Xi Yin, Liu Dongdong, Yang Chun, Wu Xiaomei, Nong Lingbo, He Weiqun, Liu Xiaoqing, Li Yimin
Department of Intensive Care Unit, First Hospital Affiliated to Guangzhou Medical University, Guangzhou 510120, Guangdong, China (Xi Y, Liu DD, Yang C, Nong LB, He WQ, Liu XQ, Li YM); Department of Intervention, First Hospital Affiliated to Guangzhou Medical University, Guangzhou 510120, Guangdong, China (Wu XM). Corresponding author: Liu Xiaoqing, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018 Jul;30(7):671-676. doi: 10.3760/cma.j.issn.2095-4352.2018.07.011.
To investigate the cause of massive hemoptysis in critical patients, and to evaluate the effect of bronchial artery embolization (BAE) on critical patients with massive hemoptysis.
A retrospective controlled analysis was conducted. The clinical data of 35 patients with life-threatening massive hemoptysis admitted to intensive care unit (ICU) of the First Hospital Affiliated to Guangzhou Medical University from January 2009 to December 2017 were analyzed. The patients were divided into BAE and non-BAE group according to whether receiving BAE or not. BAE patients were subdivided into subgroups: hemoptysis after ventilation and hemoptysis before ventilation subgroups, as well as survival and non-survival subgroups. The etiology of all massive hemoptysis was analyzed. The gender, age, acute physiology and chronic health evaluation II (APACHE II) score, amount of hemoptysis, whether presence of pleural thickening in chest CT, the length of ICU stay, total length of hospital stay, the duration of mechanical ventilation (MV), clinical effective and prognostic indicators of patients were recorded. The correlation between variables was analyzed by Spearman correlation analysis.
All 35 patients were enrolled in the finally analysis. The main cause of critical patients with massive hemoptysis was fungal infection [37.1% (13/35)], followed by pneumonia and abnormal coagulation [17.1% (6/35)], bronchiectasis [11.4% (4/35)], tumor [8.6% (3/35)], etc. In all 35 patients, 27 were treated with BAE and 8 were treated without BAE. There was no difference in gender, age, the length of ICU stay, total length of hospital stay, the duration of MV, amount of hemoptysis, APACHE II score, whether use antiplatelet agents or anticoagulants, or whether presence of pleural thickening in chest CT between the two groups. The rate of hemoptysis remission in BAE group was significantly higher than that of non-BAE group [92.6% (25/27) vs. 25.0% (2/8), P < 0.01], but there was no statistically significant difference in hospital survival as compared with that of non-BAE group [48.1% (13/27) vs. 25.0% (2/8), P > 0.05]. Subgroup analysis showed that 64.3% (9/14) of patients with hemoptysis after ventilation was caused by pulmonary fungal infection, which was significantly higher than those with hemoptysis before ventilation [15.4% (2/13), P = 0.018]. Compared with hemoptysis after ventilation group, the length of ICU stay and the duration of MV in hemoptysis before ventilation group were significantly shortened [the length of ICU stay (days): 12.0 (14.0) vs. 30.0 (81.8), the duration of MV (days): 10.0 (16.0) vs. 25.0 (68.3)], the patients using antiplatelet drugs or anticoagulant drugs was decreased significantly (case: 1 vs. 9, all P < 0.05). However, there was no statistically significant difference in gender, age, total length of hospital stay, amount of hemoptysis, APACHE II score, whether presence of pleural thickening in chest CT, the rate of hemoptysis remission, the incidence of secondary BAE or hospital survival rate between the two groups. Compared with the survival subgroup (n = 13), more patients in the non-survival subgroup (n = 14) were treated with antiplatelet or anticoagulants (P < 0.05); and Spearman correlation analysis showed that the survival of the patients with BAE was negatively correlated with the use of antiplatelet or anticoagulants (r = -0.432, P = 0.024). There was no significant difference in the gender, age, the length of ICU day, total length of hospitalization, duration of MV, estimated hemoptysis, APACHE II score, or the proportion of pleural thickening between the two groups.
The study indicated that the etiology of massive hemoptysis in critical patients was complicated. Fungal infection was the main cause in patients with hemoptysis after ventilation. BAE was effective in the control of massive hemoptysis in ICU, but it was not ideal for patients with abnormal coagulation function or abnormal platelet count or platelet dysfunction from antiplatelet or anticoagulant drugs, the overall survival rate was still low.
探讨重症患者大咯血的病因，并评估支气管动脉栓塞术（BAE）对重症大咯血患者的治疗效果。
进行回顾性对照分析。分析2009年1月至2017年12月广州医科大学附属第一医院重症监护病房（ICU）收治的35例危及生命的大咯血患者的临床资料。根据是否接受BAE将患者分为BAE组和非BAE组。BAE组患者再细分为通气后咯血亚组和通气前咯血亚组，以及生存亚组和非生存亚组。分析所有大咯血的病因。记录患者的性别、年龄、急性生理与慢性健康状况评分系统II（APACHE II）评分、咯血量、胸部CT是否存在胸膜增厚、ICU住院时间、总住院时间、机械通气（MV）时间、临床疗效和预后指标。采用Spearman相关性分析变量之间的相关性。
最终纳入分析35例患者。重症大咯血患者的主要病因是真菌感染[37.1%（13/35）]，其次是肺炎和凝血异常[17.1%（6/35）]、支气管扩张[11.4%（4/35）]、肿瘤[8.6%（3/35）]等。35例患者中，27例行BAE治疗，8例未行BAE治疗。两组患者在性别、年龄、ICU住院时间、总住院时间、MV时间、咯血量、APACHE II评分、是否使用抗血小板药物或抗凝药物、胸部CT是否存在胸膜增厚方面差异无统计学意义。BAE组咯血缓解率显著高于非BAE组[92.6%（25/27）比25.0%（2/8），P<0.01]，但与非BAE组相比，住院生存率差异无统计学意义[48.1%（13/27）比25.0%（2/8），P>0.05]。亚组分析显示，通气后咯血患者中64.3%（9/14）由肺部真菌感染引起，显著高于通气前咯血患者[15.4%（2/13），P=0.018]。与通气后咯血组相比，通气前咯血组的ICU住院时间和MV时间显著缩短[ICU住院时间（天）：12.0（14.0）比30.0（81.8），MV时间（天）：10.0（16.0）比25.0（68.3）]，使用抗血小板药物或抗凝药物的患者显著减少（例数：1比9，均P<0.05）。然而，两组患者在性别、年龄、总住院时间、咯血量、APACHE II评分、胸部CT是否存在胸膜增厚、咯血缓解率、二次BAE发生率或住院生存率方面差异无统计学意义。与生存亚组（n=13）相比，非生存亚组（n=14）中更多患者使用了抗血小板或抗凝药物（P<0.05）；Spearman相关性分析显示，BAE患者的生存与使用抗血小板或抗凝药物呈负相关（r=-0.432，P=0.024）。两组患者在性别、年龄、ICU住院天数、总住院时间、MV时间、估计咯血量、APACHE II评分或胸膜增厚比例方面差异无统计学意义。
研究表明，重症患者大咯血的病因复杂。真菌感染是通气后咯血患者的主要原因。BAE对控制ICU大咯血有效，但对于凝血功能异常或血小板计数异常或因抗血小板或抗凝药物导致血小板功能障碍的患者效果不理想，总体生存率仍较低。
