CAJ | 학술논문

目的：初步探讨局部喷洒苦参素注射液在良性气管狭窄病变腔内治疗的有效性及其副作用。方法收集35例良性气管狭窄病变患者的临床资料，通过评估咳嗽、气短等临床症状，胸部高分辨 CT （HRCT）三维重建、超细支气管镜下观察狭窄程度及长度，依照各病因、狭窄情况的不同而采取相应序贯多种介入联合治疗方法之后，采用一次性内镜喷洒管喷洒苦参素注射液。依据狭窄部位的长度、程度、截面部位局部水肿严重程度，且狭窄长度≥2 cm 或截面积≤正常截面50％即选择高浓度（1200 mg／mL），否则选择低浓度（600 mg／mL）。术后1周根据临床症状、HRCT 的三维重建、超细支气管镜下的检查动态观察病情变化，视情形每周喷洒药物1次，累计2～4次。总体随访时间3个月，期间主要观察患者咳嗽、咳痰或痰血、呼吸困难变化情况等。结果完全有效11例，基本有效17例，完全无效7例，总有效率为80．0％（28／35）。总体并发症发生率为42．8％（15／35），无死亡病例发生。无与苦参素注射液局部喷洒直接相关并发症发生。结论气管镜下局部喷洒苦参素注射液有可能在抑制瘢痕形成、阻断气管再狭窄等方面发挥一定的作用，具有安全性较高、疗效较确切、操作简便等优点，值得进一步研究探讨。
목적：초보탐토국부분쇄고삼소주사액재량성기관협착병변강내치료적유효성급기부작용。방법수집35례량성기관협착병변환자적림상자료，통과평고해수、기단등림상증상，흉부고분변 CT （HRCT）삼유중건、초세지기관경하관찰협착정도급장도，의조각병인、협착정황적불동이채취상응서관다충개입연합치료방법지후，채용일차성내경분쇄관분쇄고삼소주사액。의거협착부위적장도、정도、절면부위국부수종엄중정도，차협착장도≥2 cm 혹절면적≤정상절면50％즉선택고농도（1200 mg／mL），부칙선택저농도（600 mg／mL）。술후1주근거림상증상、HRCT 적삼유중건、초세지기관경하적검사동태관찰병정변화，시정형매주분쇄약물1차，루계2～4차。총체수방시간3개월，기간주요관찰환자해수、해담혹담혈、호흡곤난변화정황등。결과완전유효11례，기본유효17례，완전무효7례，총유효솔위80．0％（28／35）。총체병발증발생솔위42．8％（15／35），무사망병례발생。무여고삼소주사액국부분쇄직접상관병발증발생。결론기관경하국부분쇄고삼소주사액유가능재억제반흔형성、조단기관재협착등방면발휘일정적작용，구유안전성교고、료효교학절、조작간편등우점，치득진일보연구탐토。
Objective To preliminaryly explore the effect and adverse reaction of Marine Injection combined therapy through local spray in benign tracheobronchial stenosis.Methods 19 cases of bronchial tuberculosis were collected in our department.By assessing cough,shortness of breath and other symptoms,chest high -resolution CT (HRCT)of three -dimensional reconstruction,and length were observed by ultrafine bronchial stenosis.According to the pathogeny and types of stenosis,combined multiple intervention were sequentially adopted,and then Marine Injec-tion was sprayed through one -off endoscopic spray tube.All the subjects were divided into the two groups,the higher concentration Marine injection (1 200 mg/mL)group was chosen with the condition of serious inflammation,edema, ulcer and necrosis,obvious local granulation tissue hyperplasia,severe scar stenosis,and the length of stenosis greater than 2 cm or the sectional area of stenosis less than 50% of the normal sectional area,otherwise the low concentration (600 mg/mL)group was chosen.The subjects were reexamined by clinical symptoms,high -resolution CT (HRCT) of three -dimensional reconstruction,and ultrafine bronchoscopy a week after the surgery to dynamically observe the local changes.Depending on the situation,the injection was sprayed once a week,adding up to 2 -4 times.Follow -up visit lasted for 3 months,cough,expectoration or hemoptysis,and dyspnea were observed.Results 11 cases were effective fully,17 cases were effective substantially,7 cases were ineffective,the total effective rate was 80% (28 /35).The overall complication rate was 42.8% (15 /35),no deaths occurred.No complications related to local spra-ying of Marine were seen.Conclusion Local spray of Marine Injection may have preferable effect that inhibits scar formationand prevention airway restenosis.It is worth further study with a high security,precise clinic effect,easy oper-ation and etc.