Lalla Usha, Allwood Brian W, Sinha Roy Soumitra, Irusen Elvis M, Koegelenberg Coenraad F N
Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.
Respiration. 2017;93(6):436-440. doi: 10.1159/000465526. Epub 2017 Mar 30.
Treatment options for intractable life-threatening haemoptysis in mechanically ventilated patients with structural lung disease who do not respond to bronchial artery embolisation (BAE) and who are deemed unfit for surgery are limited. A 26-year-old HIV-positive male with a poorly preserved CD4 count and active pulmonary tuberculosis was intubated and mechanically ventilated for persistent life-threatening haemoptysis. Two attempts at BAE failed, and life-threatening haemoptysis recurred daily for 14 days despite antituberculous therapy. He was deemed unfit for surgery during that period. We proceeded to identify the source of bleeding endoscopically and implanted an endobronchial valve in the left upper lobe bronchus. Following the collapse of the affected lobe, haemoptysis ceased and the patient was promptly liberated from mechanical ventilation. He remained haemoptysis free for the duration of his hospitalisation. Endobronchial valves, therefore, may be a viable option in patients mechanically ventilated with persistent life-threatening haemoptysis in whom all other conventional measures fail and who are considered unfit for surgery.
对于患有结构性肺病且接受机械通气的患者，若出现难以治疗的危及生命的咯血，在对支气管动脉栓塞术（BAE）无反应且被认为不适合手术的情况下，治疗选择有限。一名26岁的HIV阳性男性，其CD4细胞计数保存不佳且患有活动性肺结核，因持续性危及生命的咯血而插管并接受机械通气。两次BAE尝试均失败，尽管进行了抗结核治疗，但危及生命的咯血仍持续14天，每天复发。在此期间，他被认为不适合手术。我们通过内镜检查确定了出血源，并在左上叶支气管植入了支气管内瓣膜。患肺叶萎陷后，咯血停止，患者迅速脱离机械通气。在住院期间，他一直未再咯血。因此，对于接受机械通气、出现持续性危及生命的咯血且所有其他常规措施均无效且被认为不适合手术的患者，支气管内瓣膜可能是一种可行的选择。
