هموپتزي شديد: رويكرد تشخيصي، عوامل خطر و پيامد آن در تجربه ي شش ساله

Massive Hemoptysis: Diagnostic Approach, Risk Factors and Outcome in Six Years Experience

ﻫﻤﻮﭘﺘﺰي وﺳﯿﻊ ﺑﻪﺻﻮرت دﻓﻊ ﺧﻠﻂ ﺧﻮﻧﯽ ﺑﯿﺶ از 100 ﻣﯿﻠﯽ ﻟﯿﺘﺮ در 24 ﺳﺎﻋﺖ ﺗﻌﺮﯾﻒ ﻣﯽﺷﻮد و ﻧﺸﺎﻧﻪي ﯾﮏ ﺑﯿﻤﺎري زﻣﯿﻨﻪاي اﺳﺖ ﮐﻪ ﺑﻪدﻟﯿﻞ اﯾﺠﺎد ﺧﻔﮕﯽ ﻣﯽﺗﻮاﻧﺪ ﺗﻬﺪﯾﺪ ﮐﻨﻨﺪهي زﻧﺪﮔﯽ ﺑﺎﺷﺪ. اﯾﻦ ﻣﻄﺎﻟﻌﻪي ﮔﺬﺷﺘﻪﻧﮕﺮ ﺷﺎﻣﻞ 126 ﺑﯿﻤﺎر ﻣﺮاﺟﻌﻪ ﮐﻨﻨﺪه ﺑﻪ ﻣﺮﮐﺰ ﺳﻞ و ﺑﯿﻤﺎريﻫﺎي رﯾﻮي ﺑﯿﻤﺎرﺳﺘﺎن ﻣﺴﯿﺢ داﻧﺸﻮري ﺑﺎ ﻫﻤﻮﭘﺘﺰي ﺷﺪﯾﺪ ﻣﺠﺎري ﻫﻮاﯾﯽ ﺗﺤﺘﺎﻧﯽ در ﻃﯽ 6 ﺳﺎل اﺳﺖ. ﻣﯿﺎﻧﮕﯿﻦ ﺣﺠﻢ ﻫﻤﻮﭘﺘﺰي 228/7±132 ﻣﯿﻠﯽﻟﯿﺘﺮ ﺑﻮد. ﻋﻠﺖ ﻫﻤﻮﭘﺘﺰي در 31 ﻧﻔﺮ )25%( ﺳﻞ، 40 ﻧﻔﺮ )31/7%( ﺑﺮوﻧﺸﮑﺘﺎزي و ﺑﺮوﻧﺸﯿﺖ ﻣﺰﻣﻦ، 8 ﻧﻔﺮ )6/3%( ﮐﯿﺴﺖ ﻫﯿﺪاﺗﯿﺪ، 8 ﻧﻔﺮ )6/3%( ﺳﺮﻃﺎن رﯾﻪ، 8 ﻧﻔﺮ )6/3%( ﭘﺮﻓﺸﺎر رﯾﻮي، 7 ﻧﻔﺮ )5/5%( آﻧﺘﺮاﮐﻮزﯾﺲ، 5 ﻧﻔﺮ )3/9%( ﭘﻨﻮﻣﻮﻧﯽ و 19 ﻧﻔﺮ )15%( ﻧﺎﺷﻨﺎﺧﺘﻪ ﺑﻮد. ﺧﻮﻧﺮﯾﺰي در 86 ﺑﯿﻤﺎر )68%( ﺑﺎ ﺳﺎﻟﯿﻦ ﺳﺮد و آدرﻧﺎﻟﯿﻦ )1/10000( در ﻃﻮل ﺑﺮوﻧﮑﻮﺳﮑﻮﭘﯽ ﺳﺨﺖ و ﻓﯿﺒﺮواﭘﺘﯿﮏ ﻣﺘﻮﻗﻒ ﺷﺪه ﺑﻮد. ﻋﻼوه ﺑﺮ روشﻫﺎي دﯾﮕﺮ، آﻣﺒﻮﻟﯿﺰاﺳﯿﻮن ﻫﻢ ﺑﺮاي دو ﻣﻮرد دﯾﮕﺮ اﻧﺠﺎم ﺷﺪه ﺑﻮد. ﺑﺮاي 27 ﺑﯿﻤﺎر ﻫﻢ ﻋﻤﻞ ﺟﺮاﺣﯽ اﻧﺠﺎم ﺷﺪه ﺑﻮد ﮐﻪ در 13 ﺑﯿﻤﺎر )10%( ﻣﻨﺠﺮ ﺑﻪ ﻣﺮگ ﺷﺪه ﺑﻮد )7 ﻣﺮگ در ﺣﯿﻦ ﺟﺮاﺣﯽ، ﯾﮏ ﻣﻮرد در اوژاﻧﺲ و 5 ﻣﻮرد در ﺑﺨﺶ(. ﺑﺮاﺳﺎس ﺷﻮاﻫﺪ اﯾﻦ ﻣﻄﺎﻟﻌﻪ، ﺑﺮوﻧﺸﮑﺘﺎزي، ﺑﺮوﻧﺸﯿﺖ ﻣﺰﻣﻦ و ﺳﻞ از ﺷﺎﯾﻊﺗﺮﯾﻦ ﻋﻠﻞ ﻫﻤﻮﭘﺘﺰي وﺳﯿﻊ در اﯾﻦ ﻣﺮﮐﺰ ﺑﻮدﻧﺪ. ﺑﯿﺸﺘﺮ اوﻗﺎت، اﯾﻦ ﺣﺠﻢ از ﺧﻮﻧﺮﯾﺰي )228 ﻣﯿﻠﯽﻟﯿﺘﺮ( را ﻣﯽﺗﻮان ﺑﺎ ﺷﺴﺘﻦ ﺳﺎﻟﯿﻦ ﺳﺮد در ﻃﻮل ﺑﺮوﻧﮑﻮﺳﮑﻮﭘﯽ ﮐﻨﺘﺮل ﮐﺮد. ﺑﺎ اﯾﻦ ﺣﺎل، اﯾﻦ ﺣﺠﻢ از ﻫﻤﻮﭘﺘﺰي ﻣﯽﺗﻮاﻧﺪ در ﺣﯿﻦ ﻋﻤﻞ ﺟﺮاﺣﯽ، ﻣﺮگ و ﻣﯿﺮ ﺑﺎﻻ )10%( و ﻋﻮارض زﯾﺎدي داﺷﺘﻪ ﺑﺎﺷﺪ.

Massive hemoptysis is defined as hemoptysis exceeding 100 ml over a 24 hour period. It is often a sign of an important underlying disease that may be life-threatening due to asphyxiation. The present retrospective study consisted of 126 consecutive patients who had been referred to Dr. Masih Daneshvari Hospital because of massive hemoptysis from lower airways during 6 years. Mean volume of hemoptysis was 228.7±132 ml. Etiology of hemoptysis were tuberculosis (n=31, 25%), bronchiectasis and chronic bronchitis (n=40, 31.7%), hydatid cyst (n=8, 6.3%), lung cancer (n=8, 63%), pulmonary hypertension (n=8, 63%), anthracosis (n=7, 5.5%), pneumonia (n=5, 3.9%), unknown (n=19, 15%). Bleeding is ceased in 86 (68%) patients with cold saline and adrenaline (1/10000) during rigid and fiberoptic bronchoscopy. Embolization had been done in 2 cases in addition to other procedures. Operation was also conducted in 27 patients and mortality was occurred in 13 (10%) patients (7 cases during surgery, 1 case in emergency unit, and 5 cases in ward). Based on the evidences from this study, bronchiectasis, chronic bronchitis and tuberculosis were the most prevalent cause of massive bleeding in this center. This volume of bleeding (228 ml) can be often controlled by cold saline washing during bronchoscopy. However, this volume of hemoptysis can lead to high mortality rates (10%) and complication during surgery.