肺结节活检术风险管理瑞金专家共识

doi:10.16150/j.1671-2870.2022.01.006

摘要/Abstract

关键词: 肺结节, 活检, 风险评估, 管理

中图分类号:

R734.2

上海交通大学医学院附属瑞金医院肺小结节诊治和管理学科群专家组. 肺结节活检术风险管理瑞金专家共识[J]. 诊断学理论与实践, 2022, 21(01): 22-31.

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出血程度	临床表现	处理
少量出血	肺实质内出血、针道出血以及少量血胸	可自行吸收,无需特殊处理
中量出血	肺实质内出血较多,间断性针道或创面渗血	建议患者患侧卧位（穿刺侧朝下）,防止血进入健侧支气管,注意保持气道通畅,可用止血药物、输血,必要时行气管插管
大量出血	大量持续出血或血胸	血胸量较大时,则推荐胸腔闭式引流;出血量大、持续出血时,及时采用介入手段或外科干预,并组织相关科室救治

出血程度	临床表现	处理
少量出血	镜下少许出血,不影响操作,视野尚清晰	无需特殊处理,操作完成后可局部注射冰生理盐水或肾上腺素止血
中量出血	镜下较多出血,填满支气管腔,导致视野不清	需要即刻处理,局部注射冰生理盐水或肾上腺素止血
大量出血	短时间出血无法控制,存在呼吸道阻塞,导致窒息等危险	应立即将患者调整为患侧卧位,及时采取综合性止血措施,必要时行气管插管

指标	表现或范围
淋巴瘤	肺炎肺泡型
血小板计数	<60×10⁹/L
凝血酶原时间	>16 s
国际标准化比值	>1.5
纤维蛋白原	<1.0 g/L
血红蛋白	<60 g/L
白蛋白	<20 g/L
血清转氨酶	>3倍上限（IU/L）

指标	参考范围
疾病评估	肺动脉压力>50 mmHg 前脑钠肽>500 pg/mL 心肌蛋白：肌酸激酶、肌红蛋白、肌钙蛋白（任意升高≥2项）心电图动态ST-T改变恶性心律失常或心室率>100次/分心脑血管狭窄面积>70% 癫痫持续状态严重程度评分量表（意识、发作类型、年龄、癫痫史）（Status Epilepticus Severity Score、STESS）>3分免疫指标：抗核抗体、可溶性抗体、抗磷脂抗体、皮肌炎抗体、类风湿因子（任意阳性≥2项）
收缩压	>180 mmHg
血红蛋白	<60 g/L
肌酐	>200 μmol/L
血钾	>5.5 mmol/L
D-二聚体	>0.5 mg/L

疾病	CCI（分）
心肌梗死	1
心力衰竭	1
外周血管疾病	1
脑血管疾病	1
慢性气道疾病	1
消化性溃疡	1
风湿性关节炎	1
糖尿病但无并发症	1
糖尿病有并发症	2
偏瘫或截瘫	2
轻度肝脏疾病	1
中重度肝脏疾病	3
肾脏疾病	2
实体恶性肿瘤或者恶性血液系统疾病	2
痴呆	1
实体恶性肿瘤伴转移	6
人类免疫缺陷病毒/获得性免疫缺陷综合征	6

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