咯血的介入治疗流程及规范.pdf

1/12下载文档可编辑咯血的介入治疗流程及规范24 小时咯血量 200ml300ml 以上或血细胞比容减少30%可以诊断为大咯血。呼吸系统疾病9%15%可引起咯血，其中大咯血占1.5%，死亡率极高,达 60%80%，主要为失血性休克或呼吸道大量血液堵塞窒息而致死。病因咯血常见的病因以肺结核(38%)、支气管扩张(30%)、支气管肺癌(9%)，慢性肺部炎症和肺脓肿(9%)多见，同时肺动脉静脉瘘、肺动脉栓塞、肺隔离症、肺霉菌病、肺外伤、先天性心脏病、二尖瓣狭窄、肺动脉高压、支气管动脉瘤、支气管动脉肺动脉瘘、支气管动脉曲张、凝血异常等也可以导致大咯血。临床表现咯血病人常有原发肺内病变存在，且有反复咯血病史且逐渐加重以及贫血貌。据估计肺泡内积血量达400ml 即可出现明显的氧气交换障碍，并且症状出现与出血速度密切相关，当病人出现面色、脉搏、呼吸、血压改变和紫绀等威胁生命的症状或需输血维持血容量均可视为大咯血。-第 1 页，共 12 页精品p d f 资料 可编辑资料-2/12下载文档可编辑解剖基础支气管动脉的起始咯血大部分来自支气管动脉（90%以上），肋间动脉等，绝大多数开口于第胸椎体上缘到第胸椎体下缘范围内的主动脉腹侧壁。右侧支气管动脉起源于：右侧肋间动脉（44.9%）；主动脉降部（30.6%）；主动脉弓（14.3%）；右锁骨下动脉（10.2%）左侧支气管动脉主要起源于：主动脉降部（86.5%）；主动脉弓（10.9%）。此外支气管动脉尚可起自头臂干，甲状颈干，胸廓内动脉，心包膈动脉，膈下动脉，腹主动脉，甚至冠状动脉等。支气管动脉的走形及分布支气管动脉自体循环大动脉发出以后都位于气管、支气管背侧，穿行于同侧迷走神经各分支组成的复杂的肺神经丛中，沿两侧支气管进入肺门。另外亦有分支到食管中段、气管及支气管旁淋巴结、肺间质淋巴结等，脊髓前、后动脉均可能起源于肋间动脉或与肋间支气管动脉共干。-第 2 页，共 12 页精品p d f 资料 可编辑资料-文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I13/12下载文档可编辑支气管动脉栓塞术采用 Seldinger技术经股动脉选择性插管至支气管动脉，先行支气管动脉造影确定出血部位、程度，再行治疗性支气管动脉栓塞出血血管。自从 1963 年 Viamonle 成功实施了第一例选择性支气管动脉造影（Selective bronchial arteriography，SBAG），1974 年法国学者Remy首先应用支气管动脉栓塞术（Bronchial artery embolization，BAE）治疗大咯血成功。人们已逐渐开始并不断增多利用BAE治疗大咯血，并取得较为满意效果，目前，大多数学者推荐为首选治疗方法。适应症及禁忌症适应症一般说来，任何急性大咯血或反复较大量咯血；一次咯血量200ml，经内科治疗无效或经手术治疗又复发咯血，如支气管扩张症所知的大咯血、肺结核咯血、肺肿瘤咯血、肺部血管畸形咯血等。怀疑出血来自支气管动脉，而无血管造影禁忌症者均可考虑行支气管动脉栓塞治疗。包括（1）反复大咯血，胸部病变广泛功能差，无法作肺切除者（大咯血患者大多有长期肺疾患）；（2）需手术治疗，暂不具备手术条件，必须先控制出血者；-第 3 页，共 12 页精品p d f 资料 可编辑资料-文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I14/12下载文档可编辑（3）咯血经手术治疗后复发者；（4）拒绝手术治疗的大咯血病人，（5）支气管动脉栓塞术后复发咯血者。禁忌症（1）严重出血倾向，插管局部皮肤感染，碘过敏，肝肾功能障碍，严重甲亢，体弱，发热和感染者；（2）肺淤血以及肺动脉严重狭窄或闭塞的先天性心血管病患者；（3）支气管动脉或肋间动脉与脊髓动脉沟通，在造影或栓塞时，将引起脊髓损伤而致截瘫者；（4）导管在靶血管固定困难或者试注对比剂明显返流者。介入手术操作常规术前准备1.术前明确出血部位，为准确栓塞提供可靠的资料，胸部摄片及 CT尤其是 HRCT 对出血部位的确定明显优于支气管镜，根据临床检查确定可能的出血部位进行栓塞。2.术前有活动性咯血的病人，需保持呼吸道通畅和吸氧3.术前可肌注安定10mg4.准备好抢救的药物和器械，如吸痰器、面罩、气管插管、气管切开包等，以备急用-第 4 页，共 12 页精品p d f 资料 可编辑资料-文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I15/12下载文档可编辑5.血管造影必需的介入器材：如穿刺鞘组、造影导管、碘对比剂6.把可能出现的并发症及危险性告诉病人家属，并在手术同意书上签名。术中操作支气管动脉术前造影为栓塞咯血的支气管动脉提供途径，是进行支气管动脉栓塞的先决条件。可采用 5F或 6F 胃左动脉导管，Cobra 导管等，在 DSA监控下，将导管插至胸主动脉弓处并成形，拉至胸主动脉相当于支气管隆突水平，上下滑动，当导管尖滑入支气管动脉入口部时，用手推非离子型造影数毫升确定为支气管动脉后行支气管动脉造影。右肺病变发生率高于左肺，尤右肺上叶易受侵犯，在活动性咯血期间，结合胸部影像学资料，应用DSA能更清晰地显示出血病灶的部位。造影一方面可显示病灶的直接出血征象（病灶区支气管动脉内造影剂外溢，当出血量0.5 1.0ml 可显示外溢），动态观察更为明显，为最可靠的定位指标，但显示率不高，为2%-24%。具体表现为：（1）肺实质内有造影剂渗出形成片状或斑点状出血；（2）同侧同叶三、四级支气管腔内有造影剂涂抹。-第 5 页，共 12 页精品p d f 资料 可编辑资料-文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I16/12下载文档可编辑另一方面可显示间接出血征象：（1）患侧支气管动脉增粗；（2）病灶血管增多、紊乱；（3）动脉瘤样改变；（4）支气管动脉肺动脉瘘形成；（5）病灶的肺实质内存在较弥散的浓染区.支气管动脉栓塞造影情况明确后，将导管头插入支气管动脉，并尽量深入，再手推注入少量对比剂（23ml）证实无返流及无脊髓动脉显影后，进行栓塞治疗。当肺部有慢性病或先天性心脏病史，造成肺动脉血运障碍，气体交换不良时，支气管动脉可增粗，起代偿肺动脉的作用，同时血流快，流量大，利于区别病变部位，插管，药物灌注及栓塞剂进入病变血管。确定出血部位后，采集一张造影片以备参考，然后将导管伸至所需支气管动脉开口，行栓塞治疗，肺癌所致出血则先行药物灌注化疗后再行支气管动脉栓塞。（1）选择性支气管动脉插管（Selective bronchial artery embolization,SBAE）及同轴超微导管选择栓塞技术（3F 的 SP导管），首先可以避免或减少栓塞剂返流引起误栓，其次避开支气管动脉肺门附近发出的食管动脉及其他小分支，支气管动脉脊髓-第 6 页，共 12 页精品p d f 资料 可编辑资料-文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I17/12下载文档可编辑支多数起自肋间支气管动脉，由肋间支发出的行选择性插管，避开肋间动脉就可以避免误栓脊髓动脉。（2）栓塞剂及栓塞方法的选择1）明胶海绵采用 1 大小颗粒进行栓塞，栓子能够进入小的病灶使之栓塞，减少侧支循环的形成，且分布均匀，又能避免液体栓塞剂所致的广泛支气管粘膜坏死。但明胶海绵在一定时间内会被吸收，而使栓塞的血管再通，可采用与末梢栓塞剂鱼肝油酸钠联合应用，鱼肝油酸钠已被证实为一种有效的末梢栓塞剂。栓塞时采用低压流控法注入。注入过程中应避免栓子返流。栓塞程度以大部分病理血管不显影为准，切忌过度栓塞，以免栓塞剂返流而引起其他血管的阻塞。2）先用明胶海绵颗粒（1 x1 x1）行末梢栓塞，再用明胶海绵条（1 x1 x10）行主干栓塞，从而作到栓塞长久，稳定的效果，明胶海绵经高温消毒后变性，在体内停留可达180 天。3）用明胶海绵和丝线微粒分别加入造影剂混合栓塞，当见到血流缓慢或完全停止时，立即终止栓塞，避免栓塞剂返流。4）亦有学者用明胶海绵加红霉素联用，报告有较好疗效。5）国外文献有报道用直径0.30.5 的 PVA联用直径 2的 PVA，或联用直径 2-3 的铂金弹簧圈，或与明-第 7 页，共 12 页精品p d f 资料 可编辑资料-文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8 ZM9I2D1B3I1文档编码:CM7Q8H6J10T6 HT4H8F2D5M8