Division of Pulmonary Medicine, Rambam Health Care Campus and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Respir Med. 2009 Aug;103(8):1196-200. doi: 10.1016/j.rmed.2009.02.004. Epub 2009 Feb 28.
Major hemoptysis a potentially life-threatening condition in pulmonology and can originate from both identifiable and unidentifiable sites. Identifiable bleeding sites can be controlled locally by iced saline, vasopressors, laser, electrocautery and balloon tamponade. Bleeding from an unidentifiable source, on the other hand, is much more difficult to control as the bleeding site is not accessible by the bronchoscope. Tranexamic acid (TA), a synthetic anti-fibrinolytic agent, is approved for treatment or prophylaxis of bleeding episodes in hemophilia or following major operative procedures via intravenous or oral routes. Its efficacy in controlling bleeding from mucosal tissue led us to apply it to patients with pulmonary bleeding. Six patients with significant hemoptysis, two who bled during bronchoscopy biopsy and four with spontaneous bleeding (lung cancer, diffuse alveolar hemorrhage, idiopathic pulmonary bleeding, metastatic thyroid carcinoma) were treated with TA. For the two who bled during bronchoscopy, we used a bolus of 500mg/5mL through the bronchoscope working channel, while the latter four received aerosolized TA 500mg/5ml 3-4 times a day. In all cases, the bleeding stopped with the first dose of TA, and the treatment was well tolerated without adverse events. While limited due to the small number of patients, these data show that TA administered either as a bolus through the bronchoscope or via inhalation seems to be effective in controlling severe hemoptysis from both identifiable and unidentifiable bleeding sites. Further clinical studies are needed to evaluate the use of the TA in this set-up.
大咯血是肺病学中一种潜在的危及生命的病症，可源自可识别和不可识别的部位。可识别的出血部位可通过冰盐水、血管加压素、激光、电烙和球囊填塞局部控制。另一方面，无法识别来源的出血更难以控制，因为支气管镜无法到达出血部位。氨甲环酸 (TA) 是一种合成的抗纤维蛋白溶解剂，已通过静脉或口服途径批准用于血友病或大手术后出血发作的治疗或预防。其控制粘膜组织出血的疗效促使我们将其应用于肺出血患者。我们对 6 名大咯血患者进行了 TA 治疗，其中 2 名在支气管镜活检时出血，4 名自发性出血（肺癌、弥漫性肺泡出血、特发性肺出血、转移性甲状腺癌）。对于在支气管镜检查期间出血的 2 名患者，我们通过支气管镜工作通道使用 500mg/5mL 的推注剂量，而其余 4 名患者接受 500mg/5ml 的雾化 TA，每天 3-4 次。在所有情况下，TA 的首剂量即可止血，且治疗耐受性良好，无不良反应。尽管由于患者数量有限，但这些数据表明，无论是通过支气管镜推注还是通过吸入给予 TA，似乎都能有效控制可识别和不可识别出血部位的严重咯血。需要进一步的临床研究来评估在这种情况下使用 TA。
