6.7. Treatment of hemorrhages in lung tuberculosis


Lung hemorrhages and haemoptysis of tubercular etiology, according to modern statistical data are constitute of 80-90% of all lung hemorrhages. Conservative, therapeutic measures have wide application in mild and moderate hemorrhages. The treatment of hemoptysis consists of:

  1. In assignment of rest is advised as semi-sitting position of the patient;
  2. Reduction of blood pressure in bronchial artery system or pulmonary artery.
  3. Increase coagulation ability of blood.

Reduction of blood pressure in bronchial arteries is achieved by intravenous introduction of:

  1. Natrium Nitroprussid (Sodium Nitroprusside),
  2. Arphonade Maximal blood pressure should not be lower than 90 mm Hg.

Pressure in system of pulmonary artery could be reduced:

  1. Imposing venouse tournquet on extremities for no more than 40 min;
  2. Intravenous introduction of Euphillinum.

For amplification of blood coagulation intravenous introduction.

  1. 10 % a solution of Natrii chloridum or Calcium gluconicum.
  2. Intravenous 1 % a solution Protamini sulfas.
  3. Intravenous fibrinolis inhibitor – 5 % a solution of Acidic aminocapronicum.

At profuse bleedings there can be a necessity of partial replacement of the lost blood. It is necessary to assign additional methods used at hemoptysis for preventive aspiration pneumonia and complications:

  1. Antibiotics of a wide spectrum;
  2. Antituberculosis drugs.

To stop hemoptysis as soon as possible in tuberculosis patients it is possible to perform out artificial pneumothorax or pneumoperitoneum. Artificial pneumothorax it is necessary to apply in cases, when the bleeding arises at the patients with fresh cavities, without expressed fibrosis. If a source of bleeding is fresh destructive processes located in the lower lobes, then recommended to impose pneumoperitoneum. As a whole differential application of the listed above medical treatment measures allows to stop hemorrhages at 80-90% of the patients. Surgical intervention is indicated at inefficiency of these methods, and also at life threatening condition.

The operations at lung hemorrhages can be:

  1. extraordinary, at moment of blood loss;
  2. urgent need – after arrest of bleeding;
  3. scheduled or planned – after when hemoptysis stopped, fulfilled special investigation and high-grade preoperational surgery.

Emergency surgical methods.

To stop hemorrhage is necessary to organize emergency surgical help, performing resection of a part or the entire lung. Depending on the form, prevalence of tubercular process, and functional data segmental resections, lobectomy or pulmonectomy could be performed. To do replaced blood transfusion is obligatory during preparation of the patients for surgery in case of massive bleeding. A patient needs to be transported in department of thoracic surgery at intensive lung hemorrhages on vital indications for rendering the emergency surgical help of.

Occlusion of a bleeding vessel is the most effective method to stop hemoptysis is.

Occlusion of bronchial artery it is possible to perform through catheter immediately after bronchial arteriography and refinement topical diagnostics of bleeding. For this purpose through catheter enter slices of teflon velour, silicon balls, fibrin sponge, clots of own blood, and in a case of a very wide vessel -a special metal spiral with a loop from teflon strings. It is possible to use other materials, which promote thrombosis and to stop of a bleeding from bronchial arteries. Catheterization and temporary balloon occlusion of artery can be carried out at bleedings from system pulmonic artery for temporary haemostasis.

Spontaneous pneumothorax (SP).

Spontaneous pneumothorax. Spontaneous pneumothorax occurs most frequently as a result of tuberculosis in the lung, owing to spontaneous pneumothorax. The reason spontaneous pneumothorax can be perforation of sub pleural focus, cavity, and emphysematous bleb. The size of a gas cavity depends on presence pleural jointing, which considerably complicate ability of lungs for compression, therefore limited closed spontaneous pneumothorax is formed. If the pleural jointing is not present, the formation of the large gas cavity is possible with subsequent squeeze of the lung. Thus the quick stoppage of one lung function can result in the stopping its respiratory function and then to arise lung-heart insufficiency. The first hours are most dangerous after spontaneous pneumothorax to the patient. If the perforation is not closed, it cause open spontaneous pneumothorax. At formation of pleuro – pulmonic fissure, valvular (gated) pneumothorax is formed. Limited closed spontaneous pneumothorax can proceed asymptomatically. If the gaseous cavity small, homodynamic disturbance is not observed. The perforation is quickly closed, the gas is soaked up, and spontaneous pneumothorax disappears without leaving any trace.

Clinical signs.
At spontaneous pneumothorax the patients complain of pain in the side of spontaneous pneumothorax, especially during cough and physical stress, also dyspnea occurs. Large and fast lung shrinking causes collaptoid state: weakness, pallor, cold sweat, often and filamentous pulse. On auscultation of the patient above area of spontaneous pneumothorax the weakened breath could be detected.

On X-ray gaseous buble is found in the pleural cavity.

Open and valvular spontaneous pneumothorax is complicated sometimes with exudative pleurisy, duration of illness longer and severe than in closed pneumothorax. Closed limited pneumothorax without damage of heart-lung activity is left without intrapleural changes. Gradually gas disappears, and the lung expands.

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