Bronhiālo artēriju embolizācija pie asins spļaušanas - tehniskie aspekti un klīniskie rezultāti
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Date
2021
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Aktualitāte:
Masīva asins spļaušana raksturojas ar augstu letalitāti. 90% gadījumu asiņošanas vieta ir aa. bronchiales. Bronhiālo artēriju embolizācija (BAE) ir neatliekama asins apturēšanas manipulācija, kurā embolizējot noteikto asiņošanas lokalizāciju, tūlītēja asins apturēšana ir sasniedzama 85-100% gadījumu. Atkārtota asins spļaušana pēc procedūras ir novērojama 10-33% gadījumu. BAE kalpo kā neatliekama iejaukšanās ar mērķi apturēt asiņošanu, kas izdošanās gadījumā, rezultējas ar iespējami labāku dzīvildzi pacientiem. Latvijā šāds pētījums vēl nav veikts.
Mērķis:
Pētnieciskā darba mērķis ir izpētīt bronhiālo artēriju embolizācijas kā neatliekamas asiņošanas apturēšanas tehniskos aspektos un klīniskos rezultātus no 2015. Līdz 2020. gadam (ieskaitot). Uzskaitīt Latvijā PSKUS veikto bronhiālo artēriju embolizāciju skaitu, izsvērt šo manipulāciju iznākumu ilgtermiņā. Noteikt biežākos klīniskos iemeslus Latvijā šīs maipulācijas veikšanai.
Materiāli un metodes:
Tika apkopoti dati no VSIA “Paula Stradiņa klīniskā universitātes slimnīca”16 pacientu vēsturēm, kam diagnosticēta asins spļaušana un veikta bronhiālo artēriju embolizācija laika posmā no 2015.-2020.gadam (ieskaitot) Paula Stradiņa klīniskās universitātes slimnīcas Diagnostiskās radioloģijas institūtā.
Veikta pacientu vēstures datu retrospektīva analīze - pacientu anamnēzes, klīnisko, laboratorisko un radioloģisko izmeklējumu datu analīze. Rezultātu apkopošanai un statistiskai datu apstrādei tika izmantotas programmas Microsoft Excel 2010 un IBM SPSS Statistics.
Rezultāti:
Visiem pacientiem tika sasniegti tūlītēji klīnisks rezultāts (100%) un asiņošana tika pārtraukta. Procedūras laikā netika novērotas nekādas komplikācijas. 19% (n = 3) pacientu tika veikta vairāk nekā viena bronhu artērijas embolizācija. 25% gadījumu notika atkārtota asiņošana. 6% - pirmajā mēnesī pēc procedūras, 12,5% 1-3 mēnešos pēc BAE un 6%> 1 gadā pēc procedūras. 50% gadījumu cēlonis bija ļaundabīgs audzējs; 13% bronhektāzes slimība ,hops; 6% (n = 1) Castleman slimība, 6% arteriāla anatomiska anomālija, 6% aspergilloze, 6% antikoagulantu izraisīta un 13% kriptogēnas izcelsmes.
75 (n = 12) BAE tika izmantotas polivinilspirta daļiņas (PVA). Divās no tām tika pievienota Hystoacrilic līme un 3 no tām tika pievienota embolizācijas spole, 25% tika izmantota tikai Hystoacrilic līme.
69% a. tika embolizēts bronhiāls dextra; 25% a.bronchialis sinistra; 6% abās bronhu artērijās.
Secinājumi:
Saskaņā ar šī pētījuma rezultātiem bronhiālās artērijas embolizācija ir pierādījusi sevi kā dzīvības glābšanas procedūru ar ļoti augstu tūlītēju panākumu līmeni šeit, Latvijā . Atkārtota asiņošana 1/4 un bez lielām komplikācijām.
Objectives: Massive hemoptysis is a potentially life-threatening medical emergency with high mortality rates. The main bleeding source in 90% is determined to be aa. bronchiales. Bronchial artery embolization (BAE) has become a cornerstone in severe hemoptysis treatment. Immediate clinical success described as termination of hemorrhage ranges from 85-100%, re-bleeding ranges 10-33%. Major complications are rare. The main objective of this study was to evaluate the success rate, complications and technical aspects of BAE in Latvia. There has not been a similar study covering this topic here in Latvia. Methods: Retrospective material analysis of 16 patients, who underwent bronchial artery embolisation in Pauls Stradiņš Clinical University hospital January 2016 - October 2020 due to episode/-s of clinical, severe hemoptysis. Statistical analysis of the data performed with Microsoft Excel and SPSS software. Results: In all patients immediate clinical success was reached (100%) and the bleeding was stopped. No complications were faced during the procedure. 19% (n=3) of the patients underwent more than one bronchial artery embolization. In 25% of cases re-bleeding occurred. In 6% - during first month after procedure, in 12.5 %. 1-3 months after BAE and in 6% >1 year after procedure. In 50% the cause was malignancy; 13% Bronchiectasis disease, Hops; 6% (n=1 ) Castleman disease, 6% arterial blood flow anatomical anomaly, 6% aspergillosis. 6% Anticoagulants and 13% Criptogenic origin. In 75 (n=12) BAEs polyvinyl alcohol particles were used (PVA). In 2 of which Hystoacrilic glue was added and in 3 of which embolisation coil was added, In 25 % only Hystoacrilic glue was used. In 69% a. bronchialis dextra was embolised; in 25% a.bronchialis sinistra; in 6% both bronchial arteries. Conclusions: According to the results of this study Bronchial artery embolisation has proven itself as life-saving procedure with very high immediate rate of success here in Latvia, recurrent hemorrhages in 1/4 and no major complications such as spinal cord ischemia or transverse myelitis.
Objectives: Massive hemoptysis is a potentially life-threatening medical emergency with high mortality rates. The main bleeding source in 90% is determined to be aa. bronchiales. Bronchial artery embolization (BAE) has become a cornerstone in severe hemoptysis treatment. Immediate clinical success described as termination of hemorrhage ranges from 85-100%, re-bleeding ranges 10-33%. Major complications are rare. The main objective of this study was to evaluate the success rate, complications and technical aspects of BAE in Latvia. There has not been a similar study covering this topic here in Latvia. Methods: Retrospective material analysis of 16 patients, who underwent bronchial artery embolisation in Pauls Stradiņš Clinical University hospital January 2016 - October 2020 due to episode/-s of clinical, severe hemoptysis. Statistical analysis of the data performed with Microsoft Excel and SPSS software. Results: In all patients immediate clinical success was reached (100%) and the bleeding was stopped. No complications were faced during the procedure. 19% (n=3) of the patients underwent more than one bronchial artery embolization. In 25% of cases re-bleeding occurred. In 6% - during first month after procedure, in 12.5 %. 1-3 months after BAE and in 6% >1 year after procedure. In 50% the cause was malignancy; 13% Bronchiectasis disease, Hops; 6% (n=1 ) Castleman disease, 6% arterial blood flow anatomical anomaly, 6% aspergillosis. 6% Anticoagulants and 13% Criptogenic origin. In 75 (n=12) BAEs polyvinyl alcohol particles were used (PVA). In 2 of which Hystoacrilic glue was added and in 3 of which embolisation coil was added, In 25 % only Hystoacrilic glue was used. In 69% a. bronchialis dextra was embolised; in 25% a.bronchialis sinistra; in 6% both bronchial arteries. Conclusions: According to the results of this study Bronchial artery embolisation has proven itself as life-saving procedure with very high immediate rate of success here in Latvia, recurrent hemorrhages in 1/4 and no major complications such as spinal cord ischemia or transverse myelitis.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Asins spļaušana; a. bronchialis; embolizācija ; BAE, Hemotysis; a. bronchialis; embolisation; BAE