Ventsiavichus V, Tsitsenas S
Probl Tuberk Bolezn Legk. 2005(1):40-3.
Hemorrhage is one of the most pressing problems in lung diseases. The paper analyzes the results of medical and surgical treatments for pulmonary hemorrhages. A total of 724 patients with hemoptysis and bleedings of various etiology were treated at the Thoracic Unit in 1985-2003. Pulmonary hemorrhages occurred in 442 (61%) patients with pulmonary tuberculosis and in 282 (39%) patients with nonspecific lung diseases. X-ray study revealed right-sided lung lesions in 268 (37%) patients; left-sided lung lesions in 203 (28%), bilateral lesions in 170 (23.5%). The visible X-ray changes were not found in 83 (11.5%) patients. Destructive pulmonary parenchymal changes were detected in 366 (50.5%) patients. Bronchological study was conducted in 703 patients with pulmonary hemorrhage: 377 (53.7%) and 214 (30.4%) patients were found to have its direct and indirect signs, respectively. Neither changes nor hemorrhagic traces were detected in 112 (15.9%) patients since they underwent bronchoscopy in a later period when bleeding had already stopped. Foam rubber sponge tamponade of the main and lobar bronchi was made in 75 (10.4%) patients with profuse bleeding; a positive effect was achieved in 61 (81.3%) patients. The treatment policy for pulmonary hemorrhage is determined by its severity and etiology and the health status of the patient. A major role was assigned to medical hemostatic therapy in the treatment of pulmonary hemorrhages. If it was ineffective, surgical treatment was used. The use of hypotension controlled by ganglionic blockers (more commonly pentamine): bleedings were suppressed in 359 (74%) of 485 patients with second- and third-degree hemorrhages yielded good results. They were medically stopped in 558 (77%) patients; death occurred in 14 (2.4%) cases. A hundred and fifty two (20.9%) were operated on; of them 8 patients underwent segmentectomy; 85 had lobectomy. Pulmonectomy, cavernostomy, and thoracoplasty were performed in 48, 4, and 7 patients, respectively. Twenty-six patients were operated on at the peak of hemorrhage. Bleedings were suppressed in 140 (92%) patients (they recovered; 12 (7.9%) patients died. In the postoperative period different complications were noted in 30 (19.7%) patients. The final results of medical and surgical treatment were as follows: bleedings were stopped in 698 (96.4%) patients (they recovered) and 26 (3.6%) died.
出血是肺部疾病中最紧迫的问题之一。本文分析了肺出血的药物治疗和手术治疗结果。1985年至2003年期间，胸科共治疗了724例咯血及各种病因出血的患者。442例（61%）肺结核患者和282例（39%）非特异性肺部疾病患者发生了肺出血。X线检查显示，268例（37%）患者右侧肺部有病变；203例（28%）患者左侧肺部有病变，170例（23.5%）患者双侧有病变。83例（11.5%）患者未发现可见的X线改变。366例（50.5%）患者检测到肺实质破坏性改变。对703例肺出血患者进行了支气管镜检查：分别有377例（53.7%）和214例（30.4%）患者发现了直接和间接征象。112例（15.9%）患者因在出血停止后的较晚时期接受支气管镜检查，未发现改变或出血痕迹。75例（10.4%）大出血患者对主支气管和叶支气管进行了泡沫橡胶海绵填塞；61例（81.3%）患者取得了积极效果。肺出血的治疗策略取决于其严重程度、病因以及患者的健康状况。药物止血治疗在肺出血治疗中起主要作用。如果无效，则采用手术治疗。使用神经节阻滞剂（更常见的是喷他明）控制低血压：485例二、三度出血患者中有359例（74%）出血得到抑制，效果良好。558例（77%）患者经药物治疗出血停止；14例（2.4%）患者死亡。152例（20.9%）患者接受了手术；其中8例患者进行了肺段切除术；85例进行了肺叶切除术。分别有48例、4例和7例患者进行了全肺切除术、空洞造口术和胸廓成形术。26例患者在出血高峰期接受了手术。140例（92%）患者出血得到抑制（康复）；12例（7.9%）患者死亡。术后30例（19.7%）患者出现了不同的并发症。药物治疗和手术治疗的最终结果如下：698例（96.4%）患者出血停止（康复），26例（3.6%）患者死亡。
