Department of Radiology, Hôpital Tenon - Assistance Publique - Hôpitaux de Paris, Paris, France.
Department of Intensive Care Medicine, Hôpital Tenon - Assistance Publique - Hôpitaux de Paris, Paris, France.
J Vasc Interv Radiol. 2024 Sep;35(9):1296-1303. doi: 10.1016/j.jvir.2024.05.017. Epub 2024 Jun 4.
To identify clinical, radiological, and angiographic characteristics associated with recurrent hemoptysis after bronchial artery embolization (BAE) in patients with lung cancer and severe hemoptysis admitted to the intensive care unit (ICU).
A total of 144 consecutive patients with lung cancer who underwent BAE for life-threatening hemoptysis admitted in the ICU between 2014 and 2022 were retrospectively included. Demographics, laboratory values, clinical course, and radiological/angiographic features were compared between those with and without recurrent hemoptysis within 1 month after embolization.
Of the 144 patients (mean age, 60.2 years [SD ± 10.9]; females, 15.3%), 34.7% (50/144) experienced clinically relevant recurrent hemoptysis within 1 month; among them, 29 of 50 (58.0%) cases necessitated a second embolization. Massive hemoptysis was observed in 54.2%, with 16.7% receiving the vasopressin analog terlipressin. The mean volume of hemoptysis and simplified acute physiology score II (SAPS II) were 235 mL (SD ± 214.3) and 31.2 (SD ± 18.6), respectively. Computed tomography (CT) angiography revealed pulmonary artery (PA) injury (11.5%) and necrosis/cavitation (25.8%), and PA embolization was performed in 15.3% of cases. Technical success rate was 92%. SAPS II (P = .01), massive hemoptysis (P < .001), terlipressin use (P = .01), necrosis/cavitation (P = .01), and PA injury on CT angiography (P < .001) were associated with recurrent hemoptysis. Independent predictors on multivariate analysis were massive hemoptysis (P = .016) and PA injury on CT angiography (P = .001).
In patients with lung cancer and life-threatening hemoptysis treated by BAE, massive hemoptysis and PA injury identified on CT angiography are independent predictors of recurrent hemoptysis.
确定因肺癌导致严重咯血而入住重症监护病房（ICU）并接受支气管动脉栓塞（BAE）治疗后发生复发性咯血的临床、影像学和血管造影特征。
回顾性纳入 2014 年至 2022 年期间因危及生命的咯血而在 ICU 接受 BAE 治疗的 144 例连续肺癌患者。比较栓塞后 1 个月内有和无复发性咯血的患者之间的人口统计学、实验室值、临床过程和影像学/血管造影特征。
144 例患者中（平均年龄 60.2 岁[标准差 ± 10.9]；女性 15.3%），34.7%（50/144）在 1 个月内出现临床相关的复发性咯血；其中 29 例（58.0%）需要进行第二次栓塞。54.2%的患者发生大咯血，16.7%的患者使用血管加压素类似物特利加压素。咯血量和简化急性生理学评分 II（SAPS II）的平均值分别为 235 毫升（标准差 ± 214.3）和 31.2（标准差 ± 18.6）。CT 血管造影显示肺动脉（PA）损伤（11.5%）和坏死/空洞（25.8%），15.3%的病例进行了 PA 栓塞。技术成功率为 92%。SAPS II（P =.01）、大咯血（P <.001）、特利加压素使用（P =.01）、坏死/空洞（P =.01）和 CT 血管造影上的 PA 损伤（P <.001）与复发性咯血有关。多变量分析的独立预测因素为大咯血（P =.016）和 CT 血管造影上的 PA 损伤（P =.001）。
在因肺癌导致严重咯血并接受 BAE 治疗的患者中，CT 血管造影上的大咯血和 PA 损伤是复发性咯血的独立预测因素。
Zotero 插件