![急诊临床路径](https://wfqqreader-1252317822.image.myqcloud.com/cover/11/36535011/b_36535011.jpg)
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第二章 急诊症状临床路径
2.咯 血
概 述
喉及喉以下呼吸道或肺组织出血,并经口腔咯出称为咯血。表现为痰中带血,或者咯鲜血,大多数(约90%)是支气管动脉源性出血,少数(约10%)为肺动脉源性出血。目前对咯血的分度标准各专家意见还不尽一致,多数以24小时内咯血量<100ml为少量,100~500ml为中量,>500ml为大量。以下是咯血诊治的临床路径。
表2.1 咯血的病因
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T2.1_59935.jpg?sign=1734447918-h05kFPoAT3JTv8idz0UtONPls5DEKhOQ-0-093eb494530f33a8d707a9e504b16680)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T2.1_1_59936.jpg?sign=1734447918-1ngCyB4i8qR8wNYqkoEWbgUX5gzN1Tm6-0-c940e83cd337886560e0a7a56e395629)
表2.2 咯血的检查
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T2.2_3222.jpg?sign=1734447918-KMM1jgMRhFGzZBoM6xlWxg7RWrSxocIY-0-2fd404e2205089f26600e1fbc4ef05f1)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T2.2_1_3270.jpg?sign=1734447918-rTeA6NVC2PuXBM2jAoUtr04g7JFFcVqM-0-735a965c1717dd3a65f10d71ff86168c)
表2.3 大量咯血的处理(24小时内咯血量>500ml)
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T2.3_3277.jpg?sign=1734447918-Plj3QHzMQyLsNyJMADzf1OuGaSq12jRb-0-e5cf882c3e09f38c793bba2902470075)
注意:咯血可通过血的颜色及pH与呕血鉴别(表2.4):咯血呈鲜红色,碱性;呕血呈棕色、暗红色,酸性。鼻咽腔出血可被误认为咯血;如不明确,可向耳鼻咽喉科医师寻求意见。
表2.4 咯血与呕血的鉴别
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T2.4_59937.jpg?sign=1734447918-vQYwWvUGfAek6MTh2OvdjxeNU0UsmVZe-0-6ed3bfaa29b57beef27e35c52f5bd514)