天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (4): 494-496.doi: 10.11958/20160031

• 应用研究 • 上一篇    下一篇

氩等离子体凝固术在支气管镜活检后止血中的应用

张永祥1,2 ， 贾玮2 ， 李月川2△， 张冬睿2 ， 马晖2   

  1. 1天津医科大学研究生院 （邮编300070）； 2天津市胸科医院呼吸与危重症医学科
  • 收稿日期:2016-01-25 修回日期:2016-03-06 出版日期:2016-04-15 发布日期:2016-05-20
  • 通讯作者: △通讯作者 E-mail:liyuechuandoctor@126.com E-mail:815142840@qq.com
  • 作者简介:张永祥 （1978）， 男， 主治医师， 硕士在读， 主要从事肺癌、 慢性阻塞性肺疾病及肺间质疾病等研究

The application of argon plasma coagulation in hemostatic treatment after bronchoscopic biopsy

ZHANG Yongxiang1,2 , JIA Wei 2 , LI Yuechuan2△, ZHANG Dongrui 2 , MA Hui 2   

  1. 1 Graduate School of Tianjin Medical University, Tianjin 300070, China; 2 Respiratory and Critical Care Unit, Tianjin Chest Hospital
  • Received:2016-01-25 Revised:2016-03-06 Published:2016-04-15 Online:2016-05-20
  • Contact: △Corresponding Author E-mail:liyuechuandoctor@126.com E-mail:815142840@qq.com

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摘要： 摘要： 目的 观察经支气管镜以氩等离子体凝固术 （APC） 对活检后出血创面行止血治疗的效果及安全性。方法 对合并冠心病、 高血压及阵发房颤等接受常规支气管镜检查并行气道内病灶活检且出血较多的患者， 行 APC 止血治疗， 观察止血效果和治疗前后患者血压、 心率及血氧饱和度变化。结果 62 例患者行支气管镜下活检后立即采用 APC 对活检处行止血治疗， 其中 60 例立即止血成功， 2 例患者活检后大出血， 在气管插管及机械通气支持下以 APC 止血成功。62 例中气道内肿物 42 例 （叶支气管开口 26 例， 段支气管开口 16 例）； 叶、 段支气管嵴增宽黏膜粗糙 16 例； 叶支气管开口肉芽组织 4 例。60 例行 APC 治疗后患者平均动脉压及心率与治疗前差异无统计学意义， 血氧饱和度较治疗前降低 （0.939±0.027 vs. 0.956±0.017， P < 0.05）。结论 经支气管镜对活检后出血部位行 APC 止血治疗具有迅速、 彻底、 安全的特点， 尤其是对于合并心血管疾病患者， 避免了常规止血治疗导致心血管并发症的发生。

关键词: 支气管镜检查, 活组织检查, 出血, 止血, 氩等离子体凝固术

Abstract: Abstract: Objective To observe the hemostatic efficacy and safety of argon plasma coagulation (APC) through bron⁃ choscope after biopsy. Methods The APC was given to patients suffered from coronary heart disease combined hyperten⁃ sion or paroxysmal auricular fibrillation and accepted bronchoscopy biopsy with much bleeding. The hemostatic effect and changes of heart rate, blood pressure and SPO2 were observed before and after treatment. Results Sixty-two patients were treated with endoscopic hemostasis by APC. The hemostasis was successful in 60 cases. The hemostasis was performed with APC successfully in 2 patients after intubation and mechanical ventilation because of the biopsy hemorrhage. Sixty-two cas⁃ es included 42 cases of airway tumor (26 cases in lobe bronchus and 16 in segmental bronchus), 16 cases of broadening of the trachea ridge and mucosal rough, and 4 cases of granulation tissue of lobe bronchus. There were no significant differenc⁃ es in mean arterial pressure and heart rate before and after treatment in 60 patients (P > 0.05). The oxygen saturation was sig⁃ nificantly lower after treatment than that before treatment (0.939±0.027 vs. 0.956±0.017, P < 0.05). Conclusion Hemosta⁃ sis treatment by APC through bronchoscope has the characteristics of rapid, thorough and safe, especially for patients com⁃ bined with cardiovascular disease. It can avoid the occurrence of cardiovascular system complications caused by convention⁃ al hemostatic treatment.

Key words: bronchoscopy, biopsy, hemorrhage, hemostasis, argon plasma coagulation