Freitag L, Macha H N
Lungenklinik Hemer.
Internist (Berl). 2004 May;45(5):555-64. doi: 10.1007/s00108-004-1173-z.
Hemoptysis is a potentially life-threatening complication of various diseases. The most common causes are infectious and inflammatory processes, followed by neoplasms, pulmonary embolisms, mitral stenoses, coagulopathies, and multiple systemic disorders. Primary examinations include a chest x-ray, an angio CT and a bronchoscopy. Sometimes, a bronchial artery angiogram is required. The patient is at risk of suffocation because blood and clots can severely obstruct his airways. Thus, the most important measures are: supplemental oxygen, positioning the patient with the bleeding side down, bronchoscopical suctioning and removal of blood and clots. Coagulopathies have to be corrected. Application of vasoactive drugs may help temporarily. In cases of bleeding from central lesions, coagulation with laser or argon-plasma-coagulator is feasible. Heavy bleeding from the periphery requires a balloon or tube tamponade. Depending on the cause and the severity of the bleeding either anti-inflammatory medical treatment, hemostyptic radiation therapy, bronchial artery embolisation or a surgical procedure must follow.
咯血是多种疾病潜在的危及生命的并发症。最常见的病因是感染性和炎症性过程,其次是肿瘤、肺栓塞、二尖瓣狭窄、凝血障碍以及多种全身性疾病。初步检查包括胸部X线、血管CT和支气管镜检查。有时,需要进行支气管动脉血管造影。患者有窒息风险,因为血液和血凝块会严重阻塞气道。因此,最重要的措施是:补充氧气、将患者出血侧向下放置、通过支气管镜抽吸并清除血液和血凝块。必须纠正凝血障碍。应用血管活性药物可能会有暂时帮助。对于中央病变出血的情况,用激光或氩等离子体凝固器进行凝固是可行的。外周大量出血需要球囊或导管填塞。根据出血的原因和严重程度,后续必须采取抗炎药物治疗、止血放射治疗、支气管动脉栓塞或外科手术。