21:19,26,Apr,2008 | (1056/0/0) | Original

differential diagnosis of hemoptysis


58 Beautiful like angels
1st floor documentation - medical books - Physical Diagnosis
Section hemoptysis
Hemoptysis is the following respiratory bleeding throat, the cough, discharge from the mouth.
First, the common causes
(A) of the bronchial disease is common in bronchiectasis, lung cancer, endobronchial tuberculosis, bronchitis, bronchial calculus bronchial foreign body.
(B) of the lung disease is common in tuberculosis, lung abscess, pneumonia, pulmonary embolism, lung fluke.
(C) the most common cardiovascular disease in patients with rheumatic mitral stenosis and left heart failure, due to pulmonary hemoptysis caused by depression of blood, blood less. The bronchial submucosa ruptured varicose veins caused by the hemoptysis, the blood more. Pulmonary vein and collateral circulation between bronchial vein, due to the elevated pulmonary venous pressure caused a small vein pressure is increased bronchial submucosa, so as to cause varicose and rupture, bleeding more acute. Some congenital heart disease such as atrial septal defect, patent ductus arteriosus, etc., causing pulmonary hypertension, hemoptysis may also occur.
(D) systemic disease
1. Blood diseases such as ITP, leukemia, hemophilia.
2. Acute infectious disease common in leptospirosis, epidemic hemorrhagic fever.
3. Others, such as connective tissue disease, alternative menstruation.
Second, the inquiry points
Hemoptysis should be noted that the incentive amount, color, inclusions, hemoptysis, and associated symptoms before and after the situation.
(A) detail about incentives, habits and past history, can provide diagnostic clues. If patients have hemoptysis history of eating raw stone crabs, fluke disease should be considered possible.
(B) the amount of hemoptysis hemoptysis can be divided into the amount of bloody sputum, a small amount of hemoptysis (daily hemoptysis less than 100ML), moderate hemoptysis (daily haemoptysis volume of 100 - 500ML), hemoptysis (blood 500ML per day above) the amount of hemoptysis and respiratory often related to vascular rupture. Blood stained sputum or small blood clots, and more lesions in the mucosa or increased capillary permeability, blood oozing caused by massive hemoptysis, can be due to the small airways due to aneurysm rupture or pulmonary venous hypertension caused by endobronchial varices.
Third, the differential diagnosis
Hemoptysis to be with the mouth, pharynx, nose bleeding identified. Oral and pharyngeal bleeding easily observed local hemorrhage. Nasal bleeding nose out of the past, often found in the nasal septum before the bottom of hemorrhage, diagnosis easier. Posterior nasal bleeding is sometimes more, may be misdiagnosed as hemoptysis, such as the use nasopharyngoscopy see blood from the nose along the pharyngeal wall after the dirty, can be confirmed. Massive hemoptysis and hematemesis must (upper gastrointestinal bleeding) phase identification (see hemoptysis).
Fourth, wi
th symptoms
(A) hemoptysis with fever seen in tuberculosis, pneumonia, pulmonary hemorrhagic leptospirosis, epidemic hemorrhagic fever, bronchial and lung cancer.
(B) hemoptysis with chest pain seen in lobar pneumonia, pulmonary infarction, pulmonary tuberculosis, bronchial and lung cancer.
(C) can be found in sputum slightly abscess sepsis, cavitary pulmonary tuberculosis, bronchiectasis, and so on. There are no bronchiectasis sputum were repeated hemoptysis, this type is called dry bronchiectasis.
(D) can be found in cough with hemoptysis, lung cancer, mycoplasma pneumonia.
(E) skin and mucous membrane bleeding associated with hemoptysis should be noted that hemorrhagic fever, blood disease.
(F) hemoptysis with pulmonary embolism should be noted jaundice, leptospirosis.
(Wang Lin)
2006-2-23 16:57 Reply
differential diagnosis of hemoptysis

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List of phonetic alias disease disease disease disease classification code description of symptoms and signs of disease, an overview of causes of disease pathophysiology diagnosis treatment diagnostic prognosis and prevention of complications, prompt epidemiological literature in particular phonetic
dà gē xuè alias disease
Hemoptysis, hemoptysis
Disease code
ICD: R04.2 Classification of Diseases
Overview of Respiratory Medicine, Diseases
Glottis lower respiratory tract or lung tissue bleeding, oral discharge are referred to as "hemoptysis" (Hemoptysis). Its performance can be a lot of bloody sputum or hemoptysis. 1 hemoptysis of more than 1100ml. Shock may occur, but no matter how much the amount of hemoptysis, can cause choking, suffocation is the leading cause of death in massive one. Disease Description
Glottis lower respiratory tract or lung tissue bleeding, oral discharge are referred to as "hemoptysis" (Hemoptysis). Its performance can be a lot of bloody sputum or hemoptysis. Therefore, based on the patient's clinical hemoptysis often and how much, to be divided: a small amount of hemoptysis, hemoptysis, and moderate hemoptysis. Due to the current lack of a unified international classification criteria, so each of the definition of massive hemoptysis are also different. Hemoptysis usually means: 1 hemoptysis of more than 100ml, or hemoptysis more than 600ml in 24h or more. Needs to be emphasized is that for the severity of hemoptysis patients to judge, should not be too rigidly adhere to the amount of hemoptysis, but should be combined with the patient's general condition, including nutritional status, complexion, pulse, respiration, blood pressure and whether cyanosis, etc., a comprehensive judgments. For those long illness or old age and frail weak cough, even if a small amount of hemoptysis may also result in the patient choked to death, so these patients treatment should be in accordance with the principles of massive hemoptysis treatment. Symptoms and signs
Repeated hemoptysis can be as long as several years or decades, in varying degrees, from a small amount of bloody sputum to massive hemoptysis varies the amount and severity of hemoptysis is sometimes inconsistent. Some patients are usually no cough, sputum and other respiratory symptoms to repeated hemoptysis as the main performance. Cause disease
There are two groups of lung blood vessels, namely the pulmonary circulation and bronchial circulation. Cone in the right ventricle from the pulmonary artery and its branches for the low-pressure system, providing about 95% of the lung blood supply. Bronchial arteries from the bottom of the aorta, the high-pressure systems, generally to about 5% of lung blood, the main airway and support structure to the blood supply. According to statistics, of which 90% of patients with massive hemoptysis from bronchial circulation of bleeding, and bleeding from the pulmonary circulation accounted for only about 10%. Currently known to cause disease hemoptysis of nearly 100 species. According to their anatomical differences can be divided into four categories, namely: â‘  trachea, bronchial disorders; â‘¡ lung disease; â‘¢ cardiovascular disorders; â‘£ systemic disease. According to a recent surgical series of integrated studies in the common cause, the cause of the common causes of hemoptysis were: â‘  bronchiectasis (about 30%); â‘¡ lung cancer (about 20%); â‘¢ tuberculosis (about 15% ~ 20%). Pathophysiology
Hemoptysis due to bronchial and surrounding tissue caused by inflammation of bronchial obstruction and bronchial wall damage and luminal expansion, deformation, often accompanied by telangiectasia or bronchial artery and pulmonary artery branch network expansion and other late match, the formation of aneurysm rupture, it can be repeated massive hemoptysis. Diagnostic tests
Diagnosis: general medical history and physical examination as well as through the above check, the cause of hemoptysis can be made more accurate diagnosis. Hemoptysis often part of clinical manifestations of systemic diseases, comprehensive, and detailed physical examination will help diagnose the cause of hemoptysis.
Laboratory tests:
1. Hematology WBC often increased during inflammation, and a left shift. If there are naive white blood cells of leukemia should be considered possible. Increased eosinophils have often prompted the possibility of parasitic disease. Have bleeding disorders, should determine the coagulation time, prothrombin time and platelet count, etc., necessary for bone marrow examination.
2. Sputum examination by sputum smear and culture, finding common pathogens, Mycobacterium tuberculosis, fungi, parasites and tumor cells such as eggs.
Other laboratory examinations:
1. Chest X-ray examination of chest X-ray diagnosis of hemoptysis is significant, it should be as routine examination. Requires multiple position projection, if necessary, should be added according to former arch-bit, point sheets and radiographs. Appears on the chest hair-like distribution along the bronchial shadows, and more tips bronchiectasis; fluid level more common in lung abscess; substantive give more consideration to lung cancer lesions. It should be noted that the massive bleeding in the lesion of blood near the airway can be inhaled, can lead to alveolar filling an aerosol, the formation of blood aspiration pneumonia. Substantial in the early lung lesions easily confused with, but blood aspiration pneumonia often absorbed within 1 week, it again will help both identify ray film.
2. Chest CT is a non-invasive examination of pulmonary dysfunction is more secure. However, patients with massive hemoptysis of activity should normally be carried out in hemoptysis stopped. Compared with ordinary X-ray, in that overlap with the heart and hilar vascular lesions and other aspects of local small lesions, CT examination has its unique advantages. In terms of evaluating patients with stable bronchiectasis, chest CT has replaced the bronchial angiography. A study abroad, CT of cystic bronchiectasis in the sensitivity of 100%, the sensitivity of the cylindrical bronchiectasis was 94%; specificity was 100%. Influenced by the prices, the current patients with massive hemoptysis, chest CT is still only as second-line inspection program.
3. Bronchoscopy for diagnosis of unclear etiology of hemoptysis, or bleeding after conservative medical treatment ineffective, currently stand at more than during the early implementation of hemoptysis bronchoscopy. It is based on:
(1) early implementation of bronchoscopy can be more accurately determine the site of bleeding.
(2) can significantly increase the diagnostic accuracy rate of the cause of hemoptysis.
(3) for the treatment provide the basis for the selection and implementation (such as surgery, bronchial artery embolization, etc.).
(4) can be carried out directly on the bleeding site localized bleeding.
The type of bronchoscope rigid bronchoscopy can be divided and can be bent bronchoscopy (ie, bronchoscopy). Usually more like surgeons use rigid bronchoscopy, and lung practitioners are more preferred bronchoscopy. In comparison, bronchoscopy is a simple, no general anesthesia, wide visible region and damage etc, and it has been widely used clinically. However, once the bleeding of more than ability to attract bronchoscopy, or recurring blood clots bronchoscope contamination and clogging, etc., should use rigid bronchoscopy to be checked. Tracheal intubation or given to prevent excessive bleeding caused by suffocation, but also for attracting bronchoscope lumen or peripheral blood clot blocked by cleaning and re-entry after the withdrawal. It should be emphasized, hemoptysis during bronchoscopy with a certain risk. So, check before to make the necessary preparations to rescue, especially for choking rescue. Also note the inspection process of the oxygen and electrocardiogram, blood pressure, oxygen saturation monitoring, reduce the incidence of adverse consequences.
4. Bronchography with chest CT and bronchoscopy a wide range of applications, only a few millimeters in diameter, has been able to carry out direct observation of airway. With bronchial angiography during operation, causing the patient with oxygen and the potential risk of bronchospasm, hemoptysis patients are often difficult to tolerate. Therefore, patients with recent or active hemoptysis, its diagnostic value is limited. At present, the bronchial angiography is mainly used for: â‘  In order to confirm the limitations of bronchiectasis (including isolation of the lungs) exists; â‘¡ scheduled for surgery to rule out the limitations of bronchiectasis patients in the treatment of more extensive lesions.
5. Angiography
(1) selective bronchial arteriography: a group of recent data, 306 patients with hemoptysis patients, bleeding from the bronchial artery, 280 patients (91.5%), from the pulmonary artery in 26 cases (only 8.5%). Another group of 72 patients with a large study found that patients with hemoptysis, bleeding from the pulmonary artery were also accounted for only 8.4%. Hemoptysis patients seen bleeding, mostly from bronchial arterial system. Selective bronchial arteriography can not only clear the exact bleeding site, and also can find the abnormal bronchial artery expansion, distortion, aneurysm formation and circulation - the existence of communicating branches of the pulmonary circulation, so as to provide the basis for the treatment of bronchial artery embolization.
(2) pulmonary angiography: The cavitary pulmonary tuberculosis, lung abscess caused by diseases such as intractable hemoptysis; and the erosion of suspected false aneurysm, pulmonary abnormalities exist, should be selective bronchial arteriography in the same time, Canada for pulmonary angiography.
6. Isotope scanning stopped bleeding underwent ventilation / perfusion scan will help clear the diagnosis of pulmonary embolism. Differential Diagnosis
For repeated hemoptysis associated with chronic cough, sputum more, and have chest X-ray shadow ring or strip or take account of cyst formation by bronchiectasis; and young patients, especially female patients, recurrent hemoptysis and chronic no other symptoms, and more support for the diagnosis of bronchial adenoma; men over the age of 40 smoking patients, accompanied by hoarseness, cough, weight loss, should be suspected primary lung cancer may be; past history of tuberculosis at the same time with recent hemoptysis have fever, cough, weight loss and other symptoms may be more prompt cavitary pulmonary tuberculosis; hemoptysis with fever, cough sputum suggestive of lung abscess odor may exist; a recent history of blunt trauma chest, pulmonary contusion should be considered; for hemoptysis with acute pleurisy of chest pain, should consider the involvement of the pleura and other pulmonary diseases; In case of skin, mucous membranes, bleeding gums, is often suggestive of clotting mechanism. Ipsilateral lung field at the beginning of hemoptysis often diminished breath sounds, coarse or appear moist rales, breath sounds were normal contralateral lung field. Bronchial disease caused by bleeding, usually a larger amount of bleeding, often the affected side can be heard when auscultation and a variety of different types of rales, systemic symptoms are not severe. The appearance of pleural friction rub, often prompted lesions involving the pleural diseases such as pulmonary infarction, pulmonary abscess and so on. Tips for the pulmonary artery pressure increased with primary pulmonary hypertension, mitral stenosis, chronic recurrent pulmonary embolism; circulation and vein in the lung field area of traffic or noise were heard and the blood vessels to support the hereditary hemorrhagic telangiectasia with pulmonary malformations ; limited to large parts of the bronchial wheeze, more suggestive of incomplete bronchial obstruction caused by the department of disease exist, such as lung cancer or bronchial foreign body. Treatment
1. The general treatment of patients with massive hemoptysis requires absolute bed rest. Health care workers should guide the patient to take the affected side lying position, and make interpretation to eliminate the patient's tension and fear. Hemoptysis period, should be to minimize unnecessary move, so as not to bump his way because of increased bleeding, died of suffocation. Should also encourage patients to cough up blood remaining in the respiratory tract Chen to avoid airway obstruction and atelectasis. Such as the psychological stress of patients, used a small dose of sedatives, such as diazepam 2.5mg, orally, 2 times / d, or 10mg intramuscular injection of diazepam. Of frequent or severe cough, could give antitussives, such as Pentoxyverine 25mg, oral, 3 times / d; or by Pula ketone 40mg, oral, 3 times / d. Necessary, to give codeine 15 ~ 30mg, oral, 3 times / d. But the elderly and frail patients, should not take antitussives. Those of pulmonary insufficiency, disabling morphine, pethidine, so as not to inhibit the cough reflex, causing suffocation.
2. Hemostasis
(1) drug to stop bleeding:
â‘  vasopressin: role in vascular smooth muscle directly, with a strong vasoconstriction. After treatment because the contraction of small pulmonary arteries, pulmonary blood flow dropped sharply reduce the pressure of pulmonary circulation, thus contributing to pulmonary vascular rupture the formation of blood clots, to stop the bleeding purposes. Specific Usage: pituitrin 5 ~ 10U 25% glucose solution 20 ~ 40ml, slow intravenous injection (10 ~ 15min Note completed); or vasopressin 10 ~ 20U 5% glucose solution 250 ~ 500m1, intravenous infusion. Repeat if necessary, 6 ~ 8h 1. Treatment process, if the patient had headache, pale, sweating, heart palpitations, chest tightness, abdominal pain, it is intended and side effects such as blood pressure, should pay attention to slow intravenous injection or intravenous infusion of speed. Of hypertension, coronary heart disease, atherosclerosis, pulmonary heart disease, heart failure and pregnancy patients, should be used with caution or not.
â‘¡ vasodilator: through expansion of the lung blood vessels, reducing pulmonary arterial pressure and pulmonary wedge pressure and pulmonary wedge pressure; while systemic vascular resistance decreased, change thy blood less, intrapulmonary blood shunt to the cycle of limbs and internal organs, act as a "bleeding within "role. Caused by pulmonary and bronchial arterial pressure decrease, to stop the bleeding purposes. For taboo pituitrin hypertension, coronary heart disease, pulmonary heart disease and pregnancy is particularly applicable to other patients. Commonly used are:
A. Phentolamine: as α-blockers, the general amount of 10 ~ 20mg 5% glucose solution 250 ~ 500ml, intravenous infusion, 1 / d, use 5 to 7 days. Home and abroad have reported that treatment of massive use of this method, efficiency is about 80%. Fewer treatment side effects, but in order to prevent orthostatic hypotension and the incidence of blood pressure, medication should stay in bed during the period. Lack of blood volume in patients should be based on blood volume and then make up for the drug.
B. procaine: commonly used dose of 50mg 25% glucose solution 20 ~ 40m1, intravenous injection, 4 ~ 6h; or 300 ~ 500mg 5% glucose 500ml, intravenous infusion, 1 / d. Who first used the drug, should be skin test.
â‘¢ atropine, anisodamine: anisodamine atropine 1mg or 10mg, intramuscular or subcutaneous injection, for patients with massive hemoptysis have a better hemostatic effect. Has also been adopted and Isosorbide chlorpromazine and other treatment of massive hemoptysis, and achieved a certain effect.
â‘£ general hemostatic: mainly through improving the blood coagulation mechanism, strengthen the role of capillary and platelet function. Such as:
A. aminocaproic acid (6 - aminocaproic acid, EACA) and ammonia toluene acid (bleeding aromatic acid, PAMBA): by inhibiting the dissolution of fibrin, played hemostasis. Specific Usage: aminocaproic acid (EACA) 6.0g 5% glucose solution 250ml, intravenous infusion, 2 / d; or Aminomethylbenzoic acid (PAMBA) 0.1 ~ 0.2g 25% glucose solution 20 ~ 40ml, the slow intravenous injection, 2 times / d, or toluene, ammonia acid (PAMBA) 0.2g 5% glucose solution 250ml, the intravenous infusion, 1 or 2 times / d.
B. Etamsylate: with enhanced platelet function and adhesion, reducing the role of vascular permeability, so as to achieve effective hemostasis: Specific Usage: Etamsylate 0.25g 25% glucose solution 40m1, intravenous, 1 or 2 times / d; or Etamsylate 0.75g 5% glucose 500ml, intravenous infusion, 1 / d.
C. batroxobin: snake from Brazil (Brazil is a viper) venom after separation and purification and preparation of a thrombin. Each ampoule contains 1 g s units (KU) of Batroxobin. Batroxobin injection 1KU of 20min after the bleeding time in healthy adults will be reduced to 1 / 2 or 1 / 3, the effect can be maintained 2 to 3 days. This product is only a bleeding effect, the number of blood prothrombin is not thereby increased, it is generally no risk of thrombosis. It can be used for intravenous or intramuscular injection, is also available for local use. Adult daily dosage of 1.0 ~ 2.0KU, children 0.3 ~ 1.0KU, attention to drug overdose effects will make it fall.
There are also reduce capillary leakage Ka Bake network (network of blood safety); involved in prothrombin synthesis of vitamin K; against heparin and protamine Yunnanbaiyao medicine, a variety of hemostatic powder. Clinical view of massive hemoptysis due to bronchial or more pulmonary artery rupture caused by the drugs so generally only as an auxiliary treatment of hemoptysis.
(2) bronchoscopy in the treatment of massive hemoptysis: use of drug treatment for poor patients with intractable hemoptysis, bronchoscopy should be promptly checked. The purpose: First, a clear bleeding site; second is to clear the airway, Chen blood; triple in conjunction with a vasoconstrictor, thrombin, balloon tamponade and other methods to effectively stop the bleeding. More bleeding, generally the first use of clear rigid bronchoscopy hemorrhage, and bronchoscopy through the application of rigid bronchoscopy, the bleeding sites found to stop the bleeding. With the current bronchoscope to stop bleeding measures commonly used:
① bronchial lavage: saline ice with 4 ℃ 50ml, bleeding through the bronchoscope into the lung segment, sucked out after 1min lien, several consecutive weeks. Normally required for each patient suitable fluid volume to 500ml. Abroad have reported a group of 23 patients with large hemoptysis patients treated with this method, all patients were under control of hemoptysis, 2 patients bleeding again a few days after the lavage, but the first 2 times using the same method after lavage bleeding stopped. I have also used this method many times treatment of massive patients with gratifying results. Speculated that the ice saline lavage of some local vasoconstriction, blood flow slows down, thus promoting the coagulation.
â‘¡ local administration: The bronchoscope will be (1:20000) adrenalin 1 ~ 2ml, or (40U/ml) 5 ~ 10ml infusion of thrombin solution to the bleeding site, can play a contraction of blood vessels and promote blood coagulation, hemostatic effect affirmed. Still others reported that in 40U/ml 5 ~ 10m1 of thrombin solution, add 2% of the fibrinogen solution 5 ~ 10ml, mix in the bleeding site after the infusion, the bleeding better.
â‘¢ balloon tamponade: fiberoptic bronchoscope Fogarty balloon catheter will be sent to the bleeding site of the lung segment or sub-segmental bronchus, the balloon through the catheter to inflate or water, resulting in bleeding sites of the bronchial tamponade to achieve hemostasis purposes. But can also prevent excessive bleeding caused by the blood spilled into the healthy lung, thus effectively protecting the contralateral lung gas exchange. General lien 24 ~ 48h after the air bag, air bag to relax, observe no further bleeding after a few hours to extubation. 1 14 patients treated by balloon tamponade of hemoptysis in patients with technology, including 10 cases of bleeding under control. After 6 weeks to 9 months of follow-up, no rebleeding occurred. In addition, the air bag filling technology is often used in patients with arterial embolization and preoperative surgical support. Operation, should pay attention to prevent over-inflated balloon and the retention time is too long, caused by ischemic injury in the bronchial mucosa and obstructive pneumonia.
(3) selective bronchial artery embolization: According to the lungs by the bronchial artery and pulmonary artery blood supply of the double, two loop systems often transport pipeline of potential, and each has a phase adjustment or compensation function. When the bronchial artery embolization, the general does not cause bronchial and lung tissue necrosis, which bronchial artery embolization for the treatment of massive provide an objective basis. The past 20 years, arterial embolization has been widely used in the treatment of patients with massive hemoptysis. Especially bilateral lesions or bleeding site; heart, poor lung function can not tolerate surgery or advanced lung cancer invading the mediastinum and large vessels were, arterial embolization is a good alternative surgical treatment methods. Selective embolization of bronchial artery angiography is usually to determine the site of bleeding in the same time. But when X-ray-negative patients, bilateral disease or the side of the lesion were bleeding source can not explain the selective bronchial arteriography will fail. Then first bronchoscopy, and often can help identify the causes of hemoptysis and bleeding sites, so as to selective bronchial arteriography and bronchial artery embolization to create the conditions. Once the bleeding site after clear, you can use absorbable gelatin sponge (Gelfoam), oxidized cellulose, polyurethane, or anhydrous alcohol and other embolic material as possible to all suspicious lesions of the arterial embolization. If bronchial artery embolization and future Sub-system, bleeding still persists, take into account the possibility of pulmonary hemorrhage. The most common is the erosion of the pseudoaneurysm, pulmonary abscess, pulmonary abnormalities, and pulmonary artery rupture. Should also be conducted at this time pulmonary angiography, once the clear lesions existed in favor of pulmonary embolism at the same time accordingly. Bronchial artery embolization treatment of massive short-term effects are generally reported around 80% efficiency. But, after all, only a palliative treatment, not a substitute for surgery, anti-inflammatory, anti-TB and other causes of treatment. Note that when imaging showed spinal artery from the bronchial artery bleeding, the embolization is contraindicated, because it would result in the risk of spinal cord injury and paraplegia.
(4) Radiation therapy: are reported in the literature, not suitable for surgery and bronchial artery embolization for advanced lung cancer and pulmonary aspergillosis in some patients with massive hemoptysis caused by infection, the limitations of radiation therapy may be effective. Speculated that radiation exposure caused by the local extravascular edema, swelling and necrosis of blood vessels, causing thrombosis and occlusion, play hemostasis.
3. Surgical treatment of most patients with massive hemoptysis after treatment of these measures can be controlled bleeding. However, despite some positive conservative treatment is still difficult to stop bleeding, and the amount of hemoptysis in patients with major direct life-threatening, you should consider surgery.
(1) surgical indications: â‘  24h hemoptysis of more than 1500ml, or hemoptysis 24h reached within 1 500ml, no bleeding tendency by medical treatment. â‘¡ repeated hemoptysis, when threatened with suffocation. â‘¢ leaf or the side of the lungs clear of chronic lung disease is not reversible (such as bronchiectasis, cavitary tuberculosis, lung abscess, pulmonary aspergilloma, etc.).
(2) surgical contraindications: â‘  a wide range of diffuse bilateral lung disease, (such as the lungs extensive bronchiectasis, bronchopulmonary multiple cysts, etc.). â‘¡ poor general condition, heart, lung failure decompensation. â‘¢ of the primary lung disease caused by hemoptysis.
(3) operation time: should the patient before surgery chest radiograph, fiberoptic bronchoscopy and other tests, a clear bleeding site. At the same time respond to the patient's general health, heart, lung function had a comprehensive evaluation. That can not accept the heart and lung function tests in patients, should be based on history, physical examination such as a comprehensive judgments. Particularly estimates of lung function after lung resection, and strive to be accurate. To select the timing of surgery in hemoptysis gap of as well. This complication of surgery, the success rate. Group 1, according to information from abroad, in the activity during an operation massive hemoptysis, the mortality rate of up to 37%, of which the direct cause of death in most patients is due to inhalation of blood during surgery due. Instead of surgery in hemoptysis gap, the mortality rate of only 8%. Can be seen in massive gap in the surgery of choice for, can significantly reduce mortality.
4. Complications
(1) apnea: a major risk patients with massive hemoptysis is asphyxia, which is the main reason leading to death. Therefore, in the course of treatment of massive hemoptysis should be alert to the occurrence of asphyxia. Once a patient has significant chest tightness, irritability, throat sounds, rapid shallow breathing, sweating, one side (or both) disappearance of breath sounds, and even unconsciousness and other clinical manifestations of suffocation, should immediately take the following measures go all out to rescue.
① clear blocked airways as soon as the product of blood to maintain airway patency: the patient picked up quickly, so head down, upper body and the edge of the bed into a 45 ℃ ~ 90 ℃ angle. Patient care assistant head light to the back of buckling, bending to reduce the airway. And slap the patient back, pour as much as possible remain in the blood in the airways. Pry open the mouth at the same time (note the denture), clean up the blood in the oropharynx, and then use coarse catheter (or a bronchoscope) through the nose into the blood in the endotracheal aspirate.
â‘¡ oxygen: immediate high-flow oxygen inhalation.
â‘¢ the rapid establishment of intravenous access: the best of two intravenous access established, and according to need to give respiratory stimulant, hemostatic drugs and supplementary blood volume.
â‘£ absolute bed: After the lifting of suffocation, keep the patient in the head and low foot high, in order to facilitate postural drainage. Ice chest can be placed, and to encourage patients to cough up blood in the airway.
⑤ strengthening the monitoring of vital signs, to prevent the re-asphyxia: Note blood pressure, heart rate, ECG, respiration and blood oxygen saturation monitor, ready to endotracheal intubation and ventilator and other facilities to prevent further choking.
(2) hemorrhagic shock: If the patient is there because of massive hemoptysis and thin pulse rate, clammy extremities, blood pressure, pulse pressure decreased, and even unconsciousness and other clinical manifestations of hemorrhagic shock, should be the treatment of hemorrhagic shock in accordance with the principles of rescue.
(3) aspiration pneumonia: hemoptysis, the patient often be absorbed by the blood of fever, body temperature of 38 ℃ or so persistent, severe cough, elevated WBC, left shift, chest radiograph showed an increase over the previous lesions, often Tip complicated with aspiration pneumonia or disseminated tuberculosis should be given adequate antibiotics or anti-TB drug treatment.
(4) pulmonary atelectasis: As massive hemoptysis, bronchial blood clot blocking; or because the patient is extremely weak, sedative, antitussive dosage excessive bronchial secretions and prevent the discharge of blood, could easily lead to atelectasis. Treatment of atelectasis, the first row is draining blood or sputum, and to encourage and help the patient cough. If atelectasis is not long, you can try aminophylline, α-chymotrypsin, etc., inhalation, airway humidification, in order to facilitate the discharge of obstruction. Atelectasis of course remove the most effective solution is partial in the fiber bronchoscopic bronchial washing to remove the airway obstruction. Complications
Concurrent asphyxia, hemorrhagic shock, aspiration pneumonia, atelectasis, and so on. Prognosis and Prevention
Prognosis: Although patients with hemoptysis, massive hemoptysis are less than 5%, but mortality is as high as 7% to 32%, it should be taken seriously enough.
Prevention: hemoptysis patients should avoid sudden restlessness, nervous, reduce abdominal pressure to avoid the massive hemoptysis. Epidemiology
Hemoptysis is the throat and lungs following respiratory tract bleeding from the mouth by coughing movements excluded. Massive hemoptysis is a second volume of more than 500ml. The cause of hemoptysis caused by numerous clinical most common. 1 hemoptysis of more than 1100ml. Shock may occur, but no matter how much the amount of hemoptysis, can cause choking, suffocation is the leading cause of death in massive one. Special Note
1, the active treatment of primary disease, has reduced activity of hemoptysis should avoid emotional, fast spicy food, avoid the drama cough or forceful defecation, so as not to induce further hemoptysis;
2, the family emergency:
1) The absolute bed rest, hemoptysis should be supine, the affected side in order to facilitate sleep and avoid aspiratio
n pneumonia, bleeding or the occurrence of atelectasis.
2) the elimination of ideological concerns, encourage patients to cough up the old left in the respiratory tract in the blood, so as to avoid blocking the respiratory tract and suffocation death.
3, the intake of digestible foods such as liquid or semi-liquid, maintaining smooth stool, stool to avoid trouble, again hemoptysis;
4, appropriate sedative drugs such as oral and stability of 2.5 ~ 5mg, 3 times a day or phenobarbital 0.3g, 3 times a day;
5, cough medicines application, generally do not antitussives big thing hemoptysis, coughing violently prevent bleeding, you can spit up in the blood after oral carbetapentane 25mg or a compound powder Campanulaceae;
6, application of hemostatic agents such as Yunnanbaiyao 0.3 ~ 0.6g, 3 times a day oral or blood safety network tablets 2.5mg, 3 times a day;
7, the hemostatic effect of a large amount of bad or hemoptysis should speed to the hospital for further treatment.
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