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.

目的 探讨近期大咯血对支气管镜诊疗操作相关出血的影响.方法 回顾性分析2015年12月—2019年12月我院支气管镜操作导致出血超过30 mL患者的临床资料,根据近1周是否发生大咯血,分为观察组(大咯血组)和对照组(无大咯血组),比较2组间的出血量以及大出血、 血凝块、 窒息的发生率.结果 观察组的出血量以及大出血的发生率高于对照组,2组间差异有统计学意义,血凝块、 窒息的发生率两组间差异无统计学意义.结论 近期大咯血的患者支气管镜操作发生大出血的风险高.

Objective:To investigate the predictive value of thrombosis and hemostasis tests on the possible occurrence of bleeding, thrombosis, and asphyxia complications during fiberoptic bronchoscopy for diagnosis and treatment.Methods:The clinical data of fifty cases with bleeding over 30 ml during fiberoptic bronchoscopy, which were screened from 36 785 patients accepting fiberoptic bronchoscopy from January 2016 to December 2019 in Guangzhou Chest Hospital, were analyzed retrospectively. These cases were divided into asphyxia group and non-asphyxia group, or hematorrhea group (more than 100 ml of bleeding) and small hemorrhage group, or thrombosis group and non-thrombosis group. As for analysis of abnormal incidence and amount level, included thrombosis and hemostasis tests were as follows: D2 polymer (D2), prothrombin time (PT), prothrombin time ratio (PTR), prothrombin time international normalized ratio (PTINR), fibrinogen (Fbg), partial activated thromboplastin time (APTT), thrombin time (TT).Results:Abnormal incidences of D2, PTINR and level of Fbg of 14 cases with asphyxia were significantly higher those of 36 cases without asphyxia ( P values were 0.033, 0.006, and 0.006 respectively). Compared with 31 cases with small hemorrhage, 19 cases with hematorrhea had a significantly higher incidence of abnormal Fbg (χ 2=4.402, P=0.036). Abnormal incidences of PTINR and Fbg of 14 cases with thrombosis were significantly higher than those of 36 cases without thrombosis ( P values were 0.006 and 0.041 respectively); moreover, the level of Fbg was the same ( t=3.446, P=0.001). Taking the abnormal coagulation function as the exposure factor, the values of 21 odds ratios ( OR) of asphyxia vs. non-asphyxia, hematorrhea vs. small hemorrhage, and thrombosis vs. non-thrombosis were from 0.355 to 14.400, of which 16 OR were above 2.500. Conclusion:It is essential that the patients with abnormal coagulation function are paid more attention to prevent complication such as hematorrhea, thrombosis, and asphyxia during fiberoptic bronchoscopy.

严重急性呼吸综合征(SARS)是一种短期内累及32个国家和地区的新发现的急性呼吸系统传染病.大量研究表明其致病微生物是一种新型的冠状病毒[1].早期对SARS流行病学特点缺乏认识,曾发生因抢救1例患者导致96位医务人员聚集性感染的罕见院内感染事件[2].为此,本文初步探讨2003年广州市胸科医院发热门诊收治的SARS病例的措施制度及运作流程,为今后的突发公共卫生事件的处理提供依据.