数字减影血管造影及介入治疗在急性动脉出血中的应用

喇志军，杨健慧

（勉县医院，陕西 汉中，724200）

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摘要：

目的 探讨数字减影血管造影（DSA）及介入栓塞术诊治急性动脉性出血的应用效果。方法 选择2014年6月至2016年5月我院收治的55例急性动脉出血患者为研究对象，其中包括大咯血17例、消化道出血29例、肝动脉破裂9例。对出血部位行 选择性DSA明确诊断，找到出血动脉，并选择插管行介入栓塞治疗。结果 患者DSA有造影剂外溢，表现出明显的出血阳性征象；55例患者行介入栓塞治疗后出血均立即停止，行DSA检查见出血动脉均已闭塞，无造影剂外溢征象，大咯血病例已无局部 异常增生血管，消化道出血病理畸形血管、动静脉瘘均已消失。动脉导管鞘留置24 h观察期间患者生命体征均平稳，无1 例发生再出血。随访6~12个月未见复发，无严重并发症病例。结论 DSA在急性动脉出血的诊断中具有诊断迅速、定位明确的优点，具有较高的诊断价值；介入治疗起效快、疗效确切，控制出血迅速，安全可靠，可作为治疗急性动脉出血的首选方案。

关键词：DSA；介入治疗；急性动脉出血

中图分类号：R543.5文献标志码：A文章编号：2096-1413(2016 )25-0094-02

The application of digital subtraction angiography and interventional therapy in acute arteriorrhagia
LA Zhi-jun, YANG Jian-hui
(Hospital of Mian County in Shaanxi Province, Hanzhong 724200, China)

ABSTRACT: Objective To explore the application of DSA and interventional therapy in acute arteriorrhagia. Methods Fifty -five cases of acute arteriorrhagia from June 2014 to May 2016 were selected, including 17 cases of massive hemoptysis, 29 cases of alimentary tract hemorrhage and 9 cases of liver rupture. Taken DSA clearly diagnose the bleeding site and find arterial bleeding for intervational embolotherapy. Results Patients with DSA had contrast spillover, and they were all showed the bleeding obvious positive signs; 55 cases of patients with bleeding after interventional embolization treatment were immediately stopped. Bleeding arteries examined by DSA had been block, no signs showed the contrast agents spillover, big hemoptysis cases had no local hyperplasia of abnormal blood vessels, gastrointestinal bleeding pathologic malformation vessels, arteriovenous fistula disappeared. During the 24 h of arterial catheter sheath detained, vital signs were stable, no longer bleeding occurred. Followed up for 6 ~12 months, there were no cases of serious complications. Conclusion DSA is safe, accurate, quick and has higher diagnostic value. With high and reliable efficiency, interventional therapy can act as the preferred alternative in the treatment of acute arteriorrhagia.
KEYWORDS: DSA; interventional therapy; acute arteriorrhagia

参考文献：
[1] 周怡婷,曹建民.腹部及盆腔急性出血的介入治疗[J].介入放射学,2008,17(12):884-887.
[2] 汪延希.急性出血性疾病血管造影及介入治疗[J].中国临床实用医学,2007,1(6):27-28.
[3] 周明,邱水波,刘闽华,等.消化道出血的诊断和栓塞治疗[J].中华放射学杂志,2006,40(10):1086-1088.
[4] 江森,孙兮文,支文祥,等.应用明胶海绵和聚乙烯醇颗粒动脉栓塞治疗肺咯血疗效及复发原因分析[J].中国医学计算机成像杂志,2005,11(1):58-62.
[5] 李麟荪.临床介入治疗学[M].南京:江苏科学技术出版社,1994:376-379.
[6] 付金强,乌建平,黄戴兰,等.消化道出血58 例数字减影血管造影分析[J].实用医院临床杂志,2010,7(4):148-149.
[7] 杨建勇,陈伟.介入治疗学临床实践[M].北京:科学出版社,2002:159-160.
[8] 李麟荪,贺树能,邹英华.介入放射学基础与方法[M].北京:人民卫生出版社,2005:480-504.
[9] 佟小强,邹英华,孙晓伟,等.微钢圈对急性出血性疾病的栓塞治疗作用[J].中华放射学杂志,2003,37(12):1087-1091.
[10] 杨建勇,陈伟.介入治疗学临床实践[M].北京:科学出版社,2002:160.


[11] 朱培欣,卢占星,夏国强,等.腹部和盆腔动脉大出血的急诊介入治疗[J].介入放射学杂志,2011,20(1):22-24.
[12] 周怡婷,曹建民.腹部及盆腔急性出血的介入治疗[J].介入放射学杂志,2008,17(12):884-887.
[13] 郭启勇.实用放射学[M].3 版.北京:人民卫生出版社,2007:80
[14] 陈义雄,陈绿姣,陈建业,等.支气管动脉栓塞治疗大咯血的疗效分 析[J].介入放射学杂志,2005,14(2):195-196.