Bjørtuft O, Brosstad F, Boe J
Dept of Thoracic Medicine, The National Hospital, University of Oslo, Norway.
Eur Respir J. 1998 Nov;12(5):1025-7. doi: 10.1183/09031936.98.12051025.
The objectives of this study were to measure the bleeding volume associated with fibreoptic bronchoscopy with transbronchial biopsies (TBB), to correlate it with coagulation tests and to compare bleeding volume in patients with and without lung transplant. A total of 104 consecutive TBB in 51 different patients was evaluated prospectively. Before each procedure, haemoglobin, blood platelets, prothrombin time (PT), activated partial thromboplastin time (aPTT) and bleeding time were measured. During the procedure, lavage fluid and blood were collected by suction. The haemoglobin concentration of the mixture was measured and bleeding volume was calculated. Clinically significant bleeding was arbitrarily defined as >20 mL blood present in lavage fluid. The mean+/-SD bleeding volume was 7+/-10 mL with no statistically significant difference between transplanted and nontransplanted patients. In eight procedures (7.7%) the bleeding volume was >20 mL (range 22-61 mL). Prebiopsy values for blood platelet counts, PT and aPTT did not predict a bleeding tendency in any of the procedures in which significant bleeding occurred. No correlation was found between bleeding time and bleeding volume in the 17 procedures performed in patients with a prolonged bleeding time (> or =10 min). The bleeding associated with transbronchial biopsies was usually minor and quantitatively similar in patients with or without lung transplant. Coagulation tests could not predict clinically significant bleeding, which may occur in patients with normal coagulation test results.
本研究的目的是测量经支气管活检的纤维支气管镜检查相关的出血量，将其与凝血试验相关联，并比较有和没有肺移植患者的出血量。前瞻性评估了51例不同患者中总共104次连续的经支气管活检。在每次操作前，测量血红蛋白、血小板、凝血酶原时间（PT）、活化部分凝血活酶时间（aPTT）和出血时间。在操作过程中，通过吸引收集灌洗液和血液。测量混合物的血红蛋白浓度并计算出血量。临床上显著出血被任意定义为灌洗液中存在>20 mL血液。平均±标准差出血量为7±10 mL，移植患者和未移植患者之间无统计学显著差异。在8次操作（7.7%）中，出血量>20 mL（范围22 - 61 mL）。活检前血小板计数、PT和aPTT值在任何发生显著出血的操作中均未预测出血倾向。在出血时间延长（≥10分钟）的患者中进行的17次操作中，未发现出血时间与出血量之间存在相关性。经支气管活检相关的出血通常较少，有或没有肺移植的患者在出血量上在数量上相似。凝血试验无法预测临床上显著的出血，这可能发生在凝血试验结果正常的患者中。
