(xiàn)的情況及胸膜增厚的情況,分析責(zé)任NBSA的出現(xiàn)與胸膜增厚的有無相關(guān)性。 結(jié)果 1.40名咯血患者,其中男30例,女10例；年齡60歲-80歲,平均年齡70.5歲；術(shù)前40名患者行胸部CT檢查提示胸膜增厚有15人,介入治療的過程中行系統(tǒng)性的胸主動(dòng)脈和(或)鎖骨下動(dòng)脈造影發(fā)現(xiàn)：其中9例咯血與病理性NBSA(合計(jì)13支)有關(guān)。患者原發(fā)病為：肺癌4例；支氣管擴(kuò)張18例；隱原性咯血14例,；肺結(jié)核4例(2例行結(jié)核球肺葉切除術(shù)；2例行抗結(jié)核藥物治療)。于術(shù)中通過對(duì)咯血患者責(zé)任BA與NBSA的栓塞：其中34例患者術(shù)后咯血停止；4例患者在病變血管栓塞后仍有少量的咯血,經(jīng)內(nèi)科保守治療后咯血停止；1例患者經(jīng)栓塞病變血管后,與1周內(nèi)再次出現(xiàn)咯血情況,行第二次TAE治療,術(shù)后咯血情況好轉(zhuǎn)(造影時(shí)發(fā)現(xiàn)已栓塞的責(zé)任血管再通)；1例病人因原發(fā)病治療無效,死亡。 2.對(duì)責(zé)任NBSA出現(xiàn)的情況及胸膜增厚的發(fā)出情況的關(guān)系采用卡方檢驗(yàn),從分析結(jié)果可以看出,責(zé)任NBSA的出現(xiàn)于胸膜增厚之間是相關(guān)的。胸膜增厚可提示有責(zé)任血管的出現(xiàn),責(zé)任血管通常是通過增厚的胸膜參與咯血的供血。 結(jié)論 1. NBSA的未進(jìn)行栓塞常常是咯血治療效果欠佳及短期內(nèi)再次復(fù)發(fā)的潛在的危險(xiǎn)因素,因此NBSA的發(fā)現(xiàn)與栓塞對(duì)于TAE治療咯血起著重要作用,責(zé)任NBSA的發(fā)現(xiàn)使選擇性插管有地放失,栓塞提高咯血的治療效果的同時(shí)減少了咯血復(fù)發(fā)的幾率,避免了短期內(nèi)2次治療的情況�？傊�,引起咯血的因素很多,咯血的責(zé)任血管同樣很復(fù)雜,因此栓塞責(zé)任血管對(duì)于止血治療有決定性意義。 2.胸膜增厚與咯血的責(zé)任NBSA的出現(xiàn)有一定的相關(guān)性,因此發(fā)現(xiàn)咯血患者病變側(cè)胸膜增厚時(shí),(1)考慮BA栓塞后,有責(zé)任NBSA參與咯血的血供可能；(2)BA造影未見異常時(shí),有NBSA參與供血的可能。即胸膜增厚不一定全伴有責(zé)任NBSA的出現(xiàn),但責(zé)任NBSA的出現(xiàn)卻往往伴有胸膜的增厚。
[Abstract]:Objective to emphasize the significance of finding and embolization of responsible NBSA-nonbr onchi al systemic arteries, for hemoptysis, and to analyze whether there is a correlation between responsible NBSA and pleural thickening of diseased side, so as to indicate the existence of responsible NBSA and improve the curative effect of hemoptysis. Methods from November 2008 to April 2013, 40 patients with hemoptysis were treated by interventional therapy in emergency department or respiratory department of our hospital. The occurrence of responsible NBSA and pleural thickening in hemoptysis patients were analyzed and the correlation between the occurrence of responsible NBSA and pleural thickening was analyzed. Results 1.Forty patients with hemoptysis, including 30 males and 10 females, aged from 60 to 80 years, with an average age of 70.5 years, 15 patients with pleural thickening were examined by chest CT before operation. Systematic angiography of thoracic aorta and / or subclavian artery during interventional therapy revealed that 9 cases of hemoptysis were associated with pathological NBSA (13 branches). The primary diseases were lung cancer (n = 4), bronchiectasis (n = 18), cryptogenic hemoptysis (n = 14), pulmonary tuberculosis (n = 4) and pulmonary tuberculectomy (n = 2). After operation, 34 patients with hemoptysis stopped hemoptysis and 4 patients still had a small amount of hemoptysis after vascular embolization, and hemoptysis stopped after conservative medical treatment. Hemoptysis occurred again in one patient after embolization of the diseased blood vessels and within 1 week. After the second Tae treatment, hemoptysis was improved after operation (one patient was found to have been embolized by recanalization of the responsible blood vessel when the angiography was performed, and 1 patient had no effect on the treatment of the primary disease. Death. 2. Chi-square test was used to analyze the relationship between the occurrence of responsible NBSA and the appearance of pleural thickening. From the analysis results, we can see that the appearance of responsible NBSA is related to pleural thickening. Pleural thickening may indicate the presence of responsible blood vessels, which are usually involved in hemoptysis by thickening the pleura. Conclusion 1. The non-embolization of NBSA is often a potential risk factor for the treatment of hemoptysis and recurrence in a short period of time. Therefore, the discovery and embolization of NBSA plays an important role in the treatment of hemoptysis. Embolization improves the effect of hemoptysis and reduces the chance of recurrence of hemoptysis. In short, there are many factors causing hemoptysis, hemoptysis responsible blood vessels are also very complex, so embolization responsible blood vessels for hemostatic treatment is decisive. 2. 2. There is a certain correlation between pleural thickening and the occurrence of the responsible NBSA for hemoptysis. Therefore, it is found that in hemoptysis patients, when pleural thickening occurs on the side of pleural thickening, the responsible NBSA may be involved in the blood supply of hemoptysis when there is no abnormality in hemoptysis. NBSA may be involved in blood supply. That is, pleural thickening is not always accompanied by the appearance of responsible NBSA, but the appearance of responsible NBSA is often accompanied by pleural thickening.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R56

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 劉航,鮑潤賢;支氣管動(dòng)脈造影[J];國外醫(yī)學(xué)(臨床放射學(xué)分冊);1984年01期

2 鄧偉吾;出血病灶不明的致死性大咯血的緊急處理[J];實(shí)用內(nèi)科雜志;1989年01期

3 于紅;李惠民;肖湘生;劉士遠(yuǎn);李成洲;陶曉峰;;支氣管動(dòng)脈CT血管成像三維解剖學(xué)研究[J];中華放射學(xué)雜志;2006年04期

4 王茂強(qiáng);劉鳳永;段峰;宋鵬;王志軍;王仲樸;;膈下動(dòng)脈參與供血的肺部出血性疾病的診斷及介入治療[J];中華放射學(xué)雜志;2007年10期

5 ;肺結(jié)核手術(shù)適應(yīng)證標(biāo)準(zhǔn)（試行方案）[J];中華結(jié)核和呼吸雜志;1994年02期

，

本文編號(hào)：2035205