支气管镜下局部治疗支气管结核临床分析
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摘要
目的探讨支气管结核支气管镜下表现特征,分析纤维支气管镜下局部治疗支气管结核的临床疗效。方法回顾性分析四川乐山市人民医院呼吸与危重症医学科2016年1月至2017年12月收治的92例支气管结核患者的临床资料,按照随机数字表法将患者分为观察组及对照组,观察组48例,对照组44例。两组患者均采用规范化3HRZE/9HR抗结核口服药物治疗及雾化吸入治疗,观察组在此基础上采用纤维支气管镜下局部注射药物治疗。比较两组患者治疗1、2、3、6个月时痰抗酸杆菌转阴率及治疗6个月时的临床疗效,记录治疗过程中的不良反应并进行远期随访。结果观察组治疗3、6个月时痰菌转阴率显著高于对照组(P<0.05);观察组治疗总有效率为85.42%,对照组为63.64%,组间比较差异具统计学意义(P<0.05);两组患者治疗过程中不良反应无明显差异(P>0.05)。观察组48例支气管结核患者经12个月抗痨和支气管镜下局部治疗,全部临床治愈率;对照组为44例支气管结核临床治愈率为77.27%,两组患者远期临床治愈率比较差异具统计学意义(P=0.000)。结论纤维支气管下局部治疗支气管结核,结合联合常规应用抗结核药物治疗,可有效促进支气管结核患者痰菌转阴,以提高临床疗效,并且可缩短治疗周期。
Objective To explore the characteristics of bronchial tuberculosis under a bronchoscope and analyze the clinical effect of local treatment of bronchial tuberculosis under a fiberoptic bronchoscope.Methods The clinical data of 92 cases of bronchial tuberculosis admitted to the Department of Respiratory and Critical Care Medicine of Leshan People' s Hospital in Sichuan Province in China from January 2016 to December 2017 were retrospectively analyzed. The patients were divided into an observation group( n = 48) and a control group( n = 44) according to the random number table method. The patients in both groups were treated with the standardized 3 HRZE/9 HR anti-tuberculosis oral drug therapy and atomization inhalation therapy,and the patients in the observation group was treated with local drug injection under a fiberoptic bronchoscope on this basis. The sputum acid-fast bacilli negative conversion rate at 1,2,3 and 6 months of treatment and the clinical efficacy at 6 months of treatment were compared between the two groups. The adverse reactions during the treatment were recorded and a long-term follow-up was conducted. Results The sputum negative conversion rate in the observation group was significantly higher than that in the control group at 3 and 6 months of treatment( P<0.05). The total effective rates were 85.42% in the observation group and 63.64% in the control group,with a statistically significant difference between the two groups( P < 0. 05). There was no significant difference in the adverse reactions between the two groups( P > 0. 05). In the observation group,48 cases of bronchial tuberculosis were treated with anti-tuberculosis and bronchoscopy for 12 months and were all clinically cured. The clinical cure rate of 44 cases of bronchial tuberculosis in the control group was 77. 27%. The difference of the long-term clinical cure rate between the two groups was statistically significant( P = 0.000).Conclusion Local treatment for the patients with bronchial tuberculosis under a fiberoptic bronchoscope combined with conventional anti-tuberculosis drugs can effectively promote the sputum negative transformation,improve the clinical efficacy and shorten the treatment period.
Objective To explore the characteristics of bronchial tuberculosis under a bronchoscope and analyze the clinical effect of local treatment of bronchial tuberculosis under a fiberoptic bronchoscope.Methods The clinical data of 92 cases of bronchial tuberculosis admitted to the Department of Respiratory and Critical Care Medicine of Leshan People' s Hospital in Sichuan Province in China from January 2016 to December 2017 were retrospectively analyzed. The patients were divided into an observation group( n = 48) and a control group( n = 44) according to the random number table method. The patients in both groups were treated with the standardized 3 HRZE/9 HR anti-tuberculosis oral drug therapy and atomization inhalation therapy,and the patients in the observation group was treated with local drug injection under a fiberoptic bronchoscope on this basis. The sputum acid-fast bacilli negative conversion rate at 1,2,3 and 6 months of treatment and the clinical efficacy at 6 months of treatment were compared between the two groups. The adverse reactions during the treatment were recorded and a long-term follow-up was conducted. Results The sputum negative conversion rate in the observation group was significantly higher than that in the control group at 3 and 6 months of treatment( P<0.05). The total effective rates were 85.42% in the observation group and 63.64% in the control group,with a statistically significant difference between the two groups( P < 0. 05). There was no significant difference in the adverse reactions between the two groups( P > 0. 05). In the observation group,48 cases of bronchial tuberculosis were treated with anti-tuberculosis and bronchoscopy for 12 months and were all clinically cured. The clinical cure rate of 44 cases of bronchial tuberculosis in the control group was 77. 27%. The difference of the long-term clinical cure rate between the two groups was statistically significant( P = 0.000).Conclusion Local treatment for the patients with bronchial tuberculosis under a fiberoptic bronchoscope combined with conventional anti-tuberculosis drugs can effectively promote the sputum negative transformation,improve the clinical efficacy and shorten the treatment period.
引文
1金发光.支气管结核介入的诊治方案[J/CD].中华肺部疾病杂志(电子版),2016,9(1):1-4.
2潘蕾,李王平,刘伟,等.125例支气管结核临床及支气管镜下特征分析[J/CD].中华肺部疾病杂志(电子版),2016,9(1):66-68.
3 Jiao AX,Sun L,Liu F,et al.Characteristics and clinical role of bronchoscopy in diagnosis of childhood endobronchial tuberculosis[J].World J Pediatr,2017,13(6):599-603.
4 Ruan JZ,Zhang TH,Li FG,et al.Surgical Treatment of Bronchial Stricture due to Endobronchial Tuberculosis:Results in 36Consecutive Cases[J].Zhongguo fei ai za zhi,2018,21(4):320-322.
5李王平,金发光,傅恩清,等.改良高压球囊扩张法对支气管结核性瘢痕样狭窄治疗的作用[J/CD].中华肺部疾病杂志(电子版),2015,8(3):288-292.
6赵磊,狄岩,王瑜玲,等.常规抗结核药物联合经支气管镜冷冻治疗支气管结核的临床疗效及其对免疫功能的影响研究[J].中国全科医学,2016,19(29):3554-3557.
7谢新凤,郑西卫.支气管镜下局部联合常规抗结核用药治疗气管支气管结核的疗效[J].宁夏医科大学学报,2017,10(9):1093-1094.
8王志国,程海林.支气管结核纤维支气管镜下检测结果临床分析[J].临床肺科杂志,2016,21(4):766-768.
9 Han Q,Chen C,Hu HQ,et al.Effect evaluation on use of bedside fiber bronchoscope in treating stroke-associated pneumonia[J].Top Stroke Rehabil,2018,25(23):1-8.
10丁卫民,傅瑜.气管支气管结核诊断和治疗指南(试行)[J].中华结核和呼吸杂志,2012,35(8):230-238.
11 Samard6i Natalija,Jovanovi Dragana,Markovi Deni Ljiljana,et al.Clinical features of endobronchial tuberculosis[J].Vojnosanitetski Pregled,2014,71(2):156-60.
12张东,孙昕,秦中华,等.经支气管内镜治疗气管-支气管结核76例的疗效[J].实用医学杂志,2018,34(1):115-118.
13高云,李占英.支气管结核内镜介入治疗气管及支气管结核74例临床疗效观察[J].中国地方病防治杂志,2017,32(7):799-799.
14尹梅,马国仁,张红.经气管镜介入冷冻联合雾化吸入治疗气管支气管结核36例临床观察[J].宁夏医科大学学报,2014,36(8):906-907.
15 Kunal S,Shah A.The concomitant occurrence of pulmonary tuberculosis with bronchial anthracofibrosis[J].Indian J Tuberc,2017,64(1):5-9.
16 Cepeda S,Pajares V,Trujillo-Reyes JC,et al.A new cyanoacrylate used as bronchial sealant in the endoscopic treatment of bronchopleural fistual[J].Arch Bronconeumol,2017,53(3):168-169.
17 Nayana A,Pritee T,Madhavi S,et al.A randomized trial to assess the utility of preintubation adult fiberoptic bronchoscope assessment in patients for thoracic surgery requiring one-lung ventilation:[J].Annals of Cardiac Anaesthesia,2016,19(2):251-255.
18 Marchioni A,Casalini E,Andreani A,et al.Incidence,Etiology,and Clinicopathologic Features of Endobronchial Benign Lesions[J].J Bronchology Interv Pulmonol,2018,25(2):118-124.
19孙瑞琳,金发光,谢永宏,等.支气管镜在气管支气管结核诊断中的临床价值[J/CD].中华肺部疾病杂志(电子版),2016,9(1):10-12.
20罗世林,毛淑华,李杰.气管支气管结核的支气管镜诊治分析[J].临床肺科杂志,2016,11(2):315-318.
21蒋博峰,马晨晨,陈阳贵,等.抗结核药物不良反应发生率及其影响因素分析[J].中华疾病控制杂志,2017,21(2):160-163.
22 Baskaran UL,Sabina EP.Clinical and experimental research in antituberculosis drug-induced hepatotoxicity:a review[J].J Integr Med,2017,15(1):27-36.
23张琦,薛欣,党丽云,等.经纤维支气管镜介入治疗对支气管结核患者转阴率及疗效的影响[J].陕西医学杂志,2016,45(12):1653-1654.
24袁欣,田丰,周军,等.不同栓塞剂对支气管扩张与肺结核所致大咯血的疗效比较[J].实用医学杂志,2017,33(9):107-110.
25 Yaguchi D,Ichikawa M,Shizu M,et al.Bronchoscopic local steroid spray to prevent bronchial tuberculosis-induced cicatricial bronchial stenosis:A case series[J].Medicine,2018,97(28):e11464.
26王娟,孙军,高长龙,等.纤维支气管镜肺泡灌洗术治疗儿童难治性支原体肺炎疗效分析?[J].临床儿科杂志,2017,35(1):16-18.
27彭红星,曾玉兰,冯伏先,等.支气管扩张合并感染患者纤维支气管镜下支气管分泌物病原菌培养及耐药性分析[J].中国感染与化疗杂志,2017,17(2):140-143.
28 Chung MY,Park B,Seo J,et al.Successful airway management with combined use of Mc GrathMAC video laryngoscope and fiberoptic bronchoscope in a severe obese patient with huge goiter:a case report[J].Korean J Anesthesiol,2018,71(3):232-236.
29李艳静,常占平,刘恩利,等.支气管镜下注药联合雾化吸入治疗支气管结核的疗效观察[J].中国临床研究,2017,30(1):58-60.
30钱卫生,薄丽艳,陈敏,等.支气管镜下冷冻治疗支气管结核的疗效分析[J/CD].中华肺部疾病杂志(电子版),2016,9(1):13-16.
31彭渝,胡成平,杨华平,等.1 221例支气管结核的支气管镜结果分析[J].Chin J Respir Crit Care Med,2015,14(2):182-185.
32 Sanjeevaiah S,Haranal MY,Buggi S.Role of flexible bronchoscopy in patients with sputum-negative pulmonary tuberculosis[J].Indian Thorac Cardiovasc Surg,https://doi.org/10.1007/s12055-018-0645-z
2潘蕾,李王平,刘伟,等.125例支气管结核临床及支气管镜下特征分析[J/CD].中华肺部疾病杂志(电子版),2016,9(1):66-68.
3 Jiao AX,Sun L,Liu F,et al.Characteristics and clinical role of bronchoscopy in diagnosis of childhood endobronchial tuberculosis[J].World J Pediatr,2017,13(6):599-603.
4 Ruan JZ,Zhang TH,Li FG,et al.Surgical Treatment of Bronchial Stricture due to Endobronchial Tuberculosis:Results in 36Consecutive Cases[J].Zhongguo fei ai za zhi,2018,21(4):320-322.
5李王平,金发光,傅恩清,等.改良高压球囊扩张法对支气管结核性瘢痕样狭窄治疗的作用[J/CD].中华肺部疾病杂志(电子版),2015,8(3):288-292.
6赵磊,狄岩,王瑜玲,等.常规抗结核药物联合经支气管镜冷冻治疗支气管结核的临床疗效及其对免疫功能的影响研究[J].中国全科医学,2016,19(29):3554-3557.
7谢新凤,郑西卫.支气管镜下局部联合常规抗结核用药治疗气管支气管结核的疗效[J].宁夏医科大学学报,2017,10(9):1093-1094.
8王志国,程海林.支气管结核纤维支气管镜下检测结果临床分析[J].临床肺科杂志,2016,21(4):766-768.
9 Han Q,Chen C,Hu HQ,et al.Effect evaluation on use of bedside fiber bronchoscope in treating stroke-associated pneumonia[J].Top Stroke Rehabil,2018,25(23):1-8.
10丁卫民,傅瑜.气管支气管结核诊断和治疗指南(试行)[J].中华结核和呼吸杂志,2012,35(8):230-238.
11 Samard6i Natalija,Jovanovi Dragana,Markovi Deni Ljiljana,et al.Clinical features of endobronchial tuberculosis[J].Vojnosanitetski Pregled,2014,71(2):156-60.
12张东,孙昕,秦中华,等.经支气管内镜治疗气管-支气管结核76例的疗效[J].实用医学杂志,2018,34(1):115-118.
13高云,李占英.支气管结核内镜介入治疗气管及支气管结核74例临床疗效观察[J].中国地方病防治杂志,2017,32(7):799-799.
14尹梅,马国仁,张红.经气管镜介入冷冻联合雾化吸入治疗气管支气管结核36例临床观察[J].宁夏医科大学学报,2014,36(8):906-907.
15 Kunal S,Shah A.The concomitant occurrence of pulmonary tuberculosis with bronchial anthracofibrosis[J].Indian J Tuberc,2017,64(1):5-9.
16 Cepeda S,Pajares V,Trujillo-Reyes JC,et al.A new cyanoacrylate used as bronchial sealant in the endoscopic treatment of bronchopleural fistual[J].Arch Bronconeumol,2017,53(3):168-169.
17 Nayana A,Pritee T,Madhavi S,et al.A randomized trial to assess the utility of preintubation adult fiberoptic bronchoscope assessment in patients for thoracic surgery requiring one-lung ventilation:[J].Annals of Cardiac Anaesthesia,2016,19(2):251-255.
18 Marchioni A,Casalini E,Andreani A,et al.Incidence,Etiology,and Clinicopathologic Features of Endobronchial Benign Lesions[J].J Bronchology Interv Pulmonol,2018,25(2):118-124.
19孙瑞琳,金发光,谢永宏,等.支气管镜在气管支气管结核诊断中的临床价值[J/CD].中华肺部疾病杂志(电子版),2016,9(1):10-12.
20罗世林,毛淑华,李杰.气管支气管结核的支气管镜诊治分析[J].临床肺科杂志,2016,11(2):315-318.
21蒋博峰,马晨晨,陈阳贵,等.抗结核药物不良反应发生率及其影响因素分析[J].中华疾病控制杂志,2017,21(2):160-163.
22 Baskaran UL,Sabina EP.Clinical and experimental research in antituberculosis drug-induced hepatotoxicity:a review[J].J Integr Med,2017,15(1):27-36.
23张琦,薛欣,党丽云,等.经纤维支气管镜介入治疗对支气管结核患者转阴率及疗效的影响[J].陕西医学杂志,2016,45(12):1653-1654.
24袁欣,田丰,周军,等.不同栓塞剂对支气管扩张与肺结核所致大咯血的疗效比较[J].实用医学杂志,2017,33(9):107-110.
25 Yaguchi D,Ichikawa M,Shizu M,et al.Bronchoscopic local steroid spray to prevent bronchial tuberculosis-induced cicatricial bronchial stenosis:A case series[J].Medicine,2018,97(28):e11464.
26王娟,孙军,高长龙,等.纤维支气管镜肺泡灌洗术治疗儿童难治性支原体肺炎疗效分析?[J].临床儿科杂志,2017,35(1):16-18.
27彭红星,曾玉兰,冯伏先,等.支气管扩张合并感染患者纤维支气管镜下支气管分泌物病原菌培养及耐药性分析[J].中国感染与化疗杂志,2017,17(2):140-143.
28 Chung MY,Park B,Seo J,et al.Successful airway management with combined use of Mc GrathMAC video laryngoscope and fiberoptic bronchoscope in a severe obese patient with huge goiter:a case report[J].Korean J Anesthesiol,2018,71(3):232-236.
29李艳静,常占平,刘恩利,等.支气管镜下注药联合雾化吸入治疗支气管结核的疗效观察[J].中国临床研究,2017,30(1):58-60.
30钱卫生,薄丽艳,陈敏,等.支气管镜下冷冻治疗支气管结核的疗效分析[J/CD].中华肺部疾病杂志(电子版),2016,9(1):13-16.
31彭渝,胡成平,杨华平,等.1 221例支气管结核的支气管镜结果分析[J].Chin J Respir Crit Care Med,2015,14(2):182-185.
32 Sanjeevaiah S,Haranal MY,Buggi S.Role of flexible bronchoscopy in patients with sputum-negative pulmonary tuberculosis[J].Indian Thorac Cardiovasc Surg,https://doi.org/10.1007/s12055-018-0645-z
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