经纤维支气管镜局部冷冻疗法与无水乙醇注射疗法在瘢痕狭窄型支气管结核气道闭塞治疗中的联合应用  

Combination of flexible bronchoscopy local cryotherapy and absolute ethanol injection therapy in the treatment of airway occlusion of scarring stenosis bronchial tuberculosis

作　　者：孙宏宇 项保利[1] 王布[1] 姬泽萱 SUN Hongyu;XIANG Baoli;WANG Bu;JI Zexuan(The First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院,河北张家口075000

出　　处：《山东医药》2023年第33期40-44,共5页Shandong Medical Journal

摘　　要：目的观察纤维支气管镜下局部冷冻联合无水乙醇注射治疗在瘢痕狭窄型支气管结核气道闭塞的疗效。方法瘢痕狭窄型支气管结核气道闭塞患者90例,所有患者在常规抗结核的基础上进行支气管镜下介入治疗,并依据介入治疗方式的不同分为冷冻组、注射组和联合组,每组30例。冷冻组接受支气管镜下局部冷冻治疗,注射组接受支气管镜下局部无水乙醇注射治疗,联合组接受支气管镜下局部冷冻联合无水乙醇注射治疗。治疗后3个月后,观察三组患者临床疗效,计算总有效率。治疗前、治疗4周后,观察并比较三组患者的肺功能指标(气管直径、FEV1、6 min步行距离)和动脉血气分析指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]。对患者进行为期3个月的随访,记录三组患者并发症发生情况。结果联合组总有效率高于冷冻组和注射组(P<0.05)。与治疗前相比,三组患者治疗后气管直径、FEV1、6 min步行距离均升高(P均<0.05);与冷冻组和注射组相比,治疗后联合组气管直径、FEV1、6 min步行距离均升高(P均<0.05)。与治疗前相比,三组患者治疗后PaO_(2)均升高、PaCO_(2)均降低(P均<0.05);与冷冻组和注射组相比,治疗后联合组PaO_(2)均升高、PaCO_(2)均降低(P均<0.05)。三组患者均未出现气胸、大咯血等严重并发症,并发症发生率均较低,且差异无统计学意义(P均>0.05)。结论与单独应用支气管镜下局部冷冻治疗和支气管镜下局部无水乙醇注射治疗相比,支气管镜下局部冷冻治疗联合无水乙醇注射治疗瘢痕狭窄型支气管结核气道闭塞的疗效显著,可有效改善肺功能和动脉血气状态,且不增加并发症。Objective To observe the effectiveness of flexible bronchoscope local cryotherapy combined with abso⁃lute ethanol injection in the treatment of scarring stenosis bronchial tuberculosis-related airway occlusion.Methods Ninety cases of bronchial tuberculosis with scarring stenosis were selected.All patients received bronchoscopy interven⁃tional therapy on the basis of routine anti-tuberculosis therapy.According to the different interventional therapy,they were divided into cryotherapy group(30 cases),injection group(30 cases)and combination group(30 cases).Patients in the cryotherapy group received local cryotherapy under bronchoscopy,the injection group received local absolute ethanol injec⁃tion under bronchoscopy,and the combination group received local cryotherapy combined with absolute ethanol injection under bronchoscopy.The clinical effectiveness of the three groups was assessed three months after treatment,and the over⁃all effective rate was calculated.The arterial blood gas analysis indexes(arterial partial pressure of carbon dioxide(PaO_(2))and arterial partial pressure of oxygen(PaCO_(2))and pulmonary function indexes(tracheal diameter,FEV1,6-min walking distance)were observed and compared between the three groups before and after treatment.The patients were followed up for 3 months,and the occurrence of complications in the three groups was recorded.Results The total effective rate of the combination group was higher than those of the freezing group and the injection group(both P<0.05).After treatment,the tracheal diameter,FEV1,and 6-minute walking distance increased in these three groups(all P<0.05).Compared with the cryotherapy group and the injection group,the tracheal diameter,FEV1,and 6-minute walking distance in⁃creased in the combination group(all P<0.05).After treatment,the PaO_(2)levels increased and the PaCO_(2)levels decreased in these three groups(all P<0.05).Compared with the cryotherapy group and the injection group,the PaO_(2)level in⁃creased and the PaCO_(2)level decreased in

关 键 词：冷冻疗法 无水乙醇注射疗法 气道闭塞 瘢痕狭窄型支气管结核 纤维支气管镜 

分 类 号：R523[医药卫生—内科学]