Differentiated approach depending on etiology and severity of pulmonary bleeding improves outcomes and reduces the number of operations for ongoing severe bleeding.
Research Institute of emergency medicine named after N.V. Sklifosofskiy Представлен анализ результатов использования фибробронхоскопии у больных с закрытой сочетанной травмой груди. Исследование показало, что у 51,6% пациентов закрытая травма груди сопровождается множественными переломами ребер с одной или обеих сторон с наличием гидро-, пневмоторакса или их сочетанием. Это значительно затрудняет рентгенологическую диагностику внутрилегочных повреждений. Фибробронхоскопия (ФБС) является прямым методом диагностики повреждения бронхов и легких, что подтверждается совпадением данных ФБС с интраоперационными на-ходками и результатами аутопсии и влияет на выбор хирургической тактики. Однако информативность однократного эндоскопического исследования при травматических разрывах бронхов на фоне продолжающегося легочного кровоте-чения недостаточно высока. Одновременно ФБС является и лечебным мероприятием, которое позволяет в большинстве случаев добиться уменьшения интенсивности легочного кровотечения вплоть до полной его остановки.
Ключевые слова: закрытая травма груди, диагностика, фибробронхоскопия.Analysis of the results of fibrobronchoscopy in patients with concomitant closed chest trauma is presented. The study showed that in 51.6% of cases closed chest trauma is accompanied by multiple fractured ribs on one or both sides with the presence of hydro-, pneumothorax, or a combination of them. This greatly complicates radiological diagnosis of pulmonary lesions. Fibrobronchoscopy is a direct method of diagnosis of bronchi and lungs injury that is proved by conjunction of fibrobronchoscopic data with intraoperative findings and autopsy results and affects on the choice of surgical approach. However, sensitivity of single endoscopy for traumatic bronchi rupture is low because of ongoing pulmonary hemorrhage. Along with that fibrobronchoscopy is a therapeutic procedure that allows in majority of cases obtaining reduction of the intensity of pulmonary hemorrhage up to its arrest.
Study objective. Evaluation of the possibilities of ventilation and perfusion scintigraphy in detecting functional disorders and determining the severity of lung damage that may occur after organ transplantation. Material and methods. The study included 27 patients after bilateral lung transplantation; mucoviscidosis was the main cause of terminal respiratory failure in most cases (19 patients; 77.8%). The ventilation scintigraphy was performed with 99mTc-pentatech using a nebulizer, and the perfusion scintigraphy was performed with 99mТс-albumin macroaggregate. The investigations were performed on Infinia II and Discovery 670 NM/CT single-photon emission tomographs (GE, USA). Results. Changes in the quantitative parameters of ventilation and perfusion scintigraphy in patients after lung transplantation were studied. When analyzing the results of radionuclide studies, we identified a restoration of function after lung transplantation, and the appearance of disorders with the development of complications in the early (up to 4 months) and later (more than one year) periods after bilateral lung transplantation. Conclusion. The study has shown that the radionuclide method has wide possibilities for assessing the ventilation and perfusion functions in patients after lung transplantation, helping in the differential diagnosis of obliterating bronchiolitis and graft vascular sclerosis, in assessing the nature of alveolar-capillary diffusion disorders, and determining the extent of functional abnormalities in every individual patient. Monitoring the function of transplanted lungs using scintigraphy allows separate monitoring of ventilation and perfusion changes, which is important for the choice of treatment tactics.
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