高龄慢性阻塞性肺病患者经气管镜肺减容术的疗效与安全性探讨  

Exploration of the efficacy and safety of in aged patients with stage IV COPD treated by bronchoscopic lung volume reduction

作　　者：王晓婧[1] 梅晓冬[1] 包明红[1] 章俊强[1] 蒋旭琴[1] 夏大庆[1] 胡代菊[1] 

机构地区：[1]安徽医科大学附属省立医院,安徽省立医院呼吸内科,合肥230001

出　　处：《中国临床保健杂志》2013年第2期164-166,I0002,共4页Chinese Journal of Clinical Healthcare

基　　金：安徽省卫生厅医学科研课题(09L209)

摘　　要：目的报告1例高龄慢性阻塞性肺病(COPD)患者成功经气管镜活瓣置入施行肺减容术治疗肺气肿,并就该技术的适应证和安全性进行探讨。方法对1例80岁患者按COPD诊疗指南进行病情评估,予以高分辨CT、肺功能和6 min步行试验检查,确定其病情分级为D级,肺功能重度损害,有不均质肺气肿,符合肺减容手术适应证。予常规气管镜检查准备后,经鼻腔插入气管镜,使用Chartis导管插入侧枝通气各肺叶段检测后,选择左下叶内前基底段予以支气管单向活瓣置入。结果患者良好耐受手术。单向活瓣置入位于左下叶内前基底段开口处,活瓣固定良好,随患者呼吸运动开闭正常。术后患者胸闷症状有所减轻,6 min步行距离增加。手术一周后胸片检查,活瓣无移位,活瓣远端肺透亮度较前降低。结论高龄重度肺功能损坏慢性阻塞性肺病患者可使用单向活瓣置入术经气管镜肺减容术治疗,该技术需要更多病例应用并长期观察以进一步确定其有效性和安全性。Objective We report a case of stage IV COPD aged patients who accepted bronchoscopic lung volume reduction and discuss the efficacy and safety of the technique. Methods An 80-year aged patient with COPD,grade D,was assessed and performed bronchoscopic lung volume reduction. Full pulmonary function tests and baseline six-minute walking distance test were examined before the operation. Chartis system was used to determinethe most emphysematous lung segment during the operation. Left inner and anterior lung segment was chosen finally and an endobronchial one-way valve was placed using flexible bronchoscope. Results The patients endured the oper- ation well. The valve was satisfactoryly fixed at the aimed position. Chest x-ray examination seven days after operation indicated attenuated emphysema. Chest tightness was relieved to some extent. Six-minute walking distance increased by 41 meters（23.9% ）. Conclusion Bronchoscopic lung volume reduction is an encouraging alternative treatment for aged patient with severe COPD. More cases and long-term follow-up are needed to further confirm the efficacy and safety.

关 键 词：肺疾病 慢性阻塞性 肺气肿 肺切除术 老年人 80以上 

分 类 号：R563.9[医药卫生—呼吸系统]