致命性大咯血是呼吸科常见的一种急危重症,合并严重气道阻塞和呼吸衰竭时单纯呼吸机支持往往无法维持患者氧合.随着体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)技术的发展,无抗凝或低剂量抗凝ECMO在大咯血中得到越来越多的应用,从而为后续的止血、清理气道血凝块等治疗创造时间.文章报道了 1例由于支气管扩张导致大咯血合并急性呼吸衰竭,并在无抗凝ECMO辅助下通过支气管动脉栓塞联合气管镜介入治疗极危重大咯血的救治过程,以提高临床医师对极危重大咯血患者的认知和诊疗经验.
Massive hemoptysis is a respiratory emergency and critical condition,and simple ventilator support is often unable to maintain oxygenation when it is combined with severe airway obstruction and respiratory failure.Extracorporeal membrane oxygenation is an advanced life support technique,and with the development of ECMO technology,non-anticoagulation or low-dose anticoagulation ECMO has been increasingly used in the treatment of massive hemoptysis,thus creating time for subsequent hemostasis,airway contouring and other treatments.In this article,we report a case of massive hemoptysis combined with acute respiratory failure due to bronchiectasis and the process of treatment for extremely critical hemoptysis by bronchial artery embolization and tracheoscopic intervention with the assistance of non-anticoagulation ECMO,in order to improve the clinicians'experience in the understanding,diagnosis and treatment of patients with extremely critical massive hemoptysis.
侯海佳;代冰
中国医科大学附属第一医院呼吸与危重症医学科,辽宁沈阳 110001
临床医学
体外膜肺氧合;大咯血;气管镜介入治疗;支气管动脉栓塞
extracorporeal membrane oxygenation;massive hemoptysis;tracheoscopic intervention;bronchial artery embolization
《中国实用内科杂志》 2024 (003)
193-197,234 / 6
辽宁省科技攻关专项(2022020623-JH1/108);沈阳市科技计划项目(21-172-9-2)
10.19538/j.nk2024030104
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