Effective Analysis Of Bronchial Arterial Embolization To Massive Hemoptysis

Massive hemoptysis is a kind of clinical acute disease with high mortality, life is often endangered to suffocate by the blocked respiratory tract or the blood- losing shock. The internal medical treatment of refractory massive hemoptysis often meets difficulty with recurrence. Theoretically, the textile fiberbronchoscope can stop bleeding directly through oppression of the aerocyst catheter and spray of the medicine under straight eyesight, however, the textile fiberbronchoscope inspection has certain risk for patients whose hemoptysis has not been controlled completely, it tends to cause suffocation, what's more, it can not deal with subsection's pathological change. Surgical operation may achieve therapy purpose through excision of the lung heart functions can not stand thorax-open operation. In recent years, progressed along with the unceasing development of radiology, BAE(Bronchial Arterial Embolization) is applied more and more widely for massive hemoptysis treatment, there also exists problems. The hemostasia effect is fairly good in the near future, but there is recurrence at a specified future date. This thesis collected 45 cases of massive hemoptysis patients applied with BAE in Number One Hospital of Jilin University during the period from October, 2004 to October, 2006., analyzing the clinical effect of BAE on massive hemoptysis from the perspectives of different intubattons and different embolization material. Embolism is carried out with two methods: bronchial arterial branch or supra-selective bronchial arterial sub- branch embolisation. Among which 25 cases with bronchial artery branch embolization, 20 cases with supra-selective bronchial artery sub - branch embolization. Material for embolism: gelfoam, anhydrous ethanol etc. The clinical effect of BAE on massive hemoptysis is analyzed from the inspection of immediate postoperative hemostasia rate, short-term hemostasia rate and center forward hemostasia rate.The result proves that the near future curative effect is satisfactory after the successful operation of BAE. There is no obvious difference in catheter- inserting techniques and embolization material. Six to twelve months'observation and interview show that 7 recurring cases are all pure gelfoam united embolization No recurrence was found in anhydrous ethanol embolization, which proves that the singnificant difference is obvious (P<0.05). With the application of anhydrous ethanol embolization pathological change far-end branch, the forward curative effect has the obvious superiority. The result prompt that the forward curative effect has obvious superiority after the application of far end branch skill of anhydrous ethanol embolism. Since misuse of anhydrous alcohol may lead to damage of spinal cord, attention should be paid to the flow rate, flow quantity, and degrees of embolization in the operation. The experience is demonstrated as follows: 1 Use the coaxial micro - catheter as surpa- selective embolization, to avoid the spinal cord branches which share the same trunk or get cross with bronchial artery and intercostal artery, so as to avoid mis - embolization; 2 When making embolization, the end of micro- catheter should be put at the ending sub- branch of the bleeding arterial, or try to approach the bleeding source as near as possible; 3.The afflux speed of anhydrous ethanol should be controlled restrictedly to avoid reflux. In this way, hemostasia can be achieved effectively with decreasing complications and the security of interposition embolization is improved tremendously.Through an analysis of influences caused by intubatton on BAE effect, all the recurring cases in this group are selective BAE, while no supra-selective BAE recurs. Supra-selective BAE can promote BAE's forward curative effect obviously.This thesis provides important scientific evidence for BAE's clinical application, and its innovations lies in the following aspects: 1. Application of anhydrous ethanol as embolization agent is satisfactory for massive hemoptysis treatment with low rate of recurrence. 2. Application of coaxial micro -catheter technique accompanied with anhydrous ethanol embolization can avoid spinal cord damage and other severe complications. Supra-selective BAE, being a kind of clinical technique which can improve massive hemoptysis patints'condition, deserves clinical popularization.