支气管镜肺减容术在极重度慢性阻塞性肺疾病中的应用  

Bronchoscopic lung volume reduction for very severe chronic obstructive pulmonary disease

作　　者：穆新林[1] 李冉[1] 周德训[1] 李原[2] 邱李恒 曹照龙[1] 高占成[1] 

机构地区：[1]北京大学人民医院呼吸与危重症医学科,北京100044 [2]北京大学人民医院核医学科,北京100044

出　　处：《中国内镜杂志》2013年第11期1121-1125,共5页China Journal of Endoscopy

摘　　要：目的总结采用Zephyr单向活瓣进行支气管镜肺减容术治疗的极重度慢性阻塞性肺疾病(COPD)患者的临床资料,提高临床医师对该技术的理解和认识。方法患者男性,52岁,肺减容术前FEV1占预计值19.3%,诊断为慢性阻塞性肺疾病(极重度)。胸部CT显示双侧非均质性肺气肿。采用ChartisR系统测定肺旁路通气,结合同位素肺通气/灌注测定结果选择肺减容的靶肺叶。采用可弯曲支气管镜行单向活瓣肺减容术。结果于右上叶B1、B2、B3段支气管置入Zephyr活瓣共3枚。术后1和8个月复查肺功能显示FEV1、FVC、DLco增加,RV下降,6 min步行试验由术前的210 m增加到术后8个月的400 m。复查胸部CT示右肺上叶局限性肺膨胀不全,右上叶肺容积缩小。术后无不良事件发生。结论采用Zephyr单向活瓣的支气管肺减容术是治疗经过严格筛选的极重度COPD的一项安全有效的方法。[Objective] To improve the recognition of bronchoscopic lung volume reduction （BI,VR） for very se- vere chronic obstructive pulmonary disease （COPD）. [ Methods ] A 52-year-old man was reported in the article who was diagnosed as very severe COPD with 19.3% of predicted FEV1 before BLVR. Computed tomography was per- formed to confirm the heterngeneous emphysema of the patient. Chartis puhnonary assessment system and ventila- tion/ perfusion lung scan were used to determine the targeted lobe for BLVR. Flexible bronchoscopy was used to deliver Zephyr Endohrnnchial Valve to targeted lobe. [ Results ] Three Zephyr Endobronchial Valves were implanted into three segments （B1, B2, B3） of right upper lobe of lung respectively. Increasing FEVI, FVC, DLco and de- creasing RV were observed one month and eight month later after BLVR. Six-minute-walking distance increased from 210m to 400m eight month later after BLVR. CT scan also indicated reduction of the volume of right upper lobe after BLVR. Less complications were observed during the period of eight-month follow up. [ Conclusion ] BLVR using Zephyr Endobronchial Valve is a safe and effective method for treatment of very severe COPD in selected patients.

关 键 词：支气管镜肺减容 肺气肿 慢性阻塞性肺疾病 

分 类 号：R563[医药卫生—呼吸系统]