Fartoukh M
Service de Pneumologie et Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, 4 Rue de la Chine, 75020 Paris, France.
Rev Mal Respir. 2010 Dec;27(10):1243-53. doi: 10.1016/j.rmr.2010.10.006. Epub 2010 Oct 30.
Recognition of the criteria of severity and the early admission to a referral center play a critical role in the prognosis of severe haemoptysis. The therapeutic management should be undertaken urgently by providing general supportive care, i.e., optimization of oxygenation and haemodynamic stabilization to prevent recurrence of massive bleeding. Interventional radiology has dramatically improved the initial management of severe haemoptysis. Attempts to control haemoptysis by first-line non-surgical methods are necessary to optimize the operative conditions and improve morbidity and mortality. Surgical lung resection remains the treatment of choice in selected patients with localized lesions complicated by severe and/or recurrent episodes of haemoptysis (bronchiectasis) or lesions associated with a high risk of recurrence of bleeding (mycetoma). Haemoptysis related to pulmonary arterial involvement remains a surgical emergency.
认识到严重程度标准并尽早转诊至转诊中心对严重咯血的预后起着关键作用。应通过提供一般支持性护理紧急进行治疗管理,即优化氧合和稳定血流动力学以防止大出血复发。介入放射学极大地改善了严重咯血的初始治疗。采用一线非手术方法控制咯血对于优化手术条件、降低发病率和死亡率是必要的。对于局限性病变合并严重和/或复发性咯血(支气管扩张)或有高出血复发风险的病变(曲菌球)的特定患者,手术肺切除仍是首选治疗方法。与肺动脉受累相关的咯血仍然是外科急症。