【摘要】 目的探讨大咯血病人的病因、诊断方法和外科处理措施。方法对12例经外科治疗的大咯血病例进行回顾性分析。结果12例中有4例肺结核（33．3％）、3例支气管扩张（25．0％）。3例在咯血间歇期急诊作纤支镜判定出血来源，7例通过摄胸片得以定位。12例病人都作急诊肺叶切除，手术死亡率为8．33％。结论大咯血病因以肺结核、支气管扩张多见，胸部摄片和紧急纤维支气管镜为主要诊断方法。急诊肺叶切除能去除出血来源及挽救病人生命，并能减少出血和感染扩散的危险，取得并发症少、死亡率低的良好效果。严格的术前准备、精确判定出血部位、平稳的麻醉处理、气管或支气管内插管、适当吸痰使下呼吸道通畅、迅速切除病肺是手术成功的关键。术后着重于咳痰、或支气管吸引下呼吸道积血或凝血块的处理；并积极预防感染。更多还原

【Abstract】 To study the etiology diagnosis and sungical management of the patients withmassive hemoptysis. Methods Retrospective analysis was made for 12 cases of the patients with massivehemoptysis who were handled through surgical therapy. Results Of the 12 cases, 4 cases werepulmonary tuberculosis, accounting for 33. 3%. 3 cases were bronchiectasis (25. 0% ). With regar tothe site of hemorrhage, 7 cases were determined though chest x-ray, and 3 cases through emergencefibrobronchoscopy during the period of hemoptysis pause. All the 12 cases were underwent emergencelung resection, the operative mortality rate was 8. 3%. Conclusions The most cause of massivehemoptysis was pulmonary tuberculosis and bronchietasis. The main way of diagnosis for massivehemoptysis was chest x-ray and fibrobronchoscopy. Emergeney lung resection can remove the sources ofhemorrhage and rescue patient s life, and with less complication and low mertality. In addition, it mayreduce the risk of bleeding or spreading of infection. Preoperative accurate diagnosis of the site of thepulmonary or brochial hemorrhage was a necessity for the success of surgely. Stable anesthesia withproper tracheal or trach-endobrachial intubation plus adaqate aspiration to keep the lower airmy patent isimportant. Speedy surgical resection of the ill lung is vital. Postoperative mangagement should focus onexpectoration or trachebronchial aspiration of the accunmlated blood or blood clots in the lower airwayand prevention of infection.更多还原