| Objective: To evaluate the efficacy and the safety of endobronchial tamponade technique using Swan-Ganz catheter fixed by surgical thread to bronchofibroscope to treat massive hemoptysis, and compare with Fogarty catheter method.Method1. clinic data: 30 hemoptysis cases, 9 men and 11 women, their ages are between 24~76 years old, and average age is 54.87±14.34 years old. All patients including 8 bronchiectasis cases, 13 lung cancer cases 6 pulmonary tuberculosis and others such as aspergillomycosis 3 cases。They conform to the following conditions and were picked out for our research: (1) the total hemoptysis quantity was above 300ml in 24 hours or reached 100ml at one time; (2) all the patients were accepted hematostatic treatment for 1 week but had no effect, and accept the treatment with double-lumen balloon floatation catheter or Fogarty catheter voluntarily; (3 )has no serious heart, lung or brain function diseases or disturbance; (4) without obvious contraindications of bronchofibroscope. We divided the 30 patients into two groups randomly: observe group (15 examples) receive endobronchial tamponade technique of Swan-Ganz catheter fixed with bronchofibroscope by thread and control group (15 examples) were treated by endobronchial tamponade technique with Fogarty catheter. The comparison between two groups in some aspects such as age, sex, hemoptysis quantity, hemoglobin quantity and so on have no statistical significance(P>0.05).2. The method of placing Swan-Ganz catheter: Fix both tips of bronchofibroscope and the Swan-Ganz catheter with surgical thread, insert them tighter from nostril into trachea,suck the blood and find the bleeding site meanwhile. The catheter is pushed forward, place proximal to bleeding site and is inflated with Sodium Chloride until the bronchus is totally blocked up. Then shut the valve, relax the thread and pull out the bronchofibroscope after ensuring no continuous bleeding is observed. Write down the dosage of Sodium Chloride in the balloon and the length of the catheter from the nose, and then fix the catheter on nosewing with a"T"shape adhesive tape.3. The method of placing Fogarty catheter: Insert the bronchofibroscope from nostril into trachea under local anesthesia; follow the bloodstain in airway and find the bleeding site, then fix the bronchofibroscope. Deliver the balloon catheter daubed Lidocaine gelatin and disinfectant paraffin oil and removal the valve system to the bleeding site accurately through bronchofibroscope working channel, then withdraw the bronchofibroscope slowly, install the valve system. Insert the bronchofibroscope to the bleeding site once more through the oral cavity, after confirming the position of the balloon of catheter; inject Sodium Chloride until the bronchus is totally blocked up in order to stop the hemorrhage. Write down the dosage of Sodium Chloride in the balloon and the length of the catheter from the nose; fix the catheter on nosewing with a"T"shape adhesive tape at last.Results1 Curative effect: The majority of patients stop bleeding immediately after the balloon catheter was inserted. observe the bleeding quantity, the time of bleeding continues after tamponade of all the patients and the total days of patients in hospital of two groups, there is no obvious difference between two groups (P>0.05). 15 patients were effective in observe group, the effectiveness is 100% while 13 patients in control group,and the effectiveness is 86.7%,the total effectiveness of massive hemoptysis treated by double-balloon catheter tamponade technique in two groups is 93.3%.2 The comparison of two groups'operation time: The average operation time on observe group is 8.3±1.0 minutes while the control group is 14.5±2.7 minutes. The average operation time on observe group is obviously shorter than control group, there is statistics difference(P<0.05), but there is no statistics difference(P>0.05) of balloon catheter keeping time on observe group and control group.3 One patient of inducing or aggravating bleeding during the operation was observed in the observe group while three in control group, there is no statistics difference(P>0.05), the patients of catheter obstructed or dislodged was observed in the observe group were one and four in the control group, there is no statistics difference yet(P>0.05)Although one patient got obstructive pneumonia after the operation in each group, they all cured by antibiotic therapy for 3 to 5 days after the catheter was pulled out.4 Security of balloon catheter tamponade technique4.1 The change of vital signs: the patients'heart rate,respiratory frequency before catheter inserted is higher than the patients two hours after the operation, and higher than which after the catheter was pulled out too,there are statistics difference(P<0.05). Patients'temperature before catheter was inserted and two hours after the operation is higher than that after the catheter was pulled out, there is statistics difference(P<0.05). No obvious change of vital signs before catheter was inserted,two hours after the operation and after the catheter was pulled out was observed between two groups, and there is no statistics difference(P>0.05)4.2 The change of blood gas analysis: Before catheter was inserted,two hours after the operation and after the catheter was pulled out , all the patients'PO2,PCO2,SaO2 measurement results are all in normal range, there is no obvious change(P>0.05), The blood gas analysis comparison between two groups is no obvious before catheter was introduced, two hours after the operation and after the catheter was pulled out, there is no statistics difference(P>0.05)Conclusion: It is very good for the Massive hemoptysis therapy by the tamponade technique with Swan-Ganz catheter fixed with bronchofibroscope by surgical thread in airway. The operating time used by endobronchial tamponade technique with Swan-Ganz catheter fixed by surgical thread is shorter than the method Fogarty catheter inserted. Also there is no obvious affection to patients'vital signs, blood gas analysis. It is a kind of more convenient, operating easily, more safety and effective method.
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