介入封堵后良性支气管残端瘘患者长期不愈合的影响因素  

The related factors of patients with unhealing benign central bronchopleural fistula in long-term management after bronchoscopic intervention

作　　者：王智娜 王颖 马洪明 高鸿 王洪武 张楠 WANG Zhi-na;WANG Ying;MA Hong-ming;GAO Hong;WANG Hong-wu;ZHANG Nan(Department of Respiratory and Critical Care 2,Emergency General Hospital,Beijing 100028,China;Department of Respiratory,Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital,Beijing 100700,China)

机构地区：[1]应急总医院呼吸与危重症2部,北京100028 [2]北京中医药大学东直门医院呼吸内科,北京100700

出　　处：《东南国防医药》2022年第4期367-372,共6页Military Medical Journal of Southeast China

摘　　要：目的对呼吸介入封堵后的良性支气管残端瘘患者进行长期管理随访,分析回顾其随访半年后的瘘口不愈合的相关影响因素。方法回顾性分析2015年1月-2020年12月应急总医院收治的55例行气管镜下封堵物置入治疗的良性支气管残端瘘患者的临床资料,收集其半年随诊的一般资料、营养指标如血红蛋白、血清白蛋白、血清总蛋白、血脂、BMI、营养风险筛查2002(NRS2002)评分结果,感染指标如是否脓胸、白细胞、中性粒细胞绝对值、淋巴细胞绝对值、超敏C反应蛋白、病原学结果,瘘口愈合情况,进行统计分析。结果55例气管镜介入治疗的良性支气管残端瘘患者中,感染(3例)是患者死亡(4例)的主要原因,存活的51例中有26例(51.0%)患者瘘口愈合,瘘口不愈合与年龄>60岁、脓胸、高营养不良评分有关(P<0.05),感染指标和营养不良正相关(r=0.434,P<0.001)。患者封堵前铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌较常见。放置支架或封堵器前后患者的病原学存在不同。脓胸引流通畅但瘘口未愈合,且未取出置入物者长期封堵后易出现革兰阴性杆菌(铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌)及白念珠菌。结论良性支气管残端瘘患者封堵后,脓胸、营养不良与无法愈合密切相关。封堵后在长期随访过程中病原学存在变化。在脓胸引流通畅的基础上,呼吸内镜封堵治疗后仍应加强监控和治疗置入物相关性呼吸道感染,才能有助于瘘口愈合。Objective Toinvestigate negative-related factors of fistula healing of patients with central benign bronchopleural fistula after 6 months’follow-up,in order to guide the long-term management of the patients.Methods 55 hospitalized patients with benign bronchopleural fistula in emergency general hospital from January 2015 to December 2020,who treated with tracheal endoscopic interventional therapy,were investigated then their clinical data including nutritional indexes(hemoglobin,serum albumin,serum total protein,lipids,BMI,nutritional risk screening 2002 scores)and infection parameters(empyema,white blood cells,neutrophil absolute value,lymphocyte absolute value,high sensitivity c-reactive protein,infection site,pathogenic results,the healing of fistular were analyzed.Results Among 55 patients with bronchopleural fistula who treated with tracheal endoscopic interventional therapy,infection(3 cases)was the main cause of death(4 cases),26 cases(51.0%)of fistula healing among 51 who were alive,fistula unhealing was related to age(>60y),empyema,high NRS2002 score,furthemore(P<0.05),infection and malnutrition were positively related(r=0.434,P<0.001).Pathogens were mostly pseudomonas aeruginosa,acinetobacter baumannii and staphylococcus aureus before occlusion.Pathogens changed after airway stent or other placement.Gram-negative bacilli(pseudomonas aeruginosa,klebsiella pneumoniae,acinetobacter bowman)and candida albicans are common in 25 patients with unhealed fistula after treatment in long-term follow-up with good drainage of empyema.Conclusion Patients who had a higher risk of malnutrition,and empyema were negatively related to healing.There were pathogen changes in patients with benign bronchopleural after bronchoscopic occlusion during long-term follow-up.Based on the patency of empyema drainage,the monitoring and treatment of stent or occluder-related respiratory infection should be strengthened after endoscopic closure in order to the fistula healing.

关 键 词：支气管残端瘘 愈合 脓胸 病原学 营养 

分 类 号：R562[医药卫生—呼吸系统]