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病例报告:血凝块导致一名孕妇左主支气管完全阻塞,需进行肺切除术。

Case report: Total obstruction of the left main bronchus by a blood clot leads to pneumonectomy in a pregnant woman.

作者信息

Ziani Hicham, Chibani Amine, Slaihi Zakariae, Benhalima Abdelkader, Armel Bouchra, ElHamzaoui Hamza, Elazzouzi Imane, Eddouali Amine, Ghattab Selma, Elarfaoui Manal, Alilou Mustapha

机构信息

Department of Intensive Care Unit.

Unit of Critical Emergency Care, Hospital IBN SINA, Rabat, Morocc.

出版信息

Ann Med Surg (Lond). 2023 Nov 20;86(1):556-560. doi: 10.1097/MS9.0000000000001527. eCollection 2024 Jan.

Abstract

INTRODUCTION AND IMPORTANCE

Airway obstruction resulting from blood clot formation is observed across various clinical scenarios and is often preceded by hemoptysis. This condition can significantly compromise respiratory function, potentially leading to life-threatening ventilatory distress.

CASE PRESENTATION

In this report, the authors present a case of acute airway obstruction associated with hemoptysis in an 18-week pregnant woman admitted to the emergency department for acute respiratory distress. Clinical and radiographic evidence strongly suggested the presence of an endobronchial blood clot causing focal airway obstruction. Diagnosis was confirmed through direct endoscopic evaluation.

CLINICAL DISCUSSION

Initial attempts to remove the obstructing clot from the airway involved lavage, aspiration, and forceps extraction by using a bronchoscope. In cases in which these measures proved ineffective, other management strategies include rigid bronchoscopy, embolization, and surgical resection.

CONCLUSION

Central airway obstruction is a critical condition caused by numerous factors such as tumours or blood clots. Treatment focuses on securing the airway, ensuring breathing, and using tools such as bronchoscopy for diagnosis and treatment. Surgery is considered a last resort when other methods are ineffective.

摘要

引言与重要性

在各种临床情况下都可观察到因血凝块形成导致的气道阻塞,且通常先有咯血。这种情况会严重损害呼吸功能,可能导致危及生命的通气窘迫。

病例介绍

在本报告中,作者介绍了一例18周妊娠的孕妇因急性呼吸窘迫入住急诊科,出现与咯血相关的急性气道阻塞的病例。临床和影像学证据强烈提示存在导致局灶性气道阻塞的支气管内血凝块。通过直接内镜评估确诊。

临床讨论

最初尝试通过支气管镜灌洗、抽吸和用钳子取出气道内阻塞性血凝块。在这些措施无效的情况下,其他管理策略包括硬质支气管镜检查、栓塞和手术切除。

结论

中央气道阻塞是由肿瘤或血凝块等多种因素引起的危急情况。治疗重点是确保气道通畅、保证呼吸,并使用支气管镜等工具进行诊断和治疗。当其他方法无效时,手术被视为最后手段。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c29f/10783306/932f7783cc14/ms9-86-556-g001.jpg

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