Objective To investigate the diagnostic value of bronchoalveolar lavage fluid-galactomannan （BALF-GM） in alveolar lavage fluid combined with Aspergillus IgG and IgM in chronic pulmonary aspergillosis （CPA）. Methods 88 patients with CPA were assigned into the study group, and 64 patients suspected with CPA who were excluded after diagnosis were divided into the control group. The levels of BALF-GM, Aspergillus IgG and IgM in all patients were analyzed retrospectively. The diagnostic value of BALF-GM, Aspergillus IgG, IgM and combined detection in CPA was analyzed by the receiver operating characteristic （ROC） curve. Results The diagnostic value of BALF-GM in CPA was higher, whereas that of Aspergillus IgG, IgM and combined detection was lower. The sensitivity of BALF-GM combined with Aspergillus IgG/IgM was significantly improved, but the specificity was decreased. The contents of BALF-GM, Aspergillus IgG and IgM in the study group were significantly higher than those in the control group （all P < 0.05）. The positive rates of BALF-GM, Aspergillus IgG, IgM and combined detection significantly differed between two groups （all P <0.05）. ROC curve analysis indicated that BALF-GM, BALF-GM+Aspergillus IgG/IgM yielded higher area under ROC curve （AUC）, sensitivity and specificity in the diagnosis of CPA. The diagnostic value of Aspergillus IgG, IgM and IgG/IgM combined detection was lower. Conclusions BALF-GM has high sensitivity and specificity in the diagnosis of CPA. BALF-GM combined with Aspergillus IgG/IgM can improve the diagnostic sensitivity, whereas significantly decrease the specificity. Therefore, it is necessary to integrate the high specificity of BALF-GM alone to minimize the incidence of false negative results.

Objective:To explore the characteristics and countermeasures of patients treated by bronchoscopic removal of pulmonary aspergilloma.Methods:This study was a retrospective study. The clinical data of 52 patients undergoing bronchoscopic removal of pulmonary aspergilloma (the treatment group) and 52 patients undergoing ordinary bronchoscopy (the control group) were reviewed in Guangzhou Chest Hospital from November 2018 to December 2020. There were 46 males and 6 females in the treatment group, with an age of (47.00±13.48) years old; there were 44 males and 8 females in the control group, with an age of (48.00±16.28) years old. The differences of heart rate, oxygen saturation, blood pressure, operation time, and bleeding were compared between the two groups. Independent sample t test was used for the measurement data, and χ2 test was used for the count data. Results:The heart rate and operation time of the treatment group were (112.0±6.46) beats/min and (39.95±8.32) min, respectively, which were higher than those of the control group [(100.0±9.11) beats/min and (8.83±2.46) min], and the blood oxygen saturation was (96.0±0.69)%, which was lower than that of the control group [(98.0±1.11)%], with statistically significant differences (all P<0.05). There were no statistically significant differences in the systolic blood pressure and diastolic blood pressure between the two groups (both P>0.05). The incidence of microscopic bleeding in the treatment group was 48.08% (25/52), which was higher than that in the control group [0.00% (0/52)], with a statistically significant difference between the two groups ( χ2=32.911, P<0.001). Conclusions:Patients treated with bronchoscopic removal of pulmonary aspergilloma are more tense and have a high risk of hypoxemia and hemorrhage. Adopting preoperative, intraoperative, and postoperative nursing strategies, control of high-risk factors, and grasping the timing of treatment play key roles in preventing serious complications.

我国作为全球结核病和耐多药结核病高负担国家之一,估算结核分枝杆菌潜伏感染(Latent Mycobacterium tuberculosis infection,LTBI)的人数巨大.及时发现LTBI者,有效控制LTBI流行而将结核病消灭在萌芽状态,将是人类实现终结结核病目标面临的重大课题.本文从LTBI的流行病学、发生与进展、实验诊断及治疗几方面对近年来的研究进展做简要综述.

目的 探讨血清烟曲霉IgG、真菌(1-3)-β-D葡聚糖(血清G试验)及血清半乳甘露聚糖(GM)检测对慢性肺曲霉病(CPA)的诊断价值.方法 选取疑似CPA的肺病患者114例,根据最终确诊情况,将确诊CPA的67例患者作为研究组,确诊为非CPA的47例患者作为对照组.采集两组患者血清,比较两组烟曲霉IgG、血清G试验、血清GM含量,并统计单个指标及联合指标诊断CPA的敏感度、特异性、准确率、阳性预测值、阴性预测值;采用MedCalc软件对各指标及其联合检测指标进行ROC曲线分析.结果 研究组患者的烟曲霉IgG、血清G试验及血清GM含量高于对照组差异有统计学意义(P<0.05);单个指标诊断CPA中,烟曲霉IgG的敏感度高于血清G试验和血清GM(P<0.001),血清G试验与血清GM的敏感度差异无统计学意义(P=0.351);但烟曲霉IgG特异性最低,血清GM特异性最高,两两比较差异有统计学意义(P<0.001).并联试验联合指标诊断的敏感度均有提升,特异性均下降,且对相对单个指标差异无统计学意义(P>0.05);烟曲霉IgG的准确率、阴性预测值高于血清G、血清GM、血清G+血清GM(P<0.001),与其他联合检测比较差异无统计学意义(P>0.05);血清GM的阳性预测值高于其他指标(P<0.001).ROC曲线分析烟曲霉IgG最佳临界点对应的所有检测指标与医院标准相比差异无统计学意义(P>0.05);血清G与血清GM检测CPA的最佳临界点对应的敏感度均高于医院标准,特异性低于医院标准,且准确率、阳性预测值及阴性预测值等高于医院标准(P<0.05);联合检测对应的敏感度、阴性预测值均高于医院标准,特异性低于医院标准(P<0.05);ROC曲线分析各指标曲线下面积差异有统计学意义(P<0.01),但两两比较差异均无统计学意义(P>0.05).结论 血清烟曲霉IgG诊断CPA具有较高的敏感度,但特异性相对较低.临床可进一步依靠血清GM指标来避免假阴性.

Objective:To analyze the clinical characteristics of 100 patients with pulmonary aspergilloma infection and explore the risk factors of pulmonary aspergilloma infection.Methods:The clinical data of 100 patients with pulmonary aspergilloma infection (observation group) (82 males and 18 females) and 50 patients with bronchiectasis and hemoptysis (control group) (38 males and 12 females) in our hospital from March 2014 to December 2015 were retrospectively analyzed. The clinical features of pulmonary aspergilloma infection and the risk factors of pulmonary aspergilloma infection were analyzed.Results:The rates of male, cough, expectoration, hemoptysis, moist rales in lung, and exudative shadow on CT were high in both groups, but there were no statistically significant differences between the two groups (all P>0.05). The rates of long-term use of antibiotics, old tuberculosis, chronic obstructive pulmonary disease (COPD), malignant tumors, halo sign, air crescent sign, cavity, and upper lung lesions in the observation group were 71.00% (71/100), 81.00% (81/100), 63.00% (63/100), 29.00% (29/100), 88.00% (88/100), 68.00% (68/100), and 81.00% (81/100), which were significantly higher than those in the control group [48.00% (24/50), 24.00% (12/50), 20.00% (10/50), 6.00% (3/50), 6.00% (3/50), 20.00% (10/50), and 0.00% (0/50)] (all P<0.05). Long term use of antibiotics, combined with old tuberculosis, COPD, halo sign, air crescent sign, cavity, and upper lung lesions were the risk factors of pulmonary aspergilloma infection (all OR>1, P<0.05). Conclusion:Pulmonary aspergilloma infection has certain clinical characteristics, a variety of factors are the risk factors leading to the occurrence of the disease, and clinical attention should be paid to the clinical diagnosis and treatment of patients with risk factors of the disease.

目的 评价不同结核菌病原学检测方法对肺结核复治确诊的应用价值.方法 收集广州市胸科医院结核内科2019年1月—12月间收治的323例拟诊为肺结核复治住院患者的临床资料,最后确诊为肺结核复治92例,非活动性肺结核231例,同时用涂片找抗酸杆菌,分枝杆菌培养,Gene Xpert MTB/RIF及SAT-TB检测痰或BALF标本,比较不同检测方法的诊断价值.结果 在肺结核复治确诊病例组中Gene Xpert MTB/RIF的阳性检出率为95.65％,分枝杆菌培养为89.13％,SAT-TB为78.26％,涂片法为69.57％,Gene Xpert MTB/RIF和分枝杆菌培养的阳性检出率明显高于SAT-TB和涂片法(P＜0.05).以临床确诊肺结核复治作为标准,涂片找抗酸杆菌的灵敏度为69.57％,特异度为91.77％,Youden指数为0.613 4;分枝杆菌培养的灵敏度为89.13％,特异度为84.42％,Youden指数为0.735 5;Gene Xpert MTB/RIF的灵敏度为95.65％,特异度为93.93％,Youden指数为0.895 8;SAT-TB的灵敏度为78.26％,特异度为98.70％,Youden指数为0.769 6.结论 Gene Xpert MTB/RIF具有较高的灵敏度,SAT-TB有较高的特异度,这两种分子生物学检测方法对临床快速诊断肺结核复治有着重要的应用价值,涂片和培养作为传统的检测手段,仍具有不可替代的作用,多种方法联合应用,结合临床分析,能对肺结核复治进行快速、准确的诊断.

目的 分析气管支气管结核(TBTB)患者咯血的临床特点,探究可能与咯血发生的相关因素,为临床诊治提供参考.方法 以确诊为活动性肺结核并TBTB的250例患者作为研究对象,根据有无咯血症状,以咯血的138例患者作为观察组,非咯血的112例患者作为对照组.比较两组患者的年龄、性别、一般实验室项目、病原学检查结果、影像学改变及支气管镜下病变累及支气管级数和病变的类型等因素,总结分析与咯血发生的相关性.结果 两组对比,男性咯血多于女性,咯血的年龄较小,观察组在纤维蛋白原(FIB)减少、肺部空洞形成、并发支气管扩张及合并阻塞性肺炎或肺不张、累及3级以上支气管及炎症浸润型支气管结核的比例明显较高,差异有统计学意义(P<0.05).两组在血象升高、C反应蛋白(CRP)升高、菌阳、病灶累及肺叶数、累及2级支气管、溃疡坏死及肉芽增殖型支气管结核的比例等方面比较,差异无统计学意义(P>0.05).对照组在合并胸膜炎、累及1级支气管、瘢痕狭窄型及淋巴结瘘型支气管结核的比例多于观察组(P<0.05).结论 TBTB并咯血以年龄较小的青壮年男性患者好发,FIB减少、肺部空洞形成、并发支气管扩张、合并阻塞性肺炎或肺不张、累及3级以上支气管的结核、炎症浸润型支气管结核的患者更易出现咯血,临床应重视上述可能与咯血发生相关的因素.

目的 研究CYP2C19基因多态性对伏立康唑治疗慢性肺曲霉病(CPA)患者的影响,为慢性肺曲霉病的个体化用药提供参考.方法 选取2019年1～10月在我院肺结核科住院并确诊为慢性肺曲霉病的80例患者作为研究对象,80例患者均使用伏立康唑抗真菌治疗.按照有无检测CYP2C19基因多态性分为试验组(n=40)及对照组(n=40).试验组患者按照基因检测的结果调整用药方案,对照组则按照伏立康唑的常规剂量给药(4 mg·kg-1,q12h).比较两组患者间及不同代谢型患者间的不良反应及治疗效果.结果 试验组40例患者分析了3个基因位点(CYP2C19*2,CYP2C19*3,CYP2C19* 17),共检出快代谢型(extensive metabolizer,EM) 14例(35.00％),中间代谢型(intermediate metabolizer,IM)18例(45.0％),慢代谢型(poor metab-olizer,PM)8例(20.0％).IM组及PM组的不良反应率比EM组高(P＜0.05).而治疗有效率,PM组高于IM组,IM组高于EM组,试验组的有效率对比对照组高(P＞0.05),发生不良反应率低.结论 CYP2C19基因多态性检测可用于指导伏立康唑治疗慢性肺曲霉病患者,提高安全性及有效性.

目的 探讨支气管肺泡灌洗液(BALF)检测半乳甘露聚糖(GM试验)在慢性肺曲霉病(CPA)的早期诊断及治疗评估中的价值.方法 选取2017年1月至2018年12月在我院肺结核科就诊的且资料完整的肺部感染患者155例作为研究对象,其中观察组为CPA患者,共75例,对照组为非CPA患者,共80例.分别采集两组患者的BALF及血清进行GM检查,对两组结果进行分析、统计,同时对观察组病人(均进行抗真菌及介入治疗)的BALF-GM进行动态检测,分别记录治疗前,治疗后第一月,第三月的BALF-GM值.结果以我院的检验标准BALF-GM≥0.9为阳性诊断标准,观察组中阳性者有86.67％最后符合病理确诊诊断.当BALF-GM阳性阈值为0.9时,观察组诊断CPA的特异度、灵敏度、阴性预测值及阳性预测值分别为93.75％、86.67％、88.23％及86.67％.观察组81.3％的病人BALF-GM值在第三个月时可降至0.9(阈值)以下.结论 支气管肺泡灌洗液GM值对慢性肺曲霉病的早期诊断具有较高的敏感性和特异性,同时可作为预测治疗效果的标志物之一,具有重要的临床检验价值.

目的:探讨支气管镜在肺结核空洞继发曲菌球的诊断价值.方法:回顾性分析广州市胸科医院内科三区2019年1月到2020年5月期间,行支气管镜检查的97例肺结核空洞继发曲菌球患者的临床资料,通过镜下表现、病理活检、BALF-GM及BALF真菌培养了解对肺结核空洞继发曲菌球的诊断阳性率.结果:97例患者,82例在气管镜直视下予组织活检,病理活检确诊曲霉菌感染68例,阳性率82.93％(68/82);97例行支气管肺泡灌洗检查,BALF-GM阳性率92.78％(90/97),BALF培养曲霉菌阳性率59.79％(58/97).结论:肺结核空洞继发曲菌球,临床表现和影像学缺乏特异性,支气管镜检查可以直视病变,提供重要的诊断线索,联合镜下活检、BALF-GM试验、BALF真菌培养等检查,可明显提高诊断的阳性率,对确诊起到决定性的作用.

目的 分析既往有肺结核病史患者咯血的病因及临床特点,为该类患者的诊治提供参考.方法 回顾性分析广州市胸科医院2018年1～12月既往有肺结核病史、以咯血为主诉的182例住院患者的相关临床资料,其中男性145例,女性37例,年龄55.13±13.73岁.分析其影像学改变、支气管镜检查、病原学等结果,总结病因及临床特点.结果 既往患肺结核治愈后至本次咯血发生的时间为10.13±8.29年.咯血的主要病因是肺结核后空洞继发曲菌球(23.63％),其次是支气管扩张和肺结核复发(23.08％)、肺炎(19.23％)及NTM肺病(8.79％),少数是肺部肿瘤(1.65％)、支气管异物(0.55％).结论 既往有肺结核病史的患者咯血绝大部分与肺的结构破坏有关,肺结核复发只是其中的病因之一,不能单凭既往有过肺结核病史和影像学改变,就诊断为肺结核复发,容易造成误诊、漏诊及误治.建议综合临床资料全面进行分析,从常见病因入手,尽量利用现有的医疗技术寻找确诊证据,同时应警惕一些少见或罕见病因.

目的 探索影响肺结核治愈但有肺结构性损坏后咳嗽咳痰患者诊断与鉴别诊断的重要因素.方法 收集2018年1-12月在广州市胸科医院住院的305例肺结核治愈但有肺结构性损坏、后又因咳嗽咳痰住院治疗患者的临床资料,回顾性分析患者的年龄、性别、基础性疾病(高血压、糖尿病、慢性阻塞性肺病、支气管张等)、临床症状、胸部影像学、病原学等特征.结果 肺部感染、肺结核再发、肺曲霉菌病、非结核分枝杆菌肺病的比例分别为48.52％(148/305)、28.85％(88/305)、13.11％(40/305)和9.51％(29/305),57.70％(176/305)的患者具有支气管张症;4种疾病的男女性别发生率比值分别为1.00 vs.1.38、1.47 vs.1.00、5.00 vs.1.00和1.00 vs.2.00,青年(≤44岁)、中年(45(59岁)、老年(≥60岁)3年龄组发生率比值分别为(1.00:1.67:2.13)、(2.00:1.10:1.00)、(4.05:3.03:1.00)和(0:1.00:1.25);呼吸困难、咯血、肺部啰音、发热为主要临床症状和体征,分别占病例总数的42.95％(131/305)、41.64％(127/305)、35.41％(108/305)和20.00％(61/305),其中95.00％(38/40)的肺曲霉菌病患者具有咯血症状;影像学主要表现为密度增高影、钙化、肺大泡、气管偏移、厚壁空洞、胸腔积液、新月征等,分别占病例总数的98.36％(300/305)、75.74％(231/305)、45.90％(140/305)、43.28％(132/305)、41.31％(126/305)、9.18％(28/305)和3.28％(10/305),其中90.00％(9/10)的新月征影像为肺曲霉菌病患者所呈现;病原学或病理学确证率分别为21.62％(32/148)、100％(88/88)、100％(40/40)和100％(29/29).结论 肺结核治愈但致肺结构性损坏后咳嗽、咳痰患者的综合特征是有相类似的临床表现及不易鉴别的影像学表现,所以对于肺结核治愈但有肺结构性损坏后再次出现咳嗽咳痰患者,不能因为具有与结核病相类似的临床症状和影像学表现、更不能因为其有结核病史盲目确立结核病诊断,而应力争获取病原学或病理学证据予以诊断和鉴别诊断.

目的 探讨研究一种更安全、有效治疗肺结核空洞继发曲菌球咯血的方法.方法 回顾性分析2015年2月至2019年4月广州市胸科医院97例肺结核空洞继发曲菌球咯血患者的临床资料,根据治疗方式将患者分为三组:介入治疗组:支气管镜下清除术联合支气管动脉栓塞术(bronchial artery emboliza?tion,BAE)29例、外科手术组34例、内科治疗组34例.比较三组治疗后不同时间段咯血复发率及并发症等情况.结果 介入组29例患者,治疗后1个月内咯血复发率为0;治疗后6个月内复发率为6.89％;治疗后12月内复发率为20.69％;均无明显并发症.外科组34例患者,术后1个月内咯血复发率为0;术后6个月内及12个月内复发率为2.94％;术后并发症的发生率为32.4％.内科组34例患者,治疗后1个月咯血复发率为44.12％,治疗后6个月内复发率为55.88％,治疗后12个月内复发率为58.82％;治疗后药物性肝损伤2例.结论 BAE能有效止血,支气管镜可有效清除曲菌球,二者同时应用可达到很好的治疗效果,可作为肺结核空洞继发曲菌球咯血非外科手术治疗的一种替代疗法.

Objective To explore the clinical features of transbronchial tuberculous mediastinal lymph-adenitis and value of bronchoscopic interventional therapy. Methods The clinical data of 50 patients who had been diagnosed as tuberculous mediastinal lymphadenitis and had received bronchoscopic interventional therapy in our hospital during the period from January 2008 to January 2013 were retrospectively analyzed. The bronchoscopic change , improvement in symptoms , and time to sputum smear and culture conversion were used to assess the therapeutic effect. The patients were followed up for six months. Results The mean age of the patients was (35 ± 15) years and the male to female ratio was 1:1.2. The lesions occurred mostly at the right middle lobe in 24% (12/50) of the patients. The total effectiveness rate was up to 98% (49/50) after chemotherapy and bronchoscopic interventional therapy. The major complication associated with interventional therapy was hemoptysis (8%, 4/50). After follow-up of 6 months , 49 patients with active lesions were stable , with smooth bronchial mucosa and no obvious obstruction by granulation and caseous necrosis tissues. Conclusions The relavent clinical symptoms of transbronchial tuberculous mediastinal lymphadenitis is mainly caused by tuberculosis inflammation which destroys and blocks the airway. The fiber bronchoscopic therapy with forceps clip and drug infusion has a definite effect and fewer complications.

目的探讨肺结核患者咯血的临床相关因素,为肺结核病患者咯血的预防与及时救治提供理论指导。方法以本院2007年1月～2011年4月住院肺结核咯血患者为治疗组,以肺结核非咯血患者为对照组,以各种标本(包括痰、支气管肺泡灌洗液、肺组织)涂片、培养与鉴定获得病例肺结核菌学资料;以临床观察、各种物理学检查(如胸部X线、CT等)及微创检查(纤维支气管镜检查)获得病例一般资料、病变类型、病变范围、病情进展、合并症等资料;分析肺结核菌阳性率、病变类型、病变范围、病情进展、合并症等与肺结核咯血发生的相关性。结果两组研究结果显示:肺结核患者咯血以青壮年好发,男性、病变有空洞、复治、结核菌阳性、病变范围广泛、病变类型为浸润肺结核(尤其是慢性纤维空洞型肺结核)、合并肺段及亚段以下支气管结核的肺结核患者易出现咯血,差异有统计学意义(p<0.05);病变类型为血行播散型肺结核、肺结核并结核性胸膜炎的肺结核患者少出现咯血,差异有统计学意义(p<0.05)。结论肺结核病患者并发咯血与患者性别、病变类型、病变范围、病变空洞、结核菌阳性率、初治复治及合并支气管结核的部位有关。

Objective To compare clinical value of bronchofibroscope excision and surgical resection in treatment of aspergilloma inside cavities of pulmonary tuberculosis.Methods One hundred and eighty three hospitalized cases with aspergilloma inside cavities of pulmonary tuberculosis were analyzed retrospectively on time of therapy,treatment costs,complication of therapy and efficacy.Results Of 183 cases,126 cases received excision of aspergilloma by bronchoscope and 57 cases received surgical resection.Average time of therapy were 49 days and 46 days using bronchofibroscope excision and surgical resection,respectively.Average treatment costs were 26 535 yuan and 50 296 yuan,respectively.Incidence rate of complications using surgical resection was higher than that of bronchofibroscope excision.But surgical resection was complete and low rate of relapse.Conclusion Bronchofibroscope excision can get relatively thorough,efficacy,less complication and low costs in patients with aspergilloma inside cavities of pulmonary tuberculosis.It is a better method in patients who are poor pulmonary function reserve,high surgical risk and reluctant to accept surgery.

Objective To investigate the diagnostic value of several bronchial washing fluid with appropriate laboratory techniques in patients with smear and culture negative pulmonary tuberculosis(TB).Methods The test results of 68 patients with smear and culture negative pulmonary TB who underwent bronchoscopy examination were retrospectively analyzed.The current study aimed at understanding the positive rate of diagnosis of pulmonary TB via multiple appropriate laboratory techniques,including bronchial washing fluid(BWF) smear,BWF culture,fluorescence quantitative PCR(FQ-PCR)and phage amplified biologically assay(PhaB).Results Among 68 patients,the positive rates of BWF smear,BWF culture,FQ-PCR and PhaB examination were 29.4%,54.4%,33.8% and 14.7% respectively.Conclusion BWF smear and FQ-PCR detection of the rapid diagnosis of smear and culture negative pulmonary tuberculosis have important clinical value.Phage amplified biologically assay for the diagnosis of smear and culture negative pulmonary tuberculosis needs further study and exploration.Culture is not only the current gold standard for diagnosis of tuberculosis,but also the highest positive rate in these types of detection methods.

目的:探讨噬菌体生物扩增法(phaB)检测肺泡灌洗液中结核分枝杆菌的临床应用价值。方法:收集疑诊为肺结核,未予抗结核的初治患者肺泡灌洗液标本80例,同时应用PhaB法、荧光涂片法、聚合酶链反应技术法(PCR检测法)、罗氏培养法进行检测,对照分析检测结果。结果:80例患者纤支镜检查有46例发现异常,使用PhaB法、荧光涂片法、聚合酶链反应技术、罗氏培养法检查阳性率分别为58.8%、47.5%、65%、76.3%;PhaB法和聚合酶链反应技术两种方法联合检测敏感性为88.5%,特异性为89.5%。结论:PhaB检测疑诊为肺结核的未予抗结核患者肺泡灌洗液结核分枝杆菌,有较高的敏感性和特异性,联合荧光涂片法和聚合酶链反应技术检测可进一步提高其敏感性。

目的总结反复大咯血患者床边紧急纤支镜检查的情况及止血效果,探讨纤支镜下止血的临床价值,安全性及止血机制。方法回顾分析2005～2009年接受床边紧急纤支镜检查治疗的40例反复大咯血患者的纤支镜检查情况,止血效果及并发症发生情况。对纤支镜床边紧急治疗反复大咯血患者的过程、检查、治疗的方法及相应的检查结果归纳总结。结果纤支镜检查到85.7%患者有不同程度的血块阻塞各级支气管;71.4%患者检查仍有活动性出血,经纤支镜清除血块,局部使用止血药后,止血有效率为88.%;血气分析提示:91.3%患者纤支镜治疗后血气有改善,未出现缺氧或二氧化碳潴留加重及出血增多病例。结论反复大咯血不止病例,床边紧急纤支镜局部止血及疏通支气管堵塞对治疗反复咯血及纠正缺氧有较好的疗效和安全性。血块阻塞引起的局部阻塞性炎性反应可能是患者反复咯血的主要原因之一。