CT血管成像对严重咯血急诊处理的应用价值

doi:10.24920/003482

摘要/Abstract

摘要：

目的探讨急诊咯血患者支气管动脉的多排CT血管成像的影像解剖特点,并评估其对急诊咯血患者处理的应用价值。

方法回顾性分析2013年1月1日至2015年12月31日急诊就诊的严重咯血患者（24小史咯血量≥100 ml）的临床与影像数据。讨论这些患者的多排CT血管成像图像特点、治疗方法和结局。

结果共108例患者进行了多排CT血管成像检查。引起咯血病因主要为支气管扩张（44%）、结核（26%）和肿瘤（18%）。多排CT血管成像能显示197条支气管动脉和相关的35条非支气管体部动脉。位于纵膈气管分叉水平的支气管动脉的平均直径为2.8±1.2 mm。接受保守治疗的52例患者的支气管动脉的平均直径为2.9±1.1 mm,与56例接受栓塞治疗患者的支气管动脉平均直径无显著性差异（2.7±1.1 mm,P=0.94）。栓塞治疗的技术成功率为95%（53/56）。随访患者的临床治愈率为94%（50/53）。

结论对于严重咯血患者,多排CT血管成像能显示出血相关支气管动脉和非支气管体部动脉的解剖特点。然而,通过多排CT血管成像测量的支气管动脉直径不能作为患者是否需要支气管动脉栓塞治疗的指征。

关键词: 咯血, 多排CT血管成像, 血管内栓塞

Abstract:

Objective To depict imaging anatomy of bronchial artery (BA) using multidetector CT-angiography (MDCTA) and evaluate the value of MDCTA for management of hemoptysis patients requiring admission to emergency room.

Methods We retrospectively studied the clinical and radiological data of patients with severe hemoptysis (≥100 ml of expectorated blood in a 24-hour period) requiring admission to emergency room from Jan 1, 2013 to Dec 31, 2015. Patients’ images of MDCTA, treatment modalities, and outcome were discussed.

Results A total of 108 patients underwent MDCTA scans. Etiology of hemoptysis was mainly bronchiectasis (44%), tuberculosis sequelae (26%) and tumor (18%). MDCTA visualized 197 traceable BAs and also suggested the involvement of 35 nonbronchial systemic arteries. The mean diameter of BAs, measured at the level of the bronchial bifurcation in the mediastinum, was 2.8±1.2 mm. The mean diameter of BAs, for 52 patients who only received conservative treatment, was 2.9±1.1 mm, and was not significantly larger than that of BAs for 56 patients who underwent bronchial artery embolization (BAE) for continued bleeding which did not resolve after conservative treatment (2.7±1.1 mm, P = 0.94). The technical success rate of embolization was 95% (53/56). Clinical success rate during follow-up was achieved in 50 (94%) of 53 patients who had undergone embolization.

Conclusions MDCTA provides useful information for identifying the anatomical characteristics of bleeding-related BAs and nonbronchial systemic arteries for the management of patients with severe hemoptysis. However, MDCTA could not determine the individuals who need BAE through measuring diameter of BAs.

Key words: hemoptysis, multidetector CT-angiography, endovascular embolization

Chen Ying, Wang Kefei, Wang Zhiwei, Liu Changzhu, Jin Zhengyu. Value of CT-Angiography in the Emergency Management of Severe Hemoptysis[J].Chinese Medical Sciences Journal, 2019, 34(3): 194-198.

图/表 2

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Groups	n	Gender (male/female, n)	Age (yrs)	Volume of blood loss in a 24-hour period (n)
Groups	n	Gender (male/female, n)	Age (yrs)	100-300 ml	> 300 ml
Group 1	52	36/16	56.6±13.5	37	15
Group 2	56	35/21	54.1±14.7	34	22
t or χ²value		0.542	0.406	1.305
P value		0.461	0.503	0.253

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