经支气管镜肺活检在肺部病变伴急性低氧性呼吸衰竭临床诊断中的应用价值  

Application value of transbronchial lung biopsy in the diagnosis of pulmonary diseases complicated with acute hypoxemic respiratory failure

作　　者：金亦凡 汪泱[1] 张晓辉[1] 毛静宇[1] 陈成[1] Jin Yifan;Wang Yang;Zhang Xiaohui;Mao Jingyu;Chen Cheng(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属第一医院呼吸与危重症医学科,苏州215000

出　　处：《国际呼吸杂志》2024年第2期212-217,共6页International Journal of Respiration

摘　　要：目的探讨经支气管肺活检(TBLB)对伴急性低氧性呼吸衰竭(AHRF)肺部病变的诊断价值及其影响因素。方法本研究为回顾性横断面研究,采用非随机抽样的方法,选取2015年9月至2023年3月苏州大学附属第一医院呼吸与危重症医学科重症病房(RICU)收治的115例伴AHRF的原因不明肺部病变且接受TBLB的患者为研究对象。记录患者一般人口学资料、影像学资料、病理结果及TBLB术后24 h内发生的不良事件,采用logistic回归分析确定TBLB对此类患者诊断价值的影响因素。结果通过TBLB,115例患者中有48例(41.74%)获得指向性诊断,67例(58.26%)未能获得指向性病理诊断的患者中有29例借助其他方式获得了明确诊断。logistic回归分析显示,女性、氧合指数>200 mmHg、恶性病变有利于TBLB获得指向性病理诊断,而影像学呈现亚实性病变不利于TBLB获得指向性诊断。TBLB术后24 h并发症总发生率为15.65%(18/115),严重并发症低于1%。结论TBLB对伴急性低氧性呼吸衰竭的恶性肺部病变的诊断价值较高,但对良性病变诊断价值有限,总体安全性良好。Objective To explore the diagnostic value of transbronchial lung biopsy(TBLB)in pulmonary diseases complicated with acute hypoxemic respiratory failure(AHRF)and to clarify the associated factors.Methods This was a retrospective cross-sectional study,and non-random sampling was used.A total of 115 patients with unexplained pulmonary infiltrates with AHRF who underwent TBLB in Respiratory and Critical Care Unit of the First Affiliated Hospital of Soochow University from September 2015 to March 2023 were enrolled.The general demographic data,imaging data,pathological results,and adverse events within 24 h after TBLB were recorded.Logistic regression analysis was used to determine the factors affecting the diagnostic value of TBLB in such patients.Results Using TBLB,48 patients(41.74%)obtained definite pathological diagnosis and the left 67(58.26%)patients didn′t obtain the definite diagnosis.Of 67 undiagnosed cases,29 patients(58.26%)were clearly diagnosed by other methods later.According to logistic regression analysis,females,oxygenation index>200 mmHg,and malignant lesions are favor factors for definite pathological diagnosis;while subsolid lesions tend to lead to indefinite pathological diagnosis.Within 24 h after TBLB,adverse events occurred in 15.65%(18/115)patients,with the incidence of serious adverse events<1%.Conclusions TBLB shows high diagnostic value for malignant lung lesions with acute hypoxic respiratory failure,but has limited diagnostic value for benign lesions,and the overall safety is good.

关 键 词：低氧 呼吸功能不全 支气管镜检查 肺部病变 诊断价值 

分 类 号：R563.8[医药卫生—呼吸系统]