Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Am Fam Physician. 2022 Feb 1;105(2):144-151.
Hemoptysis is the expectoration of blood from the lower respiratory tract, usually from bronchial arteries. The most common causes are acute respiratory infections, cancer, bronchiectasis, and chronic obstructive pulmonary disease. No cause is identified in 20% to 50% of cases. Hemoptysis must be differentiated from pseudohemoptysis, which is blood that originates from nasopharyngeal or gastrointestinal sources. The initial evaluation includes determining the severity of bleeding and stability of the patient and may require bronchoscopy for airway protection. Mild hemoptysis comprises more than 90% of cases and has a good prognosis, whereas massive hemoptysis has a high mortality rate. A history and physical examination can assist in identifying an etiology, but diagnostic testing is often required. Chest radiography is a good initial test, but it has limited sensitivity for determining the site and etiology of the bleeding. Computed tomography and computed tomography angiography of the chest with intravenous contrast are the preferred modalities to determine the etiology of bleeding; however, bronchoscopy may also be needed. In addition to supportive medical treatment, management should include treatment of the underlying etiology because recurrence often takes place in the absence of treatment of the identified cause. Bronchial arterial embolization is used to treat massive hemoptysis, particularly when an involved artery is noted on computed tomography angiography. Surgery is reserved for patients whose medical treatment and embolization are not effective.
咯血是指来自下呼吸道的血液咳出，通常来自支气管动脉。最常见的原因是急性呼吸道感染、癌症、支气管扩张和慢性阻塞性肺疾病。在 20%至 50%的病例中未确定病因。咯血必须与假性咯血相区别，假性咯血是指来自鼻咽或胃肠道的血液。初始评估包括确定出血的严重程度和患者的稳定性，可能需要支气管镜检查以保护气道。轻度咯血占 90%以上，预后良好，而大量咯血死亡率高。病史和体格检查有助于确定病因，但通常需要诊断性检查。胸部 X 线摄影是一种很好的初始检查，但对于确定出血部位和病因的敏感性有限。胸部 CT 和 CT 血管造影加静脉造影是确定出血病因的首选方法，但也可能需要支气管镜检查。除了支持性的医疗治疗外，管理还应包括对潜在病因的治疗，因为在未治疗已确定的病因的情况下，常复发。支气管动脉栓塞用于治疗大量咯血，尤其是在 CT 血管造影上发现受累动脉时。手术仅适用于药物治疗和栓塞治疗无效的患者。
