5．喀血

Emergent Treatment for Life-threating Hemoptysis

大量喀血に対する緊急治療としては，血管内治療や気管支鏡を用いた止血が優先され，外科手術は最後の手段というのが近年のコンセンサスであり1），緊急手術の経験は限られている．本稿では，外科手術以外の治療を含めた基本的な治療について述べ，緊急処置を要する喀血に対するわれわれの経験を共有したい．

Life-threatening hemoptysis results significant airway obstruction, abnormal gas exchange. When a patient presents with life-threatening hemoptysis, the initial steps are to provide adequate oxygenation and ventilation, secure the airway, position the patient lateral decubitus with bleeding side down, and perform initial treatments to control the bleeding. Bronchoscopy is an important early procedure and can be both diagnostic and therapeutic. For patients who are stable, contrast chest computed tomography （CT） provides diagnostic information before angiography. In most cases, initial measures are successful, allowing time for a more detailed diagnostic investigation and generation of a therapeutic plan. For most patients, arteriography is appropriate for identifying and embolizing a responsible lesion. For patients with refractory life-threatening hemoptysis, repeating previous interventions or evaluating for surgery is appropriate. Patients with aneurysms should be evaluated for urgent surgery.