肺泡灌洗术联合氨溴索局部用药治疗支气管扩张合并感染的疗效及对IL-2和IL-4的影响
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摘要
目的:探讨纤维支气管镜肺泡灌洗术联合氨溴索局部用药治疗支气管扩张合并感染的疗效及对白介素(IL)-2和IL-4的影响。方法:选取2012年1月至2017年1月在海南省儋州市人民医院住院诊断为支气管扩张合并感染的患者500例,随机分为治疗组和对照组,每组250例。对照组给予常规治疗,治疗组在常规治疗的基础上给予纤维支气管镜肺泡灌洗术联合氨溴索局部用药治疗。比较两组临床疗效及治疗前、后IL-2、IL-4和呼吸功能。结果:治疗组总有效率(94.4%)显著高于对照组(78.0%)(P<0.01)。治疗组痰液密度(MD)评分、脓性黏液(MP)评分和痰总量均显著低于对照组(均P<0.05)。治疗后,两组超敏C反应蛋白(hs-CRP)、降钙素原(PCT)和IL-4水平较治疗前明显下降,氧分压(PaO_2)、1s用力呼吸容积(FEV1)和1s用力呼气量占用力肺活量比值(FEV1/FVC)较治疗前明显提高,且治疗组变化更为显著(P<0.05)。两组治疗后黏液体积(MVP)评分和IL-2水平比较,差异无统计学意义(P>0.05)。治疗组不良反应发生率高于对照组(P<0.05)。结论:纤维支气管镜肺泡灌洗术联合氨溴索局部用药能有效治疗支气管扩张合并感染,改善患者的呼吸功能。
Objective:To investigate the efficacy and the influence of bronchalveolar lavage combined with ambroxol topical administration on the interleukin(IL)-2 and IL-4 levels in bronchiectasis complicated with infection patients.Methods:A total of 500 bronchiectasis complicated with infection patients in our hospital from January 2012 to January 2017 were selected,and randomized to a treatment group(n=250)and a control group(n=250).The patients in the treatment group received conventional therapy,and those in the treatment group were treated as the control group with addition of bronchalveolar lavage combined with ambroxol topical administration.The clinical efficacy,IL-2,IL-4 and respiratory function were coMP 评分ared.Results:The total effective rate in the treatment group(94.5%)was significantly higher than that in the control group(78.0%)(P<0.01).The mucus density(MD),purulent mucus(MP)and total amount of expectoration in the treatment group were significantly lower than those in the control group(P<0.05).After treatment,the hypersensitive C-reactive protein(hs-CRP),procalcitonin(PCT)and IL-4 levels in both groups were significantly decreased,while the partial pressure of oxygen(PaO_2),forced respiration volume(FEV1)and forced expiratory volume to forced vital capacity(FEV1/FVC)were significantly increased.These changes were more significant in the treatment group(P <0.05).No significant differences were found in the mucus volume(MVP)and IL-2 level between the two groups(P>0.05).The incidence of adverse reactions in the treatment group was higher than that in the control group(P<0.05).Conclusion:Bronchalveolar lavage combined with ambroxol topical administration was effective in the treatment of bronchiectasis complicated with infection.It could improve the respiratory function of patients.
Objective:To investigate the efficacy and the influence of bronchalveolar lavage combined with ambroxol topical administration on the interleukin(IL)-2 and IL-4 levels in bronchiectasis complicated with infection patients.Methods:A total of 500 bronchiectasis complicated with infection patients in our hospital from January 2012 to January 2017 were selected,and randomized to a treatment group(n=250)and a control group(n=250).The patients in the treatment group received conventional therapy,and those in the treatment group were treated as the control group with addition of bronchalveolar lavage combined with ambroxol topical administration.The clinical efficacy,IL-2,IL-4 and respiratory function were coMP 评分ared.Results:The total effective rate in the treatment group(94.5%)was significantly higher than that in the control group(78.0%)(P<0.01).The mucus density(MD),purulent mucus(MP)and total amount of expectoration in the treatment group were significantly lower than those in the control group(P<0.05).After treatment,the hypersensitive C-reactive protein(hs-CRP),procalcitonin(PCT)and IL-4 levels in both groups were significantly decreased,while the partial pressure of oxygen(PaO_2),forced respiration volume(FEV1)and forced expiratory volume to forced vital capacity(FEV1/FVC)were significantly increased.These changes were more significant in the treatment group(P <0.05).No significant differences were found in the mucus volume(MVP)and IL-2 level between the two groups(P>0.05).The incidence of adverse reactions in the treatment group was higher than that in the control group(P<0.05).Conclusion:Bronchalveolar lavage combined with ambroxol topical administration was effective in the treatment of bronchiectasis complicated with infection.It could improve the respiratory function of patients.
引文
[1]马艳良.成人支气管扩张症诊治专家共识解读[J].结核病与肺部健康杂志,2013,2(2):79-82.
[2]WEYCKER D,EDELSBERG J,OSTER G,et al.Prevalence and economic burden of bronchiectasis[J].Clinical Pulmonary Medicine,2005,12(4):205-209.
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[4]王志华,朱念,蔡金芳,等.支气管肺泡灌洗术在重症肺炎合并呼吸衰竭治疗中的作用[J].中国现代医学杂志,2012,22(31):86-88.
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[6]刘春云,龚享文,陈谦,等.经纤支镜灌注氨溴索注射液对支气管扩张症急性加重期氧化应激与炎症反应状态的影响[J].中国老年学杂志,2015,35(18):5213-5216.
[7]李詝,李久荣,高金明.北京协和医院136例支气管扩张症住院患者临床特征分析[J].中国医学科学院学报,2014,36(1):61-67.
[8]陈俊先,苏伟强,彭家银,等.支气管扩张病原菌定植相关危险因素分析[J].吉林医学,2017,38(2):273-275.
[9]VENNING V,BARTLETT J,JAYARAM L.Patients hospitalized with an infective exacerbation of bronchiectasis unrelated to cystic fibrosis:clinical,physiological and sputum characteristics[J].Respirology,2017,48(suppl 60):A5021.
[10]司盼盼,刘继先,吴昊,等.电视胸腔镜手术与传统开胸手术治疗支气管扩张症的疗效及安全性[J].山东医药,2013,53(45):82-83.
[11]余美红.床旁纤维支气管镜下肺泡灌洗对呼吸机相关性肺炎患者炎症介质水平的影响[J].全科医学临床与教育,2016,14(4):416-419.
[12]吴琳,张苏宁.支气管镜下肺泡灌洗并抗生素灌注辅助治疗肺癌术后肺部感染效果观察[J].山东医药,2017,57(16):91-93.
[13]颜文森,李斌,王燕,等.盐酸氨溴索对重症肺炎TNF-α、hs-CRP等炎症因子水平变化的影响及临床治疗效果分析[J].中国生化药物杂志,2017,37(6):307-309.
[14]罗彬,姜华,冯琦.监测重症肺炎患者血清及支气管肺泡灌洗液中炎症因子水平变化[J].辽宁医学院学报,2016,37(6):27-29.
[15]敖勇.纤维支气管镜肺泡灌洗对重症肺炎伴呼吸衰竭患者呼吸功能及炎症活动的影响[J].宁夏医科大学学报,2016,38(3):310-313.
[16]王海斌,刘宇智,金宁.支气管镜肺泡灌洗治疗支气管扩张合并感染临床效果评价[J].齐齐哈尔医学院学报,2017,38(5):541-542.
[17]孟玉红.支气管肺泡灌洗联合镜下注入氨溴索治疗支气管扩张疗效观察[J].临床医学,2017,37(6):57-58.
[18]朱旭华,李佳,张倩云.支气管镜肺泡灌洗氨溴索辅助治疗支气管扩张并感染的疗效[J].湖北科技学院学报(医学版),2016,30(6):487-488.
[19]胡霞,陈方方,蔡俊秀.纤支镜联合氨溴索肺泡灌洗对脑梗死合并重症肺部感染患者炎性因子的影响[J].临床肺科杂志,2015,20(8):1518-1523.
[20]任钰鑫,王文涛,祁绍艳,等.纤支镜联合氨溴索肺泡灌洗对脑梗死合并重症肺部感染患者炎性因子的影响[J].中国实用神经疾病杂志,2016,19(9):59-60.
[21]陈昌远,刘海丽,邝秋秋,等.支气管肺泡灌洗大剂量氨溴索治疗急性肺脓肿的效果观察[J].中国医药导报,2014,11(9):65-67.
[2]WEYCKER D,EDELSBERG J,OSTER G,et al.Prevalence and economic burden of bronchiectasis[J].Clinical Pulmonary Medicine,2005,12(4):205-209.
[3]周云春.COPD合并支气管扩张病原体流行病学及耐药性研究进展[J].中外医学研究,2012,10(2):150-152.
[4]王志华,朱念,蔡金芳,等.支气管肺泡灌洗术在重症肺炎合并呼吸衰竭治疗中的作用[J].中国现代医学杂志,2012,22(31):86-88.
[5]成人支气管扩张症诊治专家共识编写组.成人支气管扩张症诊治专家共识(2012版)[J].中华危重症医学杂志,2012,5(5):20-30.
[6]刘春云,龚享文,陈谦,等.经纤支镜灌注氨溴索注射液对支气管扩张症急性加重期氧化应激与炎症反应状态的影响[J].中国老年学杂志,2015,35(18):5213-5216.
[7]李詝,李久荣,高金明.北京协和医院136例支气管扩张症住院患者临床特征分析[J].中国医学科学院学报,2014,36(1):61-67.
[8]陈俊先,苏伟强,彭家银,等.支气管扩张病原菌定植相关危险因素分析[J].吉林医学,2017,38(2):273-275.
[9]VENNING V,BARTLETT J,JAYARAM L.Patients hospitalized with an infective exacerbation of bronchiectasis unrelated to cystic fibrosis:clinical,physiological and sputum characteristics[J].Respirology,2017,48(suppl 60):A5021.
[10]司盼盼,刘继先,吴昊,等.电视胸腔镜手术与传统开胸手术治疗支气管扩张症的疗效及安全性[J].山东医药,2013,53(45):82-83.
[11]余美红.床旁纤维支气管镜下肺泡灌洗对呼吸机相关性肺炎患者炎症介质水平的影响[J].全科医学临床与教育,2016,14(4):416-419.
[12]吴琳,张苏宁.支气管镜下肺泡灌洗并抗生素灌注辅助治疗肺癌术后肺部感染效果观察[J].山东医药,2017,57(16):91-93.
[13]颜文森,李斌,王燕,等.盐酸氨溴索对重症肺炎TNF-α、hs-CRP等炎症因子水平变化的影响及临床治疗效果分析[J].中国生化药物杂志,2017,37(6):307-309.
[14]罗彬,姜华,冯琦.监测重症肺炎患者血清及支气管肺泡灌洗液中炎症因子水平变化[J].辽宁医学院学报,2016,37(6):27-29.
[15]敖勇.纤维支气管镜肺泡灌洗对重症肺炎伴呼吸衰竭患者呼吸功能及炎症活动的影响[J].宁夏医科大学学报,2016,38(3):310-313.
[16]王海斌,刘宇智,金宁.支气管镜肺泡灌洗治疗支气管扩张合并感染临床效果评价[J].齐齐哈尔医学院学报,2017,38(5):541-542.
[17]孟玉红.支气管肺泡灌洗联合镜下注入氨溴索治疗支气管扩张疗效观察[J].临床医学,2017,37(6):57-58.
[18]朱旭华,李佳,张倩云.支气管镜肺泡灌洗氨溴索辅助治疗支气管扩张并感染的疗效[J].湖北科技学院学报(医学版),2016,30(6):487-488.
[19]胡霞,陈方方,蔡俊秀.纤支镜联合氨溴索肺泡灌洗对脑梗死合并重症肺部感染患者炎性因子的影响[J].临床肺科杂志,2015,20(8):1518-1523.
[20]任钰鑫,王文涛,祁绍艳,等.纤支镜联合氨溴索肺泡灌洗对脑梗死合并重症肺部感染患者炎性因子的影响[J].中国实用神经疾病杂志,2016,19(9):59-60.
[21]陈昌远,刘海丽,邝秋秋,等.支气管肺泡灌洗大剂量氨溴索治疗急性肺脓肿的效果观察[J].中国医药导报,2014,11(9):65-67.