经纤支镜下局部注药治疗气管支气管结核的疗程研究
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摘要
目的探讨经纤支镜下气管内局部注入抗结核药物治疗气管支气管结核的疗程。方法选取自2014年1月—2016年12月在安徽医科大学附属安庆医院呼吸内科确诊的初治气管支气管结核(Ⅰ~Ⅲ型)患者共82例,采用随机数字表法将其分为2组,观察组42例,对照组40例,2组患者全部给予2HREZ/10HRE全身化学治疗方案,同时观察组患者在治疗开始给予连续8周的经纤支镜气管内局部注入利福平(0.3 g/支)、异烟肼(0.1 g/支)各一支,而对照组给予连续4周的经纤支镜气管内局部注药治疗。观察并比较2组患者的不良反应发生率(胃肠道反应及肝功能损害、过敏反应)、治疗2个月末痰菌阴转率、疗程结束后气管狭窄发生率及肺功能下降率差异有无统计学意义。结果 2组患者在胃肠道反应、肝功能损害及过敏反应发生率上差异均无统计学意义(P>0.05)。观察组治疗2个月末痰菌阴转率较对照组相比明显升高,差异有统计学意义(P<0.05),气管狭窄发生率及肺功能下降率分别较对照组低,差异有统计学意义(P<0.05)。结论全身化疗联合经纤支镜气管内局部注药8周治疗气管支气管结核较局部注药4周疗效显著,并发症少,值得在临床工作中推荐使用。
Objective To explore the treatment course of injecting anti tuberculosis drugs into the endotracheal focus by fiberoptic bronchoscopy for the patients with tracheobronchial tuberculosis. Methods A total of 82 patients who were first diagnosed with tracheobronchial tuberculosis( type Ⅰ-Ⅲ) in the respiratory department of our hospital from January,2014 to December,2016 were selected,and divided into two groups by random digital table method,with 42 cases in the observation group and 40 cases in the control group. Both groups of patients were given 2 HREZ/10 HRE chemotherapy. At the same time,the patients in the observation group(42 cases) were injected with rifampin(0. 3 g/branch)and isoniazid(0. 1 g/branch) in the trachea by the bronchoscope for 8 weeks after the treatment,while the control group received 4 weeks of local injection therapy. The incidence rates of adverse reactions( which included gastrointestinal reactions,liver function damage,and anaphylaxis),the sputum negative conversion rate at end of the second month,the incidence rate of tracheal stenosis and the decline rate of pulmonary function in the two groups were observed and compared. Results There was no significant difference in the rate of gastrointestinal reaction,liver function damage and anaphylaxis in the two groups( P > 0. 05). The sputum negative conversion rate at end of the second month in the observation group was significantly higher than that in the control group( P < 0. 05),and the incidence of tracheal stenosis and the decline rate of pulmonary function were lower than those in the control group,and the differences were statistically significant( P < 0. 05). Conclusion Systemic chemotherapy combined with local injection by bronchoscope for 8 weeks was more effective than local injection for 4 weeks and with fewer complications in the treatment of tracheobronchial tuberculosis and it is worth recommending to use in clinical work.
Objective To explore the treatment course of injecting anti tuberculosis drugs into the endotracheal focus by fiberoptic bronchoscopy for the patients with tracheobronchial tuberculosis. Methods A total of 82 patients who were first diagnosed with tracheobronchial tuberculosis( type Ⅰ-Ⅲ) in the respiratory department of our hospital from January,2014 to December,2016 were selected,and divided into two groups by random digital table method,with 42 cases in the observation group and 40 cases in the control group. Both groups of patients were given 2 HREZ/10 HRE chemotherapy. At the same time,the patients in the observation group(42 cases) were injected with rifampin(0. 3 g/branch)and isoniazid(0. 1 g/branch) in the trachea by the bronchoscope for 8 weeks after the treatment,while the control group received 4 weeks of local injection therapy. The incidence rates of adverse reactions( which included gastrointestinal reactions,liver function damage,and anaphylaxis),the sputum negative conversion rate at end of the second month,the incidence rate of tracheal stenosis and the decline rate of pulmonary function in the two groups were observed and compared. Results There was no significant difference in the rate of gastrointestinal reaction,liver function damage and anaphylaxis in the two groups( P > 0. 05). The sputum negative conversion rate at end of the second month in the observation group was significantly higher than that in the control group( P < 0. 05),and the incidence of tracheal stenosis and the decline rate of pulmonary function were lower than those in the control group,and the differences were statistically significant( P < 0. 05). Conclusion Systemic chemotherapy combined with local injection by bronchoscope for 8 weeks was more effective than local injection for 4 weeks and with fewer complications in the treatment of tracheobronchial tuberculosis and it is worth recommending to use in clinical work.
引文
[1]高明谦.经气管镜介入冷冻联合雾化吸入治疗气管支气管结核的疗效[J].中国处方药,2017,15(4):138-139.
[2]中华医学会结核病学分会,《中华结核和呼吸杂志》编辑委员会.气管支气管结核诊断和治疗指南(试行)[J].中华结核和呼吸杂志,2012,35(8):581-587.
[3]赵丽芬,刘延梅.人文关怀在治疗耐多药结核病患者中的作用[J].西北药学杂志,2016,31(2):205-207.
[4]方育霞,李光明,杨蓉美,等.支气管镜冷冻及注药联合雾化治疗溃疡坏死型支气管结核[J].第三军医大学学报,2015,37(20):2106-2108.
[5]杨元利,张永峰,窦权利,等.气管支气管结核282例临床特征及纤维支气管镜检查结果分析[J].陕西医学杂志,2017,46(12):1756-1757.
[6]Jung SS,Park HS,Kim JO,et al.Incidence and clinical predictors of endobronchial tuberculosis in patients with pulmonary tuberculosis[J].Respirology,2015,20(3):488-495.
[7]Baris SA,Onyilmaz T,Basyigit I,et al.Endobronchial Tuberculosis Mimicking Asthma[J].Tuberc Res Treat,2015,2015:781842
[8]贾丽萍,陈慧冬,黄汉平,等.35例结核分枝杆菌感染致气管支气管软化症的临床分析[J].临床肺科杂志,2017,22(11):2037-2040.
[9]Campos J,Ernst G,Borsini E,et al.Tracheobronchial Tuberculosis Without Lung Involvement[J].J Clin Med Res,2015,7(8):646-648.
[10]Guo X,Wang C,Wang X,et al.Characteristics and risk factor analysis of 410 cases of tracheobronchial tuberculosis[J].Exp Ther Med,2014,8(3):781-784.
[11]张东,孙昕,秦中华.经支气管内镜治疗气管-支气管结核76例的疗效[J].实用医学杂志,2018,34(1):115-118.
[12]谢新凤,郑西卫.支气管镜下局部联合常规抗结核用药治疗气管支气管结核的疗效[J].宁夏医科大学学报,2017,39(9):1093-1094.
[13]孙勇.42例气管结核气管镜下冷冻治疗联合镜下给药疗效观察[J].现代医院,2016,16(10):1455-1456.
[14]《中华结核和呼吸杂志》编辑委员会.支气管结核的几点专家共识[J].中华结核和呼吸杂志,2009,32(8):568-571.
[15]崔嘉,徐建华,刘福升,等.经支气管镜介入治疗气管支气管结核的近期临床效果初步分析[J].中国防痨杂志,2013,35(12):1020-1024.
[16]龙云铸,刘毅,刘双柏,等.气管支气管结核患者经电子支气管镜介入治疗的近期与远期疗效观察[J].新疆医科大学学报,2016,39(6):735-738.
[17]黄洪,余奕慧,李静,等.经电子支气管镜联合介入治疗气管支气管结核[J].实用医学杂志,2014,30(10):1607-1610.
[18]Lei Y,Tian HZ,Ming H,et al.Analysis of the surgical treatment of endobronchial tuberculosis(EBTB)[J].Surg Today,2014,44(8):1434-1437.
[19]刘斌远,史海霞,吕广波.支气管结核经纤维支气管镜介入治疗与单纯全身化疗对比研究[J].河北医药,2012,34(6):852-853.
[20]陈丽娟,吕志强,张蔚,等.支气管内膜结核41例临床分析[J].岭南急诊医学杂志,2014,19(6):452-454.
[21]邝浩斌,梁敏青,方琼.初治肺结核合并气管支气管结核痰菌阴转及其危险因素分析[J].中国防痨杂志,2013,35(10):812-815.
[2]中华医学会结核病学分会,《中华结核和呼吸杂志》编辑委员会.气管支气管结核诊断和治疗指南(试行)[J].中华结核和呼吸杂志,2012,35(8):581-587.
[3]赵丽芬,刘延梅.人文关怀在治疗耐多药结核病患者中的作用[J].西北药学杂志,2016,31(2):205-207.
[4]方育霞,李光明,杨蓉美,等.支气管镜冷冻及注药联合雾化治疗溃疡坏死型支气管结核[J].第三军医大学学报,2015,37(20):2106-2108.
[5]杨元利,张永峰,窦权利,等.气管支气管结核282例临床特征及纤维支气管镜检查结果分析[J].陕西医学杂志,2017,46(12):1756-1757.
[6]Jung SS,Park HS,Kim JO,et al.Incidence and clinical predictors of endobronchial tuberculosis in patients with pulmonary tuberculosis[J].Respirology,2015,20(3):488-495.
[7]Baris SA,Onyilmaz T,Basyigit I,et al.Endobronchial Tuberculosis Mimicking Asthma[J].Tuberc Res Treat,2015,2015:781842
[8]贾丽萍,陈慧冬,黄汉平,等.35例结核分枝杆菌感染致气管支气管软化症的临床分析[J].临床肺科杂志,2017,22(11):2037-2040.
[9]Campos J,Ernst G,Borsini E,et al.Tracheobronchial Tuberculosis Without Lung Involvement[J].J Clin Med Res,2015,7(8):646-648.
[10]Guo X,Wang C,Wang X,et al.Characteristics and risk factor analysis of 410 cases of tracheobronchial tuberculosis[J].Exp Ther Med,2014,8(3):781-784.
[11]张东,孙昕,秦中华.经支气管内镜治疗气管-支气管结核76例的疗效[J].实用医学杂志,2018,34(1):115-118.
[12]谢新凤,郑西卫.支气管镜下局部联合常规抗结核用药治疗气管支气管结核的疗效[J].宁夏医科大学学报,2017,39(9):1093-1094.
[13]孙勇.42例气管结核气管镜下冷冻治疗联合镜下给药疗效观察[J].现代医院,2016,16(10):1455-1456.
[14]《中华结核和呼吸杂志》编辑委员会.支气管结核的几点专家共识[J].中华结核和呼吸杂志,2009,32(8):568-571.
[15]崔嘉,徐建华,刘福升,等.经支气管镜介入治疗气管支气管结核的近期临床效果初步分析[J].中国防痨杂志,2013,35(12):1020-1024.
[16]龙云铸,刘毅,刘双柏,等.气管支气管结核患者经电子支气管镜介入治疗的近期与远期疗效观察[J].新疆医科大学学报,2016,39(6):735-738.
[17]黄洪,余奕慧,李静,等.经电子支气管镜联合介入治疗气管支气管结核[J].实用医学杂志,2014,30(10):1607-1610.
[18]Lei Y,Tian HZ,Ming H,et al.Analysis of the surgical treatment of endobronchial tuberculosis(EBTB)[J].Surg Today,2014,44(8):1434-1437.
[19]刘斌远,史海霞,吕广波.支气管结核经纤维支气管镜介入治疗与单纯全身化疗对比研究[J].河北医药,2012,34(6):852-853.
[20]陈丽娟,吕志强,张蔚,等.支气管内膜结核41例临床分析[J].岭南急诊医学杂志,2014,19(6):452-454.
[21]邝浩斌,梁敏青,方琼.初治肺结核合并气管支气管结核痰菌阴转及其危险因素分析[J].中国防痨杂志,2013,35(10):812-815.