hemoptysis

[kǎ xiě]

The process of bleeding from respiratory organs (i.e. trachea, bronchus or lung tissue) below the throat and expelling from the mouth by coughing

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synonym Hemoptysis (hemoptysis) Usually refers to hemoptysis

This entry is made by Compilation and application of scientific encyclopedia entries of "Science Popularization China" authentication.

Dong Guilan

Chief physician (review)

Department of Oncology, Tangshan People's Hospital

Hemoptysis refers to the respiratory organs below the throat (i.e. trachea a bronchial tube Or lung tissue) and cough The process of moving out of the mouth. Hemoptysis can not only be caused by Respiratory diseases It can also be caused by Diseases of circulatory system , trauma and other systemic diseases or systemic factors. It should be connected with oral cavity, pharynx Epistaxis as well as haematemesis Phase identification.

TCM disease name: hemoptysis
Foreign name: Hemoptysis
Visiting department: Respiratory Medicine

Common location: Trachea, bronchus, lung
Common causes: Respiratory system diseases, circulatory system diseases, trauma, systemic bleeding prone diseases, etc
common symptom: Bleeding due to coughing, less sputum and more blood, or coughing up a lot of blood

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pathogeny

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The diseases that cause hemoptysis are not limited to Respiratory diseases , although hemoptysis is mainly caused by respiratory diseases. The following lists various diseases that cause hemoptysis.

1. Respiratory system disease

as pulmonary tuberculosis 、 bronchiectasia 、 bronchitis 、 pulmonary abscess 、 lung cancer 、 pneumonia 、 Paragonimiasis 、 Pulmonary amebiasis 、 Pulmonary echinococcosis 、 Pulmonary mycosis , Lung Cysticercosis 、 Bronchial calculus , Pulmonary metastatic tumor, lung adenoma 、 silicosis Etc. These inflammations cause bronchial mucosa or lesions blood capillary Permeability Elevated, or submucosal Vascular wall Burst and cause bleeding.

two Diseases of circulatory system

The common ones are Rheumatic heart disease mitral stenosis 、 Hypertensive heart disease 、 Pulmonary hypertension 、 aortic aneurysm 、 Pulmonary infarction and Pulmonary arteriovenous fistula Etc.

3. Trauma

Thoracic trauma contusion 、 Rib fracture 、 Gunshot wound 、 Explosive wound And medical procedures (such as chest or Pulmonary puncture , Biopsy Bronchoscopy Sometimes it can cause hemoptysis.

4. Systemic bleeding Tendentiousness disease

Common examples are leukemia 、 hemophilia 、 Aplastic anemia , pulmonary hemorrhage type Leptospirosis , Popularity hemorrhagic fever , Lung type plague 、 Thrombocytopenic purpura 、 Disseminated intravascular coagulation 、 Chronic renal failure 、 uremia Etc.

5. Other rare diseases or abnormalities

Such as alternative menstruation (not from Vaginal bleeding ）、 Oxygen poisoning , pulmonary hemorrhage nephritis syndrome, bronchiectasis nasosinusitis Visceral translocation syndrome.

clinical manifestation

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Hemoptysis with fever , mostly seen in pulmonary tuberculosis, pneumonia, pulmonary abscess, pulmonary hemorrhagic leptospirosis, epidemic hemorrhagic fever Bronchial carcinoma Etc.

Hemoptysis with Chest pain , common in Lobar pneumonia 、 pulmonary embolism , pulmonary tuberculosis, bronchial cancer, etc.

Hemoptysis with Cough , can be seen in bronchial carcinoma Mycoplasma pneumonia Etc.

Hemoptysis with Mucosal hemorrhage of skin , visible in Hematopathy (such as leukemia, thrombocytopenic purpura), leptospirosis, epidemic hemorrhagic fever, etc.

Hemoptysis with jaundice , mostly seen in leptospirosis, lobar pneumonia Pulmonary infarction Etc.

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1. Medical history inquiry

The bleeding is the first time or several times. If it is repeated, whether it is different from the past. Cough and hemoptysis associated with young adults Low fever Tuberculosis should be considered. Attention should be paid to middle-aged people, especially male smokers lung cancer The possibility of; Carefully inquire and observe the hemoptysis volume and color, whether there is sputum, and pay attention to when inquiring personal history tuberculosis Exposure history, years of smoking history, Menstrual history , occupational dust exposure history, Raw food Crabs, etc.

Hemoptysis with Chest pain More often seen in Pulmonary infarction 、 Pneumococcal pneumonia ； Hemoptysis with Cough It is mostly seen in bronchi lung cancer ， Blood sputum See at pulmonary abscess ； Massive hemoptysis More often seen in Cavitary pulmonary tuberculosis ， bronchiectasia aneurysm Rupture, etc. Domestic literature report, none jaundice type Leptospirosis There are also pathogenic Massive hemoptysis 。

2. Physical examination

Patients with hemoptysis should be examined carefully and repeatedly in the chest. Some chronic heart and lung diseases can be combined Pestle finger (toe), patients with progressive pulmonary tuberculosis and lung cancer often have obvious lose weight 。 Some hematological diseases have a tendency to bleed all over the body.

three laboratory examination

Sputum examination helps to find Mycobacterium tuberculosis 、 fungus , bacteria cancer cell 、 parasite Eggs Heart failure cells Etc; Bleeding time ， Coagulation time ， prothrombin time ， platelet count And other examinations are helpful for bleeding disease diagnosis ； Red blood cell count And Yuan Erythrin The measurement helps to infer the degree of bleeding, Eosinophilia Tips Parasitosis Possibility.

4. Instrument inspection

(1) X-ray examination All patients with hemoptysis should have X-ray examination, chest x-ray ， Chest radiograph Tomography, if necessary Bronchography Assist in diagnosis.

(2) CT examination It is helpful to find small bleeding lesions.

(3) Bronchoscopy Ambiguous hemoptysis or bronchial obstruction Atelectasis % of patients should consider bronchoscopy, such as tumour 、 Tuberculosis Foreign matters, etc., taken at the same time Biopsy Etc.

(4) Radionuclide gallium examination It is helpful for the differential diagnosis of lung cancer and other pulmonary masses.

diagnosis

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The diagnosis can be confirmed according to the medical history, clinical manifestations and relevant examinations.

differential diagnosis

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Need and haematemesis Phase identification.

treatment

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one General treatment

Oxygen inhalation, monitoring, hemostasis, blood transfusion, infusion and symptomatic treatment Etiological treatment 。

two Massive hemoptysis Rescue of

Large hemoptysis should be rescued in time, otherwise the patient's life will be threatened.

The impact of massive hemoptysis on the human body is not only related to the amount of hemoptysis and the speed of bleeding, but also related to the general condition of the patient. If the patient is ill for a long time and weak, even if the bleeding is less than 300ml, it may be fatal.

The direct danger caused by massive hemoptysis is mainly asphyxia and Hemorrhagic shock , indirect danger is secondary pulmonary infection or clot Caused by bronchial obstruction Atelectasis , if pulmonary tuberculosis Patients can also spread through blood.

(1) Posture Keep calm, don't panic, let the patient take Decubitus position , head deviation On one side, encourage the patient to gently cough out the blood to avoid blood retention respiratory tract Inside. If the location of the lesion is known, take it Lateral decubitus position To avoid blood flowing into the contralateral lung. If the bleeding part is unknown, the patient shall lie flat with his head to one side to prevent suffocation.

(2) Sedation Avoid mental tension, provide mental comfort, and give a small amount if necessary Sedatives , such as oral diazepam.

（3） cough Patients with severe cough and massive hemoptysis can be given an appropriate amount antitussive , but we must be careful and forbid violent sedation cough mixture To avoid excessive inhibition of the cough center, which may lead to blood stasis in the airway and suffocation.

(4) Observe the condition Closely observe the patient's hemoptysis volume, breathing, pulse and other conditions to prevent shock.

(5) Do not defecate forcefully Prevent forced defecation from aggravating hemoptysis.

(6) Keep respiratory tract unobstructed Such as patient feeling Chest tightness For shortness of breath and suffocation, help patients to remove oral and nasal secretions, maintain indoor air circulation, and take oxygen when conditions permit.

(7) Rescue of asphyxiated patients In case of massive hemoptysis and asphyxia, immediately conduct body position drainage and remove Trendelenburg's position (The end of the bed can be raised by about 45 degrees), or the side head can be slapped on the back.

After preliminary treatment, if the hemoptysis is slightly relieved and the patient's blood pressure, pulse and respiration are relatively stable, the patient should be escorted to the nearby hospital as soon as possible for further treatment; If bleeding continues, please First Aid Centre The emergency physician shall carry out on-site rescue. Once the condition is slightly stable and the transfer is allowed, it is still necessary to send the patient to the hospital for oxygen inhalation, monitoring, hemostasis, blood transfusion, infusion and symptomatic and etiological treatment.

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