Check hemoptysis, massive hemoptysis should be how

hemoptysis should do what check?

1. hematologic inflammation WBC often increased, and a shift to the left, if there is infantile leukemia should be considered the possibility of white blood cells, increased eosinophils often prompts the possibility of parasitic disease, bleeding disease, should determine the clotting time, prothrombin time and platelet count, etc., necessary for bone marrow examination.

2. sputum examination by sputum smear and culture, find the general pathogen, Mycobacterium tuberculosis, fungi, parasites and tumor cells and other eggs.

1. chest X-ray chest X-ray diagnosis of hemoptysis is significant, it should be as routine examination, requiring more than one position projection, if necessary, should be added according to the anterior arch position, spot film and radiographs, appear on the chest hair-like distribution along the bronchial shadows, and more tips bronchiectasis; fluid levels prevalent in the lung abscess; substantial lung cancer lesions more consideration, it is worth noting that a lot of bleeding in the lesion of blood near the airway can be inhaled Such inhalation can lead to alveolar filling, the formation of blood aspiration pneumonia, in the early lung parenchymal disease easily confused with, but the blood aspiration pneumonia often absorbed within 1 week, so once again radiography will help identify the two.

2. chest CT is a non-invasive examination, pulmonary dysfunction is more secure, but the activity in patients with massive hemoptysis should normally be carried out after the cessation of hemoptysis, compared with ordinary X-ray, found overlap with the heart and hilar lesions and vascular lesions and other aspects of local small, CT examination has its unique advantages in the evaluation of patients with stable bronchiectasis, chest CT has been basically replaced bronchography, a study abroad, CT cystic bronchiectasis of the sensitivity of 100%, the sensitivity of cylindrical bronchiectasis was 94%; specificity were 100%, subject to price factors, patients present with massive hemoptysis, chest CT is still only as second-line inspection program.

3. bronchoscopy for the diagnosis of the cause of hemoptysis is unclear, or bleeding after conservative treatment ineffective, currently, many advocates in the early implementation of hemoptysis during bronchoscopy, which is based on:

(1) the early implementation of bronchoscopy can more accurately determine the bleeding site.

(2) can significantly improve the accuracy of diagnosis of the cause of hemoptysis.

(3) for the treatment of choice and provide the basis for implementation (such as surgery, bronchial artery embolization, etc.).

(4) can be localized directly on the bleeding site to stop bleeding.

bronchoscopy can be divided into the types of bronchoscopy and rigid bronchoscopy can be bent (ie, bronchoscopy), usually more like surgeons use rigid bronchoscopy, and pulmonary physicians is even more preferred bronchoscopy, compared to , the bronchoscope is a simple, no general anesthesia, wide visible region and injury, etc., it has been widely used clinically, however, once the bleeding more than the ability to attract bronchoscopy, or recurring blood clots stain and plug the bronchoscopy, etc., should be replaced by rigid bronchoscopy to check, or endotracheal intubation to prevent excessive bleeding caused by suffocation, but also for bronchoscopy was to attract the lumen or peripheral blood clotting Block after block out cleaning and re-entry, it should be stressed, hemoptysis during bronchoscopy has some risk, therefore, make the necessary checks before the rescue preparations, especially for choking rescue ready, and should pay attention to the inspection process of oxygen and ECG, blood pressure, oxygen saturation monitoring, reduce the incidence of adverse effects.

4. bronchography with chest CT and bronchoscopy a wide range of applications, only a few millimeters in diameter have been able to look directly at the airway observation, coupled with bronchial angiography of the operation, resulting in patients with hypoxia and potential risk of bronchospasm, hemoptysis patients are often difficult to tolerate, so the recent or active hemoptysis patients, its diagnostic value is limited, at present, mainly used for bronchography: ① In order to confirm the limitations of bronchodilators (including isolation lobe) of the existence of; ② the proposed line to exclude the limitations of surgical treatment of bronchiectasis patients with more extensive disease exists.

5. angiography

(1) selective bronchial arteriography: in recent years, a set of data shows that 306 cases of hemoptysis patients, bleeding from the bronchial artery were 280 cases (91.5%), from the pulmonary artery in 26 cases (only 8.5% ), the other group of 72 patients found that patients with massive hemoptysis, bleeding from the pulmonary artery were also accounted for only 8.4%, showing that patients with hemoptysis bleeding, mostly from bronchial arterial system, selective bronchial arteriography can not only clear bleeding The exact location, but also to find the abnormal expansion of the bronchial arteries, distorted, aneurysm formation, and circulation - the existence of the traffic branch pulmonary circulation, so as to provide the basis for bronchial artery embolization.

(2) pulmonary angiography: the cavitary pulmonary tuberculosis, lung abscess caused by disorders such as intractable hemoptysis; and erosion of suspected false aneurysm, pulmonary abnormalities exist, should be selective bronchial arteriography in the Also, add as pulmonary angiography.

6. isotope scanning to stop bleeding underwent ventilation / perfusion scans help confirm the diagnosis of pulmonary embolism.