【作者】 王彦；

【导师】 吴泰华；

【作者基本信息】 大连医科大学 ， 内科学， 2013， 硕士

【摘要】 咯血(hemoptysis)并非一种单独疾病，可以出现在任何年龄阶段，它是指喉及喉以下的呼吸道和肺出血，经口咳出，是各种严重疾病的重要表现，即使是少量咯血也应该引起高度重视。许多呼吸系统良恶性疾病、循环系统疾病、自身免疫系统疾病都可表现为咯血。据统计可引起咯血疾病有100种，早些年90%以上的咯血是由支气管扩张、肺结核和肺脓肿引起，随着结核治疗的普及、百日咳疫苗接种、抗生素的及时使用，支气管扩张和肺结核发生率显著下降。目前由于环境污染、吸烟等多种因素，导致肺癌发病率呈逐年上升，引起咯血的发生率有明显提高。近几年国内有文献报道在我国咯血主要疾病中，肺结核（占52.9%）、支气管扩张（占22.7%）、肺癌（占6.6%）、肺炎（占3.1%）、其他（占14.7%)。目前医疗技术对其病因诊断的准确性已相当高，但是仍然有部分患者的咯血原因不十分清楚，通过病史采集、体格检查、X线或CT扫描以及纤维支气管镜检查及凝血因子测定，仍不能解释的咯血原因，约占7-25%[1]，将其定义为隐源性咯血(cryptogenic hemoptysis，CH)，它是一个相对的概念，目前国内外对CH尚无统一明确的定义。CH给临床上诊治带来了困难，在治疗原则和预后都存在着争议，随着时代发展、检查设备更新，CH的外延范围而逐渐缩小，有时支气管动脉造影可能是唯一发现出血部位、指导治疗的方法。本文对大连医科大第一附属医院呼吸科2007年1月-2013年1月632例以咯血入院的患者的诊治进行总结，发现有72例患者为CH，其中男性49例，女性23例，并选取2例诊断为CH进行报道，总结临床特点、诊治及转归，对其针对性的诊治进行讨论。更多还原

【Abstract】 Hemoptysis is not a single disease, and it can occure in any age.The definition ofhemoptysis is the hemorrhage of laryngeal、lower respiratory tract and lung.It coughs upthrough the mouth and it is also an important clinical manifestation of all kinds ofserious disease.Therefore,a small amount of hemoptysis should be paid much attentionto it.Hemoptysis can be occurred in benign and malignancy disease of respiratorysystem,circulatory system disease,and autoimmune disease.According to thestatistics,there are about100kinds of diseases can cause hemoptysis.In early years,morethan90%of the hemoptysis was caused by bronchiectasis,lung abscess, andtuberculosis.With the popularity of the treatment of tuberculosis,the use of pertussisvaccines,and the timely use of antibiotics,the incidence of tuberculosis andbronchiectasis dropped significantly.At present,due to a variety of factors,such asenvironmental pollution and smoking,the incidence of lung cancer increased year byyear and then the incidence of hemoptysis increased dramatically.In recent years, someliterature reported that the main hemoptysis related diseases consisted of52.9%ofpulmonary tuberculosis,22.7%of bronchiectasis,6.6%of lung cancer,3.1%ofpneumonia,and14.7%of other diseases.Nowadays,the accuracy of medical technology for the etiological diagnosis ofhemoptysis is quite high,but some reasons of hemoptysis are not very clear,7-25%ofhemoptysis still can not explain through history collection,physical examination,X rayor CT scans,fiber bronchoscope examination,and determination of clotting factors.It isdefined as the cryptogenic hemoptysis(CH).CH is a relative concept, there is no cleardefinition of unity at home and abroad.It brought difficulties to clinical diagnosis andmade treatment principle and prognosis controversial.With the development of age andthe update of the equipment,the denotation of CH is gradually narrowed down.However,sometimes bronchial arteriography may be the only approach to findbleeding and guide treatment.In this paper,we collected632cases of hemoptysis from Jan,2007to Jan,2013inthe first affiliated hospital of Dalian medical university.We found72cases were CH andits includes,49cases of men and23cases of women.Then I chose2cases which havealready been diagnosed as CH to report,to sum up the clinicalcharacteristics,diagnosis,treatment and prognosis.At last,I made a discussion about thecorresponding diagnosis and treatment.更多还原