Sarmiento Armand Gregorio C, Danguilan Jose Luis J, Mariano Zenaida M, Barzaga Maria Teresa A
Department of Thoracic Surgery and Anesthesia, Lung Center of the Philippines, Quezon, Philippines.
Department of Pathology, Lung Center of the Philippines, Quezon, Philippines.
J Vis Surg. 2017 Aug 21;3:111. doi: 10.21037/jovs.2017.05.09. eCollection 2017.
The purpose of this study is to determine the effect of using autologous platelet rich plasma (PRP) in patients having massive hemoptysis within a period of one week.
This is a prospective cohort study involving 20 consecutive patients admitted who met the criteria for massive hemoptysis from July to October 2011. After stabilizing the patient, fiberoptic bronchoscopy (FOB) was performed for localization of bleeding within 6 hours from diagnosis. A 50mL of blood was extracted from the patient whom was to be used for autologous PRP concentrate. After identifying the anatomic site of bleeding, autologous PRP concentrate was instilled on the affected bronchus and was allowed to stay for 5 minutes after instillation. Patients were then monitored from the time the bleeding stopped in the first 24 hours, 2 days and 7 days respectively.
Mean age of the study population with massive hemoptysis was 47 years old (SD 17.3). Majority of cases were male 18 out of 20 (90%) and smokers 14 (70%) with a normal BMI (75%). Identification of bleeding site was more commonly seen on the right upper lobe 9 out of 20 (45%). Overall, 14 out of 20 patients (70%) were reported to have stopped bleeding immediately. Subsequent hospital days showed that 8 out of 20 patients (40%) had no hemoptysis. However, one [1] post-tuberculosis (TB) bronchiectatic patient had recurrence of massive hemoptysis, approximately 250 mL per expectorate, expired within the 7 days observation and one patient had lobectomy on the 2nd day. The rest had non-massive hemoptysis wherein their expectorations were only streaks of blood. Moreover, there was one [1] patient who had recurrence of massive hemoptysis 1 week after autologous PRP infusion and was eventually intubated. Majority of the subjects, eleven [11] were diagnosed to have post-TB bronchiectasis. The rest of the patients were worked-up prior to operation.
Overall, it was observed that the use of autologous PRP was able to stop bleeding in 40% of the study population for 7 days. It is simple and easy to reproduce as it was directly extracted from the patient.
本研究的目的是确定在一周内对大量咯血患者使用自体富血小板血浆（PRP）的效果。
这是一项前瞻性队列研究，纳入了2011年7月至10月期间连续收治的20例符合大量咯血标准的患者。患者病情稳定后，在确诊后6小时内进行纤维支气管镜检查（FOB）以确定出血部位。从患者身上抽取50mL血液用于制备自体PRP浓缩液。确定出血的解剖部位后，将自体PRP浓缩液注入受影响的支气管，并在注入后停留5分钟。然后分别在出血停止后的头24小时、2天和7天对患者进行监测。
大量咯血研究人群的平均年龄为47岁（标准差17.3）。大多数病例为男性，20例中有18例（90%），吸烟者14例（70%），BMI正常（75%）。出血部位最常见于右上叶，20例中有9例（45%）。总体而言，20例患者中有14例（70%）报告立即止血。随后的住院天数显示，20例患者中有8例（40%）没有咯血。然而，1例肺结核（TB）后支气管扩张患者出现大量咯血复发，每次咯血量约250mL，在7天观察期内死亡，1例患者在第2天接受了肺叶切除术。其余患者有非大量咯血，其痰液中只有血丝。此外，有1例患者在自体PRP输注1周后出现大量咯血复发，最终插管。大多数受试者，11例被诊断为肺结核后支气管扩张。其余患者在手术前进行了检查。
总体而言，观察到使用自体PRP能够使40%的研究人群在7天内止血。它简单易行，因为它是直接从患者身上提取的。
