Yang Xue, Ma Wei, Shi Xin, Sun Xiao, Wei Yumei, Yan Ziguang, Li Shuangling
Department of Geriatrics, Peking University First Hospital, Beijing, China.
Department of Cardiology, Peking University First Hospital, Beijing, China.
Ann Transl Med. 2021 Apr;9(7):582. doi: 10.21037/atm-20-2502.
Massive hemoptysis can be life-threatening and is frequently encountered in clinical practice, but rare during pregnancy. There have been limited case reports of massive hemoptysis in pregnancy in patients with conditions such as Takayasu's arteritis, bronchiectasis, bronchial carcinoid tumor, and tuberculosis. The most important management is early control of the hemorrhage and airway protection. We report on 2 patients at 33 and 27 gestational weeks who were admitted to the emergency department because of massive hemoptysis. Therapeutic rigid bronchoscopy with the application of high-frequency jet ventilation was performed under general anesthesia during cesarean section to control potential bleeding and stabilize the airway; this was then followed by bronchial artery embolization (BAE) postsurgically. The lives of both mothers and infants were saved. At the 16- and 11-month follow-ups, the patients showed no symptoms. To our knowledge, this is the first report on the application of therapeutic rigid bronchoscopy concurrent with cesarean section in order to protect the airway and reduce the side effects of the subsequent treatment for both mother and fetus in hemoptysis cases. By reporting these cases and conducting a literature review, we present a novel treatment method for massive hemoptysis in pregnant patients that may improve patients' outcomes.
大咯血可危及生命，在临床实践中经常遇到，但在妊娠期间很少见。关于大动脉炎、支气管扩张症、支气管类癌肿瘤和肺结核等疾病患者妊娠期间发生大咯血的病例报告有限。最重要的处理是早期控制出血和保护气道。我们报告2例分别处于孕33周和27周的患者，因大咯血入住急诊科。剖宫产期间在全身麻醉下进行治疗性硬质支气管镜检查并应用高频喷射通气，以控制潜在出血并稳定气道；然后在术后进行支气管动脉栓塞术（BAE）。母婴均获救。在16个月和11个月的随访中，患者均无症状。据我们所知，这是首例关于在剖宫产同时应用治疗性硬质支气管镜以保护气道并减少咯血病例中后续治疗对母亲和胎儿副作用的报告。通过报告这些病例并进行文献综述，我们提出了一种可能改善妊娠患者大咯血治疗效果的新方法。
